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Kasza J, Wan YI. Unravelling the effect of anaesthesia provider sex on patient outcomes: statistical analyses for sound conclusions. Br J Anaesth 2024; 133:483-485. [PMID: 38965015 DOI: 10.1016/j.bja.2024.06.004] [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: 04/30/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Abstract
Unravelling the impact of the sex of the anaesthesia provider on the outcomes of patients requires careful statistical analysis and the validity of many assumptions. A recent study in the British Journal of Anaesthesia investigates the effect of anaesthesia provider sex on patient outcomes, using data from two academic healthcare networks in the USA. The authors show that female provider sex was associated with a lower risk of intraoperative complications. They also show that there was no meaningful difference between male and female providers with respect to postoperative outcomes. There have been several recent studies considering the effect of healthcare provider sex on outcomes. We will discuss the interpretation of these results and the validity of the underlying assumptions.
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Affiliation(s)
- Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Yize I Wan
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
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2
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Richter A, Ulbricht S, Brockhaus S. Categorization of continuous covariates and complex regression models-friends or foes in intersectionality research. J Clin Epidemiol 2024; 171:111368. [PMID: 38657875 DOI: 10.1016/j.jclinepi.2024.111368] [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: 09/29/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To reduce health inequities, it is important to identify intersections in characteristics of individuals subject to privilege or disadvantage. Different proposals for that have recently been published. One approach (1) considers models specified with first- and all second-order effects and another (2) the stratification based on multiple covariates; both categorize continuous covariates. A simulation study was conducted in order to review both methods with regard to identification of intersections showing true differences, rate of false-positive results, and generalizability to independent data compared to an established approach (3) of backward variable elimination according to Bayesian information criterion (BE-BIC) combined with splines. STUDY DESIGN AND SETTING R software has been used to simulate the covariates age, sex, body mass index, education, and diabetes to examine their association with a continuous frailty score for osteoporosis using multiple linear regression. In setting 1, none of the covariates was associated with the frailty score, that is, only noise is present in the data. In setting 2, the covariates age, sex, and their interaction were associated with the frailty score, such that only females above 55 years formed an intersection associated with an increased frailty score. All approaches were compared under varying sample sizes (N = 200-3000) and signal-to-noise ratios (SNRs, 0.5-4) in 1000 replications. For model evaluation, bootstrap resampling was used. The models were fitted in internal learning data and then used to predict outcomes in the internal validation data. The mean squared error (MSE) was used for comparison and the frequency of false-positive findings calculated. RESULTS In setting 1, approaches 1 and 2 generated spurious effects in more than 90% of simulations across all sample sizes. In a smaller sample size, approach 3 (BE-BIC) selected 36.5% of the correct model, in larger sample size in 89.8% and always had a lower number of spurious effects. MSE in independent data was generally higher for approaches 1 and 2 when compared to 3. In setting 2, approach 1 selected most frequently the correct interaction but frequently showed spurious effects (>75%). Across all sample sizes and SNR, approach 3 generated least often spurious results and had lowest MSE in independent data. CONCLUSION Categorization of continuous covariates is detrimental to studies on intersectionality. Due to high and unrestricted model complexity, such approaches are prone to spurious effects and often lack interpretability. Approach 3 (BE-BIC) is considerably more robust against spurious findings, showed better generalizability to independent data, and can be used with most statistical software. For intersectionality research, we consider it most important to describe relevant differences between intersections and to avoid nonreproducible and spurious findings.
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Affiliation(s)
- Adrian Richter
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Sabina Ulbricht
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sarah Brockhaus
- Faculty of Computer Science and Mathematics, University of Applied Sciences Munich, Munich, Germany
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3
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Barbek R, Lüdecke D, von dem Knesebeck O. Intersectional inequalities in health anxiety: multilevel analysis of individual heterogeneity and discriminatory accuracy in the SOMA.SOC study. Front Public Health 2024; 12:1388773. [PMID: 38989118 PMCID: PMC11233522 DOI: 10.3389/fpubh.2024.1388773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/14/2024] [Indexed: 07/12/2024] Open
Abstract
Background Intersectional approaches are needed to disaggregate the complex interaction of social identities contributing to (mental) health disparities. Health anxiety represents an overlooked public mental health issue. Therefore, intersectional inequalities in health anxiety were examined using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Methods Analyses are based on cross-sectional data of the adult population living in Germany (N = 2,413). Health anxiety was assessed with the Whiteley Index-7. Applying intersectional MAIHDA, health anxiety in the intersectional strata of gender, history of migration, and income was predicted. Discriminatory accuracy was assessed via the intra-class correlation and the proportional change in variance. Results Analyses revealed additive social inequalities in health anxiety with greatest impact of low income but no clear intersectional gradient. Most affected by health anxiety were females who immigrated themselves with low income, males whose parent(s) immigrated with low income, and males who immigrated themselves with medium income. Conclusion Intersectional approaches contribute to a more comprehensive understanding of (mental) health disparities. In addition to general efforts to counteract health inequalities, combining universal screening and targeted psychotherapeutic treatment seems promising to specifically reduce inequalities in health anxiety.
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Affiliation(s)
- Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Godbout-Parent M, Julien N, Nguena Nguefack HL, Pagé MG, Guénette L, Blais L, Beaudoin S, Bertrand C, Lacasse A. Changing society, changing research: integrating gender to better understand physical and psychological treatments use in chronic pain management. Pain 2024; 165:674-684. [PMID: 37820267 PMCID: PMC10859849 DOI: 10.1097/j.pain.0000000000003072] [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: 12/21/2022] [Revised: 07/07/2023] [Accepted: 07/31/2023] [Indexed: 10/13/2023]
Abstract
ABSTRACT Treatment of chronic pain should be multimodal and include pharmacological, physical, and psychological treatments. However, because various barriers to physical and psychological treatments (PPTs) exist, a better understanding of biopsychosocial factors leading to their use is relevant. This study aimed to explore the association between gender identity, gender-stereotyped personality traits, and the use of PPTs in chronic pain management. The ChrOnic Pain trEatment cohort, a self-reported data infrastructure resulting from a web-based recruitment of 1935 people living with chronic pain (Quebec, Canada) was analyzed. Gender identity was operationalized as women, men, and nonbinary. Gender-stereotyped personality traits were measured using the Bem Sex-Role Inventory (feminine, masculine, androgynous, undifferentiated). A checklist of 31 types of PPTs that can be used for chronic pain management was presented to participants (yes/no). From the 1433 participants, 85.5% reported using at least one PPT. Hot-cold therapies (43.4%), exercise (41.9%), and meditation (35.2%) were the most frequently used PPTs, but most popular PPTs were not the same among women and men. Women reported a significantly higher use of PPTs in general (87.2% vs 77.2%; P < 0.001). Multivariable and interaction analyses showed that identifying as a man decreased the odds of reporting the use of PPTs (odds ratio: 0.32, 95% confidence interval: 0.11-0.92) but only among participants who scored high on both masculine and feminine personality traits (those classified as androgynous). The high prevalence of PPTs use found in our study is positive. Our results are relevant for a more personalized promotion of PPTs for chronic pain management.
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Affiliation(s)
- Marimée Godbout-Parent
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Nancy Julien
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Line Guénette
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec—Université Laval, Québec, QC, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Sylvie Beaudoin
- Person With Lived Experience, Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Christian Bertrand
- Person With Lived Experience, Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
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Barbek R, Toussaint A, Löwe B, von dem Knesebeck O. Intersectional inequalities in somatic symptom severity in the adult population in Germany found within the SOMA.SOC study. Sci Rep 2024; 14:3820. [PMID: 38360818 PMCID: PMC10869707 DOI: 10.1038/s41598-024-54042-8] [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: 09/18/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
Somatic symptoms are common in a wide range of medical conditions. In severe cases, they are associated with high individual and economic burden. To explore social inequalities in somatic symptom severity (SSS) and to identify social groups with highest SSS, we applied an intersectional research approach. Analyses are based on cross-sectional data of the adult population living in Germany (N = 2413). SSS was assessed with the Somatic Symptom Scale-8. A multiple linear regression model with three-way interaction of gender, income and history of migration and post-hoc pairwise comparison of estimated marginal means was conducted. Analyses revealed intersectional inequalities in SSS along the axis of gender, income, and history of migration. Highest SSS was found in males with low income whose parent(s) immigrated, females with low income who immigrated themselves, and females with low income and no history of migration. Intersectional approaches contribute to a more comprehensive understanding of health disparities. To reduce disparities in SSS, proportionate universal interventions combining universal screening and targeted treatment seem promising.
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Affiliation(s)
- Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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Levandowski BA, Pro GC, Rietberg-Miller SB, Camplain R. We are complex beings: comparison of statistical methods to capture and account for intersectionality. BMJ Open 2024; 14:e077194. [PMID: 38296287 PMCID: PMC10828873 DOI: 10.1136/bmjopen-2023-077194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Intersectionality conceptualises how different parts of our identity compound, creating unique and multifaceted experiences of oppression. Our objective was to explore and compare several quantitative analytical approaches to measure interactions among four sociodemographic variables and interpret the relative impact of axes of marginalisation on self-reported health, to visualise the potential elevated impact of intersectionality on health outcomes. DESIGN Secondary analysis of National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional study of 36 309 non-institutionalised US citizens aged 18 years or older. PRIMARY OUTCOME MEASURES We assessed the effect of interactions among race/ethnicity, disability status, sexual orientation and income level on a self-reported health outcome with three approaches: non-intersectional multivariate regression, intersectional multivariate regression with a single multicategorical predictor variable and intersectional multivariate regression with two-way interactions. RESULTS Multivariate regression with a single multicategorical predictor variable allows for more flexibility in a logistic regression problem. In the fully fitted model, compared with individuals who were white, above the poverty level, had no disability and were heterosexual (referent), only those who were white, above the poverty level, had no disability and were gay/lesbian/bisexual/not sure (LGBQ+) demonstrated no significant difference in the odds of reporting excellent/very good health (aOR=0.90, 95% CI=0.71 to 1.13, p=0.36). Multivariate regression with two-way interactions modelled the extent that the relationship between each predictor and outcome depended on the value of a third predictor variable, allowing social position variation at several intersections. For example, compared with heterosexual individuals, LGBQ+ individuals had lower odds of reporting better health among whites (aOR=0.94, 95% CI=0.93 to 0.95) but higher odds of reporting better health among Black Indigenous People of Color (BIPOC) individuals (aOR=1.13, 95% CI=1.11 to 1.15). CONCLUSION These quantitative approaches help us to understand compounding intersectional experiences within healthcare, to plan interventions and policies that address multiple needs simultaneously.
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Affiliation(s)
- Brooke A Levandowski
- Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - George C Pro
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Ricky Camplain
- Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
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Prieto L. Exploring the Influence of Social Class and Sex on Self-Reported Health: Insights from a Representative Population-Based Study. Life (Basel) 2024; 14:184. [PMID: 38398693 PMCID: PMC10890034 DOI: 10.3390/life14020184] [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: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
This study investigates the intricate interplay between social class, sex, and self-reported health (SRH) using data from the European Health Survey of Spain 2020 (EESE2020). Employing a cross-sectional design and a representative sample of 22,072 individuals, the analysis explores the persistence of disparities after adjusting for covariates, focusing on health-related variables. The study employs logistic regression models and directed acyclic graphs (DAGs) to delineate the direct effects of social class and sex on SRH, identifying a minimum adjustment set to control for confounding variables. Results reveal a gradient effect of social class on SRH, emphasizing the enduring impact of socioeconomic factors. Sex-based disparities in SRH diminish after considering additional health-related variables, highlighting the importance of a holistic approach. DAGs serve as transparent tools in disentangling complex relationships, guiding the identification of essential covariates. The study concludes that addressing health inequalities requires comprehensive strategies considering both individual health behaviours and socio-economic contexts. While recognizing limitations, such as the cross-sectional design, the findings contribute to a nuanced understanding of health disparities, informing evidence-based interventions and policies for a more equitable healthcare system.
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Affiliation(s)
- Luis Prieto
- Distance Learning, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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8
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Alghamdi NA, Dunn K, Cairns D, Melville C. Utilising quantitative methods to study the intersectionality of multiple social disadvantages in women with common mental disorders: a systematic review. Int J Equity Health 2023; 22:264. [PMID: 38110942 PMCID: PMC10729432 DOI: 10.1186/s12939-023-02061-8] [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: 11/29/2022] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Women are at greater risk of common mental disorders. The intersectionality concept provides a framework to examine the effects of multiple social disadvantages on women's mental health. We conducted a systematic review to collect and analyse information to identify the quantitative methodologies and study designs used in intersectional research to examine women's mental health and multiple social disadvantages. Included studies used accepted statistical methods to explore the intersectional effects of gender and one or more types of social disadvantage from the PROGRESS-Plus inequity framework: a place of residence, race/ethnicity, occupation, gender/ sex, religion, education, socioeconomic status, social capital (O'Neill et al. J Clin Epidemiol 67:56-64, 2014). The scope of this systematic review was limited to studies that analysed common mental disorders in women and men comparatively. Studies focusing on only one gender were excluded, ensuring a comprehensive comparative analysis of the intersection of social disadvantages in mental health.Twelve papers were included in the narrative synthesis (Table 1). Eight of the included papers (67%) reported an intersectional effect of gender and one or more additional types of social disadvantage. The multiplicative effect of gender and socioeconomic status on the risk of common mental disorders was the most commonly reported interaction. This systematic review shows that multiplicative and simultaneous interactions of multiple social disadvantage increase the risk of common mental disorders experienced by women. Moreover, it underlines the potential for quantitative research methods to complement qualitative intersectionality research on gender and mental health. The findings of this systematic review highlight the importance of multiple social disadvantage in understanding the increased risk of mental health experienced by women.
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Affiliation(s)
- Nadia Alhamd Alghamdi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Deborah Cairns
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Sherman AD, Febres-Cordero S, Bonds Johnson K, Clark KD, Klepper M, Duroseau B, Lin Y, Zhang W, Coleman M, Prakash D, Daniel GA, Chand AT, Kalu U, Tarter R, Allgood S, Cohen S, Kelly U, Balthazar M. Intersectionality in nursing research: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023; 5:100155. [PMID: 37982092 PMCID: PMC10655863 DOI: 10.1016/j.ijnsa.2023.100155] [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: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
Background An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants. Objective This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision. Design & Methods Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research. Results The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years. Conclusions Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.
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Affiliation(s)
- Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH, USA
| | | | | | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Mercy Coleman
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Diane Prakash
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Gaea A. Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Arzina Tabassum Chand
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Ugo Kalu
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Robin Tarter
- Oregon Health and Science University, Portland, OR, USA
| | | | - Sydney Cohen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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10
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Rodrigues IB, Fahim C, Garad Y, Presseau J, Hoens AM, Braimoh J, Duncan D, Bruyn-Martin L, Straus SE. Developing the intersectionality supplemented Consolidated Framework for Implementation Research (CFIR) and tools for intersectionality considerations. BMC Med Res Methodol 2023; 23:262. [PMID: 37946142 PMCID: PMC10636989 DOI: 10.1186/s12874-023-02083-4] [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: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The concept of intersectionality proposes that demographic and social constructs intersect with larger social structures of oppression and privilege to shape experiences. While intersectionality is a widely accepted concept in feminist and gender studies, there has been little attempt to use this lens in implementation science. We aimed to supplement the Consolidated Framework for Implementation Research (CFIR), a commonly used framework in implementation science, to support the incorporation of intersectionality in implementation science projects by (1) integrating an intersectional lens to the CFIR; and (2) developing a tool for researchers to be used alongside the updated framework. METHODS Using a nominal group technique, an interdisciplinary framework committee (n = 17) prioritized the CFIR as one of three implementation science models, theories, and frameworks to supplement with intersectionality considerations; the modification of the other two frameworks are described in other papers. The CFIR subgroup (n = 7) reviewed the five domains and 26 constructs in the CFIR and prioritized domains and constructs for supplementation with intersectional considerations. The subgroup then iteratively developed recommendations and prompts for incorporating an intersectional approach within the prioritized domains and constructs. We developed recommendations and prompts to help researchers consider how personal identities and power structures may affect the facilitators and inhibitors of behavior change and the implementation of subsequent interventions. RESULTS We achieved consensus on how to apply an intersectional lens to CFIR after six rounds of meetings. The final intersectionality supplemented CFIR includes the five original domains, and 28 constructs; the outer systems and structures and the outer cultures constructs were added to the outer setting domain. Intersectionality prompts were added to 13 of the 28 constructs. CONCLUSION Through an expert-consensus approach, we modified the CFIR to include intersectionality considerations and developed a tool with prompts to help implementation users apply an intersectional lens using the updated framework.
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Affiliation(s)
- Isabel B Rodrigues
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Yasmin Garad
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | - Diane Duncan
- Physician Learning Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lora Bruyn-Martin
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Sharon E Straus
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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11
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Prada K, de Moissac D, Gueye NR, Hardy S, Avanthay-Strus J. Living in a liminal space: Experiences of 2SLGBTQ + official language minority Canadians during the COVID-19 pandemic. CULTURE, HEALTH & SEXUALITY 2023; 25:1465-1482. [PMID: 36593120 DOI: 10.1080/13691058.2022.2160016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The intersecting identities of those identifying with multiple minorities, such as 2SLGBTQ + and ethnolinguistic minorities, bring individuals to have unique experiences, especially concerning health and wellness. This topic is particularly poorly understood among French-speaking official language minority 2SLGBTQ + populations in Canada. Hence, this study was conducted to generate insights into their needs and experiences, through the lens of intersectionality. This quantitative community-based study, a first of its kind in Western Canada, describes the sociodemographic profile, experiences of discrimination and stigmatisation, and needs and challenges pertaining to mental health and social supports of this double minority group. Data were obtained by an online survey conducted in the Canadian province of Manitoba in June 2020. The participant sample was largely homogenous: most were under the age of 55 years, white, educated, and from urban areas. Many reported experiencing dual marginalisation, feeling unaccepted by both of their minority communities (Francophone and 2SLGBTQ+). A sense of isolation, as well as a lack of social connectedness and psychological support, were often reported. Social initiatives and mental health support within environments proactively affirming of the official language of the minority and inclusive of diverse 2SLGBTQ + identities are needed.
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Affiliation(s)
- Kevin Prada
- Psychology, Université de Saint-Boniface, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Canada
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Lacasse A, Nguena Nguefack HL, Page G, Choinière M, Samb OM, Katz J, Ménard N, Vissandjée B, Zerriouh M. Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain. BMJ Open 2023; 13:e070509. [PMID: 37518085 PMCID: PMC10387645 DOI: 10.1136/bmjopen-2022-070509] [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] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP. DESIGN Retrospective cohort study. PARTICIPANTS This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion. OUTCOME Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories). RESULTS Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1). CONCLUSIONS Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.
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Affiliation(s)
- Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Hermine Lore Nguena Nguefack
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - G Page
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Manon Choinière
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Oumar Mallé Samb
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Nancy Ménard
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Bilkis Vissandjée
- Faculty of Nursing and Public Health Research Institute (CReSP), Université de Montréal, Montreal, Quebec, Canada
- SHERPA Research Centre, Montreal, Quebec, Canada
| | - Meriem Zerriouh
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Finne E, Razum O. [Consequences of the COVID-19 pandemic: Are there risk groups for reduced subjective well-being after the first lockdown?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03737-w. [PMID: 37474793 PMCID: PMC10371891 DOI: 10.1007/s00103-023-03737-w] [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: 02/16/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Measures to contain COVID-19 have created burdens that have widened health inequalities. We examine the extent to which risk groups for reduced subjective well-being can be identified after the 2020 lockdown. In doing so, we also consider possible interactions of different social grouping characteristics as part of an intersectional approach. METHOD Socio-Economic Panel (SOEP) data from the years 2018-2020 were analyzed. A total of 16,000 cases with information on changes in well-being (SF-12 scores and individual indicators) were included in the analyses. We use the classification method "random forests" to identify groups with different trends in well-being. For the interpretation of the content, we also present results from a regression model with social and health aspects as predictors. RESULTS Demographic and social characteristics explained only a very small part of the changes in subjective well-being (R2 = 0.007-0.012) and did not allow for the differentiation of homogeneous risk groups. Although some significant predictors were found in the regression models, the corresponding effects were mostly small. In addition to the initial state of well-being before the pandemic began, the presence of chronic illnesses and disabilities in particular contributed to the explanation of subjective well-being. DISCUSSION The currently available data do not allow a clear identification of risk groups for losses in well-being in the first year of the COVID-19 pandemic. Health status before the onset of the pandemic appears to be more important for short-term changes in subjective well-being than socio-demographic and socio-economic categorization characteristics.
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Affiliation(s)
- Emily Finne
- Fakultät für Gesundheitswissenschaften, School of Public Health, Arbeitsgruppe Epidemiologie & International Public Health, Universität Bielefeld, PF 10 01 31, 33501, Bielefeld, Deutschland.
| | - Oliver Razum
- Fakultät für Gesundheitswissenschaften, School of Public Health, Arbeitsgruppe Epidemiologie & International Public Health, Universität Bielefeld, PF 10 01 31, 33501, Bielefeld, Deutschland
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Cruz-Kan K, Dufault B, Fesehaye L, Kornelsen J, Hrymak C, Zubert S, Ratana P, Leeies M. Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators. CAN J EMERG MED 2023; 25:617-626. [PMID: 37389771 DOI: 10.1007/s43678-023-00533-y] [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: 09/26/2022] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients. METHODS We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens. RESULTS A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism. CONCLUSIONS Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.
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Affiliation(s)
- Kanisha Cruz-Kan
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lula Fesehaye
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Jodi Kornelsen
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Shelly Zubert
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Paul Ratana
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada.
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Leeies M, Ho J, Wilson LC, Lalani J, James L, Carta T, Gruber J, Shemie SD, Hrymak C. Sociodemographic Variables in Canadian Organ Donation Organizations: A Health Information Survey. Transplant Direct 2023; 9:e1494. [PMID: 37305650 PMCID: PMC10256411 DOI: 10.1097/txd.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/13/2023] Open
Abstract
Health systems must collect equity-relevant sociodemographic variables to measure and mitigate health inequities. The specific variables collected by organ donation organizations (ODOs) across Canada, variable definitions, and processes of the collection are not defined. We undertook a national health information survey of all ODOs in Canada. These results will inform the development of a standard national dataset of equity-relevant sociodemographic variables. Methods We conducted an electronic, self-administered cross-sectional survey of all ODOs in Canada from November 2021 to January 2022. We targeted key knowledge holders familiar with the data collection processes within each Canadian ODO known to Canadian Blood Services. Categorical item responses are presented as numbers and proportions. Results We achieved a 100% response rate from 10 Canadian ODOs. Most data were collected by organ donation coordinators. Only 2 of 10 ODOs reported using scripts explaining why sociodemographic data are being collected or incorporated training in cultural sensitivity for any given variable. A lack of cultural sensitivity training was endorsed by 50% of respondents as a barrier to the collection of sociodemographic variables by ODOs, whereas 40% of respondents identified a lack of training in sociodemographic variable collection as a significant barrier. Conclusions Few programs routinely collect sufficient data to examine health inequities with an intersectional lens. Most data collection occurs midway through the ODO interaction, creating a missed opportunity to better understand differences in social identities of patients who register their intention to donate in advance or who decline the donation. National standardization of equity-relevant data collection definitions and processes of the collection is needed.
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Affiliation(s)
- Murdoch Leeies
- Section of Critical Care, Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Organ Donation Organization, Winnipeg, MB, Canada
| | - Julie Ho
- Department of Internal Medicine and Immunology, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Adult Kidney Program, Winnipeg, MB, Canada
| | | | | | - Lee James
- Canadian Blood Services, Ottawa, ON, Canada
| | - Tricia Carta
- Transplant Manitoba, Gift of Life Organ Donation Organization, Winnipeg, MB, Canada
| | - Jackie Gruber
- British Columbia Institute of Technology, Vancouver, BC, Canada
| | - Sam D. Shemie
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care Medicine, Montreal Children’s Hospital, McGill University Health Centre and Research Institute, McGill University, Montreal, QC, Canada
| | - Carmen Hrymak
- Section of Critical Care, Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Organ Donation Organization, Winnipeg, MB, Canada
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Mena E, Stahlmann K, Telkmann K, Bolte G. Intersectionality-Informed Sex/Gender-Sensitivity in Public Health Monitoring and Reporting (PHMR): A Case Study Assessing Stratification on an "Intersectional Gender-Score". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2220. [PMID: 36767592 PMCID: PMC9916012 DOI: 10.3390/ijerph20032220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
To date, PHMR has often relied on male/female stratification, but rarely considers the complex, intersecting social positions of men and women in describing the prevalence of health and disease. Stratification on an Intersectional Gender-Score (IG-Score), which is based on a variety of social covariables, would allow comparison of the prevalence of individuals who share the same complex intersectional profile (IG-Score). The cross-sectional case study was based on the German Socio-Economic Panel 2017 (n = 23,269 age 18+). After stratification, covariable-balance within the total sample and IG-Score-subgroups was assessed by standardized mean differences. Prevalence of self-rated health, mental distress, depression and hypertension was compared in men and women. In the IG-Score-subgroup with highest proportion of males and lowest probability of falling into the 'woman'-category, most individuals were in full-time employment. The IG-Score-subgroup with highest proportion of women and highest probability of falling into the 'woman'-category was characterized by part-time/occasional employment, housewife/-husband, and maternity/parental leave. Gender differences in prevalence of health indicators remained within the male-dominated IG-Score-subgroup, whereas the same prevalence of depression and self-rated health was observed for men and women constituting the female-dominated IG-Score-subgroup. These results might indicate that sex/gender differences of depression and self-rated health could be interpreted against the background of gender associated processes. In summary, the proposed procedure allows comparison of prevalence of health indicators conditional on men and women sharing the same complex intersectional profile.
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Affiliation(s)
- Emily Mena
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, Faculty of Human and Health Sciences, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Katharina Stahlmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, Faculty of Human and Health Sciences, University of Bremen, 28359 Bremen, Germany
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Klaus Telkmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, Faculty of Human and Health Sciences, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, Faculty of Human and Health Sciences, University of Bremen, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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Wilson OWA, Smith M, Duncan S, Hinckson E, Mizdrak A, Richards J. Differences in physical activity participation among young adults in Aotearoa New Zealand. BMC Public Health 2023; 23:150. [PMID: 36690969 PMCID: PMC9869605 DOI: 10.1186/s12889-023-15063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine socio-demographic differences in physical activity (aerobic and muscle-strengthening) among young adults (18-24 years). METHODS Data collected between 2017-2019 as a part of Sport New Zealand's Active NZ survey were examined using logistic regression analyses to determine the odds of participants meeting aerobic, muscle-strengthening and combined physical activity recommendations. Gender, ethnicity, employment/student status, disability status, and socio-economic deprivation were included as explanatory variables in analyses. RESULTS The proportion of young adults meeting recommendations varied according to physical activity type (aerobic:63.2%; strength:40.1%; combined:37.2%). Young adults not employed/studying had lower odds of meeting recommendations than those full-time employed (OR = 0.43 [0.34-0.54]). Physical activity levels differ according to gender and this intersects with ethnicity, employment/student status, and social deprivation. For example, the odds of Pasifika young adults meeting combined physical activity recommendations compared to Europeans were not different (OR = 0.95 [0.76-1.19]), but when stratified by gender the odds were significantly higher for men (OR = 1.55 [1.11-2.16]) and significantly lower for women (OR = 0.64 [0.47-0.89]. Similarly, young adults in high deprivation areas had lower odds of meeting combined physical activity recommendations than those in low deprivation areas (OR = 0.81 [0.68-0.95]), but this was mainly due to the difference among women (OR = 0.68 [0.54-0.85]) as there was no difference among men (OR = 0.97 [0.76-1.25]). CONCLUSIONS Intersections between socio-demographic characteristics should be considered when promoting physical activity among young adults in Aotearoa New Zealand, particularly young adults not employed/studying, and young women who live in deprived areas or identify as Asian or Pasifika. Tailored approaches according to activity type for each of these groups are required.
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Affiliation(s)
- Oliver W A Wilson
- Te Hau Kori, Faculty of Health, Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand
| | - Melody Smith
- School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Scott Duncan
- School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Erica Hinckson
- School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Anja Mizdrak
- Department of Public Health, University of Otago, PO Box 7343, Wellington, 6242, New Zealand
| | - Justin Richards
- Te Hau Kori, Faculty of Health, Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
- Sport New Zealand Ihi Aotearoa, Wellington, New Zealand.
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Parry M, Beleno R, Nissim R, Baiden D, Baxter P, Betini R, Bjørnnes AK, Burnside H, Gaetano D, Hemani S, McCarthy J, Nickerson N, Norris C, Nylén-Eriksen M, Owadally T, Pilote L, Warkentin K, Coupal A, Hasan S, Ho M, Kulbak O, Mohammed S, Mullaly L, Theriault J, Wayne N, Wu W, Yeboah EK, O'Hara A, Peter E. Mental health and well-being of unpaid caregivers: a cross-sectional survey protocol. BMJ Open 2023; 13:e070374. [PMID: 36639219 PMCID: PMC9843178 DOI: 10.1136/bmjopen-2022-070374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Unpaid caregiving, care provided by family/friends, is a public health issue of increasing importance. COVID-19 worsened the mental health conditions of unpaid caregivers, increasing substance/drug use and early development of chronic disease. The impact of the intersections of race and ethnicity, sex, age and gender along with unpaid care work and caregivers' health and well-being is unknown. The aim of this study is to describe the inequities of caregiver well-being across the intersections of race and ethnicity, sex, age and gender using a cross-sectional survey design. METHODS AND ANALYSIS We are collaborating with unpaid caregivers and community organisations to recruit a non-probability sample of unpaid caregivers over 18 years of age (n=525). Recruitment will focus on a target sample of 305 South Asian, Chinese and Black people living in Canada, who represent 60% of the Canadian racial and ethnic populations. The following surveys will be combined into one survey: Participant Demographic Form, Caregiver Well-Being Index, interRAI Self-report of Carer Needs and the GENESIS (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond-Premature Acute Coronary Syndrome) PRAXY Questionnaire. Sample characteristics will be summarised using descriptive statistics. The scores from the Caregiver Well-Being Index will be dichotomised into fair/poor and good/excellent. A two-stage analytical strategy will be undertaken using logistic regression to model fair/poor well-being and good/excellent well-being according to the following axes of difference set a priori: sex, race and ethnicity, gender identity, age, gender relations, gender roles and institutionalised gender. The first stage of analysis will model the main effects of each factor and in the second stage of analysis, interaction terms will be added to each model. ETHICS AND DISSEMINATION The University of Toronto's Health Sciences Research Ethics Board granted approval on 9 August 2022 (protocol number: 42609). Knowledge will be disseminated in pamphlets/infographics/email listservs/newsletters and journal articles, conference presentation and public forums, social media and through the study website. TRIAL REGISTRATION NUMBER This is registered in the Open Sciences Framework with a Registration DOI as follows: https://doi.org/10.17605/OSF.IO/PB9TD.
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Affiliation(s)
- Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ron Beleno
- Patient Partner (Caregiver), AGE WELL, University Health Network, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Baiden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Pamela Baxter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Heather Burnside
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Gaetano
- Patient Partner (Caregiver), Dementia Canada, Calgary, Alberta, Canada
| | - Salima Hemani
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jane McCarthy
- Director, Programs and Services, The Ontario Caregiver Organization, Toronto, Ontario, Canada
| | - Nicole Nickerson
- Patient Partner (Caregiver), Canadian Women's Heart Health Alliance, Halifax, Nova Scotia, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Mats Nylén-Eriksen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Tasneem Owadally
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Louise Pilote
- General Internal Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kyle Warkentin
- Patient Partner (Caregiver), Gender Outcomes International Group, Vancouver, British Columbia, Canada
| | - Amy Coupal
- Chief Executive Officer, The Ontario Caregiver Organization, Toronto, Ontario, Canada
| | - Samya Hasan
- Executive Director, Council of Agencies Serving South Asians, Toronto, Ontario, Canada
| | - Mabel Ho
- Director, Education and Research, Yee Hong Centre for Geriatric Care, Scarborough, Ontario, Canada
| | - Olivia Kulbak
- Policy Analyst, Canadian Cancer Society, Toronto, Ontario, Canada
| | - Shan Mohammed
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Laura Mullaly
- Manager, Knowledge Mobilization, Mental Health Commission of Canada, Ottawa, Ontario, Canada
| | - Jenny Theriault
- Executive Director, Caregivers Nova Scotia, Halifax, Nova Scotia, Canada
| | - Nancy Wayne
- Executive Director, Canadian Black Policy Network, Toronto, Ontario, Canada
| | - Wendy Wu
- Patient Partner (Caregiver), North York Toronto Health Partners, Toronto, Ontario, Canada
| | - Eunice K Yeboah
- Executive Director, Canadian Black Policy Network, Toronto, Ontario, Canada
| | - Arland O'Hara
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Soklaridis S, Black G, LeBlanc C, MacKinnon KR, Holroyd-Leduc J, Clement F, Schrewe B, Ross HJ, Calleja S, Stergiopoulos V, Taylor VH, Kuper A. Academic Productivity of Equity-Deserving Physician Scholars During COVID-19: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:123-135. [PMID: 36576772 PMCID: PMC9779983 DOI: 10.1097/acm.0000000000004971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The COVID-19 pandemic presented new barriers and exacerbated existing inequities for physician scholars. While COVID-19's impact on academic productivity among women has received attention, the pandemic may have posed additional challenges for scholars from a wider range of equity-deserving groups, including those who hold multiple equity-deserving identities. To examine this concern, the authors conducted a scoping review of the literature through an intersectionality lens. METHOD The authors searched peer-reviewed literature published March 1, 2020, to December 16, 2021, in Ovid MEDLINE, Ovid Embase, and PubMed. The authors excluded studies not written in English and/or outside of academic medicine. From included studies, they extracted data regarding descriptions of how COVID-19 impacted academic productivity of equity-deserving physician scholars, analyses on the pandemic's reported impact on productivity of physician scholars from equity-deserving groups, and strategies provided to reduce the impact of the COVID-19 pandemic on academic productivity of physician scholars from equity-deserving groups. RESULTS Of 11,587 unique articles, 44 met inclusion criteria, including 15 nonempirical studies and 29 empirical studies (22 bibliometrics studies, 6 surveys, and 1 qualitative study). All included articles focused on the gendered impact of the pandemic on academic productivity. The majority of their recommendations focused on how to alleviate the burden of the pandemic on women, particularly those in the early stages of their career and/or with children, without consideration of scholars who hold multiple and intersecting identities from a wider range of equity-deserving groups. CONCLUSIONS Findings indicate a lack of published literature on the pandemic's impact on physician scholars from equity-deserving groups, including a lack of consideration of physician scholars who experience multiple forms of discrimination. Well-intentioned measures by academic institutions to reduce the impact on scholars may inadvertently risk reproducing and sustaining inequities that equity-deserving scholars faced during the pandemic.
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Affiliation(s)
- Sophie Soklaridis
- S. Soklaridis is a senior scientist, Department of Education, Centre for Addiction and Mental Health, and associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5119-8473
| | - Georgia Black
- G. Black is a research analyst, Department of Education, Centre for Addiction and Mental Health, Department of Education, Toronto, Ontario, Canada
| | - Constance LeBlanc
- C. LeBlanc is professor, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; ORCID: http://orcid.org/0000-0003-0553-3335
| | - Kinnon R. MacKinnon
- K.R. MacKinnon is assistant professor, School of Social Work, York University, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-2039-6746
| | - Jayna Holroyd-Leduc
- J. Holroyd-Leduc is professor and head, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Clement
- F. Clement is professor, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brett Schrewe
- B. Schrewe is clinical assistant professor, Department of Pediatrics, University of British Columbia, Victoria, British Columbia, Canada; ORCID: http://orcid.org/0000-0001-9743-2894
| | - Heather J. Ross
- H.J. Ross is division head of cardiology, Peter Munk Cardiac Centre, and professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-4384-3027
| | - Sabine Calleja
- S. Calleja is a librarian, Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5297-0736
| | - Vicky Stergiopoulos
- V. Stergiopoulos is a clinician scientist, Centre for Addiction and Mental Health, and professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3941-9434
| | - Valerie H. Taylor
- V.H. Taylor is professor, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Ayelet Kuper
- A. Kuper is a scientist and associate director, Wilson Centre, University Health Network/University of Toronto, and associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6399-6958
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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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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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Nguena Nguefack HL, Pagé MG, Choinière M, Vanasse A, Deslauriers S, Angarita-Fonseca A, Blanchette MA, Lacasse A. Distinct care trajectories among persons living with arthritic conditions: A two-year state sequence analysis. FRONTIERS IN PAIN RESEARCH 2022; 3:1014793. [PMID: 36444387 PMCID: PMC9699830 DOI: 10.3389/fpain.2022.1014793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES Developing solutions to optimize care trajectories (CareTs) requires examining patient journeys through the health care system. This study aimed to describe CareTs among people living with arthritis and evaluate their association with self-reported health outcomes. METHODS Analyses were conducted using the TorSaDE Cohort (n = 102,148), which connects the 2007 to 2016 Canadian Community Health Surveys (CCHS) with Quebec administrative databases (longitudinal claims). CareTs of participants living with arthritis according to CCHS (n = 16,631), over the two years before CCHS completion, were clustered using state sequence analysis (months as a time unit). CareT group membership was then put in association with self-reported outcomes (pain intensity and interference, self-perceived general and mental health). RESULTS The analysis revealed five CareT groups characterized predominantly by: (1) arthritis-related visits to a specialist (n = 2,756; 16.6%), (2) arthritis-related emergency department visits (n = 2,928; 17.6%), (3) very high all-cause health care utilization and arthritis-related hospitalizations (n = 1,570; 9.4%), (4) arthritis-related medical visits to general practitioners and specialists (n = 2,708; 16.3%), (5) low all-cause health care utilization (n = 6,669; 40.1%). Multivariable results revealed that CareT group membership was associated with higher levels of pain interference (CareT group #3 vs. #5: OR: 1.4, 95%CI: 1.1-1.8) and fair/poor self-perceived general health (CareT group #1 vs. #5: OR: 1.551, 95%CI: 1.319-1.824; #2 vs. #5: OR: 1.244, 95%CI: 1.062-1.457; #3 vs. #5: OR: 1.771, 95%CI: 1.451-2.162; #4 vs. #5: OR: 1.481, 95%CI: 1.265-1.735). DISCUSSION Sate sequence analysis is an innovative method of studying CareTs and valuable for making evidence-based decisions taking into account inter- and intra-individual variability.
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Affiliation(s)
| | - M. Gabrielle Pagé
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Manon Choinière
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Deslauriers
- VITAM – Centre de recherche en santé durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Adriana Angarita-Fonseca
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marc-André Blanchette
- Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
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Freitas RS, Santos IDS, Matos SMAD, Aquino EMLD, Amorim LDAF. Ideal cardiovascular health at ELSA-Brasil: non-additivity effects of gender, race, and schooling by using additive and multiplicative interactions. CAD SAUDE PUBLICA 2022; 38:e00266221. [PMID: 35946616 DOI: 10.1590/0102-311xen266221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
This study aims to assess the non-additivity effects of gender, race, and schooling on ideal cardiovascular health among participants of the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil. This is a cross-sectional study using data from the baseline of ELSA-Brasil, conducted from 2008 to 2010. The American Heart Association defined a score of ideal cardiovascular health (ICH) as the sum of indicators for the presence of seven favorable health factors and behaviors: non-smoking, ideal body mass index, physical activity and healthy diet, adequate levels of total cholesterol, normal blood pressure, and absence of diabetes mellitus. Multiplicative and additive interactions between gender, race, and schooling were assessed using the Poisson regression model to discuss intersectionality. The mean cardiovascular health score was 2.49 (SD = 1.31). This study showed a positive interaction between gender and schooling (women with high school and higher education) in both additive and multiplicative scales for the score of ideal cardiovascular health. We observed a trend towards higher mean values of cardiovascular health for increased schooling, with a marked difference among women. The lowest cardiovascular health scores observed reinforce the importance of understanding the psychosocial experiences that influence health attitudes, access to health care, and healthy lifestyle choices, which affect ICH, to reduce inequities in health and propose more adequate public policies that assist and prevent cardiovascular diseases.
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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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A novel psychometric approach to assessing intersectional hiv stigma: the geometric intersectional stigma scales. J Behav Med 2022; 45:804-811. [PMID: 35687209 PMCID: PMC9510112 DOI: 10.1007/s10865-022-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/04/2022] [Indexed: 10/31/2022]
Abstract
Recent advances in stigma theories have emphasized intersectionality, but there are currently few approaches to measuring intersectional HIV stigma. Here we present a novel approach to assessing intersectional HIV stigma. Black/African American sexual minority men living with HIV (N = 437) completed newly developed measures of enacted and anticipated stigma along with a battery of instruments to examine construct validity. For each endorsed stigma item, participants rated three personal attributes ascribed to the stigma experiences, specifically race, same-sex sexual behavior, and HIV status. Based on the notion that intersecting orthogonal dimensions such as attributions for experiencing stigma can be conceptualized geometrically, we used the Pythagorean Theorem to calculate intersectional stigma scores. Results showed that the enacted and anticipated stigma scales and the assessment of intersectional stigma attributes demonstrated acceptable response rates, internal consistency and a pattern of associations with correlates that suggests construct validity. In separate tests of construct validity, regression models predicting medication adherence indicated varied results among stigma measures, demonstrating clear advantages to separating the assessment of stigma experiences from the attributes to which stigma experiences are ascribed. Findings from this geometric approach to assessing intersectional HIV stigma were promising and warrant further investigation.
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Godbout-Parent M, Nguena Nguefack HL, Angarita-Fonseca A, Audet C, Bernier A, Zahlan G, Julien N, Pagé MG, Guénette L, Blais L, Lacasse A. Prevalence of cannabis use for pain management in Quebec: A post-legalization estimate among generations living with chronic pain. Can J Pain 2022; 6:65-77. [PMID: 35694144 PMCID: PMC9176231 DOI: 10.1080/24740527.2022.2051112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Medical cannabis has been legal in Canada since 2001, and recreational cannabis was legalized in October 2018, which has led to a widespread increase in the accessibility of cannabis products. Aims This study aimed to estimate the prevalence of cannabis use among adults living with chronic pain (CP) and investigate the relationship between age and cannabis use for CP management. Methods A cross-sectional analysis of the COPE Cohort data set, a large Quebec sample of 1935 adults living with CP, was conducted. Participants completed a web-based questionnaire in 2019 that contained three yes/no questions about past-year use of cannabis (i.e., for pain management, management of other health-related conditions, recreational purposes). Results Among the 1344 participants who completed the cannabis use section of the questionnaire, the overall prevalence of cannabis use for pain management was 30.1% (95% confidence interval 27.7-32.7). Differences were found between age groups, with the highest prevalence among participants aged ≤26 years (36.5%) and lowest for those aged ≥74 years (8.8%). A multivariable logistic model revealed that age, region of residence, generalized pain, use of medications or nonpharmacological approaches for pain management, alcohol/drug consumption, and smoking were associated with the likelihood of using cannabis for pain management. Conclusions Cannabis is a common treatment for the management of CP, especially in younger generations. The high prevalence of use emphasizes the importance of better knowledge translation for people living with CP, rapidly generating evidence regarding the safety and efficacy of cannabis, and clinicians' involvement in supporting people who use cannabis for pain management.
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Affiliation(s)
- Marimée Godbout-Parent
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Adriana Angarita-Fonseca
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada,Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Claudie Audet
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Andréanne Bernier
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Ghita Zahlan
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Nancy Julien
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada,médecine, Université de MontréalDépartement d’anesthésiologie et de médecine de la douleur, Faculté de, Montréal, Québec, Canada
| | - Line Guénette
- Faculté de pharmacie, Université Laval, Québec, Québec, Canada,Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada,CONTACT Anaïs Lacasse, PhD Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, 445, boul. de l’Université, Rouyn-Noranda, QCJ9X 5E4, Canada
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Karver TS, Atkins K, Fonner VA, Rodriguez-Diaz CE, Sweat MD, Taggart T, Yeh PT, Kennedy CE, Kerrigan D. HIV-Related Intersectional Stigma and Discrimination Measurement: State of the Science. Am J Public Health 2022; 112:S420-S432. [PMID: 35763725 PMCID: PMC9241460 DOI: 10.2105/ajph.2021.306639] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/18/2023]
Abstract
Background. Across settings, individuals from populations that are multiply stigmatized are at increased risk of HIV and experience worse HIV treatment outcomes. As evidence expands on how intersecting stigmatized identities and conditions influence HIV outcomes, researchers have used diverse quantitative approaches to measure HIV-related intersectional stigma and discrimination. To date, no clear consensus exists regarding how to best quantitatively measure and analyze intersectional stigma and discrimination. Objectives. To review and document existing quantitative measures of HIV-related intersectional stigma and discrimination to inform research, programmatic, and policy efforts. Search Methods. We searched 5 electronic databases for relevant studies. References of included articles were screened for possible inclusion. Additional articles were screened on the basis of consultations with experts in the field. Selection Criteria. We included peer-reviewed studies published between January 1, 2010, and May 12, 2021, that were HIV related and presented 1 or more quantitative measures of stigma and discrimination using an intersectional lens in measure design or analysis. Data Collection and Analysis. Systematic methods were used to screen citations and abstract data via a standardized coding form. Data were analyzed by coding categories stratified according to 2 subgroups: (1) studies incorporating a single intersectional measure and (2) studies that examined intersectional stigma through analytical approaches combining multiple measures. Main Results. Sixteen articles met the inclusion criteria, 7 of which explicitly referenced intersectionality. Ten studies were from the United States. All of the studies included participants living with HIV. Among the 4 studies incorporating a single intersectional stigma measure, 3 explored race and gender stigma and 1 explored gender and HIV stigma. Studies involving analytic approaches (n = 12) mostly examined intersectional stigma via interaction terms in multivariate regression models. Three studies employed structural equation modeling to examine interactive effects or latent constructs of intersectional stigma. Conclusions. Research on the measurement of HIV-related intersectional stigma and discrimination is currently concentrated in high-income settings and generally focuses on the intersection of 2 identities (e.g., race and gender). Efforts are needed to expand appropriate application of intersectionality in the development, adaptation, and use of measures of HIV-related intersectional stigma and discrimination. The use of context-, identity-, or condition-adaptable measures should be considered. Researchers should also carefully consider how to meaningfully engage communities in the process of measurement development. Public Health Implications. The measures and analytic approaches presented could significantly enhance public health efforts in assessing the impact of HIV-related intersectional stigma and discrimination on critical health outcomes. (Am J Public Health. 2022;112(S4):S420-S432. https://doi.org/10.2105/AJPH.2021.306639).
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Affiliation(s)
- Tahilin Sanchez Karver
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Kaitlyn Atkins
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Virginia A Fonner
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Carlos E Rodriguez-Diaz
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Michael D Sweat
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Tamara Taggart
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Ping Teresa Yeh
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Caitlin E Kennedy
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Deanna Kerrigan
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Jordan G, Burke L, Bailey J, Kreidstein S, Iftikhar M, Plamondon L, Young C, Davidson L, Rowe M, Bellamy C, Abdel-Baki A, Iyer SN. A Mixed Methods Study Examining Citizenship Among Youth With Mental Health Challenges. Front Psychiatry 2022; 13:852947. [PMID: 35664471 PMCID: PMC9158458 DOI: 10.3389/fpsyt.2022.852947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Multiple stakeholders have recently called for greater research on the barriers to citizenship and community belonging faced by people with mental health challenges. Citizenship has been defined as a person's access to the rights, roles, responsibilities, resources and relationships that help people feel a sense of belonging. Factors that may impact citizenship include financial precarity; intersecting forms of marginalization and oppression (e.g., racism); and the mental health care people receive. Research has yet to examine experiences of citizenship among youth with mental health challenges. To address this gap, this study will examine how youth experience citizenship; predictors of citizenship; how citizenship shapes recovery; and the degree to which youth are receiving citizenship-oriented care. Methods The research objectives will be evaluated using a multiphase mixed methods research design. Quantitative data will be collected cross-sectionally using validated self-report questionnaires. Qualitative data will be collected using a hermeneutic phenomenological method using semi-structured interviews and focus groups. Analyses Multiple stepwise regression analyses will be used to determine predictors of citizenship and if of citizenship predict recovery. Pearson correlations will be computed to determine the relationship between participants' perceived desire for, and receipt of citizenship-oriented care. Phenomenological analysis will be used to analyze qualitative data. Findings will then be mixed using a weaving method in the final paper discussion section. Conclusion Findings from this study may support the development of citizenship-oriented healthcare in Canada.
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Affiliation(s)
- Gerald Jordan
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Yale Program for Recovery and Community Health, Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Laura Burke
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Julia Bailey
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sof Kreidstein
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Myera Iftikhar
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Lauren Plamondon
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Courtney Young
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Larry Davidson
- Yale Program for Recovery and Community Health, Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Michael Rowe
- Yale Program for Recovery and Community Health, Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Chyrell Bellamy
- Yale Program for Recovery and Community Health, Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Amal Abdel-Baki
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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Nguena Nguefack HL, Gabrielle Pagé M, Guénette L, Blais L, Diallo M, Godbout-Parent M, Angarita-Fonseca A, Lacasse A. Gender Differences in Medication Adverse Effects Experienced by People Living With Chronic Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:830153. [PMID: 35620635 PMCID: PMC9128021 DOI: 10.3389/fpain.2022.830153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesUnderstanding gender differences in chronic pain (CP) outcome research is essential to optimal treatment delivery. This study explored the associations between gender identity, gender roles, and the number of non-life-threatening pain medication adverse effects reported as severe by people living with CP.MethodsThe analyses were conducted using the COPE Cohort, a dataset generated through a web-based recruitment of adults with CP. Participants were asked how they identified themselves (women, men, unknown, unspecified) and gender roles were measured using the Bem Sex-Role Inventory (subgroups were formed applying the median split method). Pain medication adverse effects were assessed using a standardized checklist (none/mild/moderate/severe). A zero-inflated Poisson model was used to assess gender identity, gender roles and their interaction as potential predictors of the number of pain medication adverse effects.ResultsA total of 1,343 participants reported using pain medications. Adjusting for potential confounders, both gender identity (men vs. women: ß = −0.32, p = 0.0024) and gender roles (androgynous vs. undifferentiated: ß = 0.26, p = 0.0030) were associated with the number of pain medication adverse effects reported as severe, and they interacted with each other. The stratified analysis by gender roles showed that women reported a greater number of severe adverse effects than men among those classified as masculine and androgynous.DiscussionAlthough we are unable to confirm whether the associations can be explained by differences in the experience or in the reporting of effects, gender identity and gender roles should both be explored when studying pain medication adverse effects.
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Affiliation(s)
| | - M. Gabrielle Pagé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département d'anesthésiologie et de Médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Québec City, QC, Canada
- Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec – Université Laval, Québec, QC, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Mamadou Diallo
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marimée Godbout-Parent
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Adriana Angarita-Fonseca
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
- *Correspondence: Anaïs Lacasse
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Slade T, Duebel E, Ryan J. "Your double-blind RCT needs feminism": an argument for engaging critical theory in quantitative rehabilitation research. Disabil Rehabil 2022; 45:1563-1571. [PMID: 35507752 DOI: 10.1080/09638288.2022.2068679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Rehabilitation science has, for years, endorsed a connection between quantitative research and the philosophical assumptions of positivism. These assumptions can limit the scope of rehabilitation research, particularly in relation to matters of equity, diversity, and inclusivity. As our field moves toward a greater focus on inclusivity in research design and patient-centred care, it is imperative that we reconsider the theoretical foundations of rehabilitation research and practice. METHODS We provide an analysis of positivism on equity, diversity, and inclusivity within quantitative rehabilitation research, using the Participant Intervention Comparison Outcome (PICO) model to provide structure for the resultant discussion and recommendations. RESULTS Our analysis reveals that there are significant limitations and ethical concerns to engaging in positivism as the primary paradigm for quantitative rehabilitation research. We argue that decoupling of positivism and quantitative research methods may be warranted. CONCLUSIONS Equitable and inclusive rehabilitation research requires the researcher to consider variables which are neglected in the positivist paradigm. We argue that critical theory can equip researchers with a lens to better address injustices within rehabilitation research. We provide a series of recommendations for researchers to engage critical theory at each stage of the PICO model of clinical trials.IMPLICATIONS FOR REHABILITATIONCommon assumptions in quantitative rehabilitation research (i.e., positivism) can limit the utility of research findings to rehabilitation patients.Equitable, diverse, and inclusive participant samples in research better reflect the diversity of real world rehabilitation patients, helping us better serve these populations.Critical theory can help researchers and clinicians identify and avoid interventions that may cause harm to rehabilitation patients.Research and practice that prioritize concepts of "normalcy" (i.e., "normal gait," "normal behaviours") may perpetuate negative concepts of disability and further marginalize the individuals that our interventions aim to serve.
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Affiliation(s)
- Teri Slade
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Erin Duebel
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Jacalyn Ryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Wandschneider L, Miani C, Razum O. Decomposing intersectional inequalities in subjective physical and mental health by sex, gendered practices and immigration status in a representative panel study from Germany. BMC Public Health 2022; 22:683. [PMID: 35392864 PMCID: PMC8991479 DOI: 10.1186/s12889-022-13022-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background The mapping of immigration-related health inequalities remains challenging, since immigrant populations constitute a heterogenous socially constructed group whose health experiences differ by social determinants of health. In spite of the increasing awareness that population mobility and its effects on health are highly gendered, an explicit gender perspective in epidemiology is often lacking or limited. Methods To map inequalities in self-reported physical and mental health in Germany at the intersections of sex, gendered practices and immigration status, we used data from the German Socioeconomic Panel (SOEP) and applied an intercategorical intersectional approach conducting multilevel linear regression models. We differentiated between sex (male/female) as reported in the survey and gendered social practices, quantified through a gender score (on a femininity-masculinity continuum). Results We included 20,897 participants in our analyses. We saw an intersectional gradient for physical and mental health. Compared to the reference group, i.e. non-immigrant males with masculine gendered practices, physical and mental health steadily decreased in the intersectional groups that did not embody one or more of these social positions. The highest decreases in health were observed in the intersectional group of immigrant females with feminine gendered practices for physical health (-1,36; 95% CI [-2,09; -0,64]) and among non-immigrant females with feminine practices for mental health (-2,51; 95% CI [-3,01; -2,01]). Conclusions Patterns of physical and mental health vary along the intersectional axes of sex, gendered practices and immigration status. These findings highlight the relevance of intersections in describing population health statuses and emphasise the need to take them into account when designing public health policies aiming at effectively reducing health inequalities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13022-1.
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Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany.,Research Institute Social Cohesion (RISC), Bielefeld University, Bielefeld, Germany
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Weinberger AH, Steinberg ML, Mills SD, Dermody SS, Heffner JL, Kong AY, Pang RD, Rosen RL. Assessing Sex, Gender Identity, Sexual Orientation, Race, Ethnicity, Socioeconomic Status, and Mental Health Concerns in Tobacco Use Disorder Treatment Research: Measurement Challenges and Recommendations From a Society for Research on Nicotine and Tobacco Pre-conference Workshop. Nicotine Tob Res 2022; 24:643-653. [PMID: 34622932 PMCID: PMC8962699 DOI: 10.1093/ntr/ntab201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022]
Abstract
This paper reports on topics discussed at a Society for Research on Nicotine and Tobacco pre-conference workshop at the 2019 annual Society for Research on Nicotine and Tobacco meeting. The goal of the pre-conference workshop was to help develop a shared understanding of the importance of several tobacco-related priority groups in tobacco use disorder (TUD) treatment research and to highlight challenges in measurement related to these groups. The workshop focused on persons with minoritized sex, gender identity, and sexual orientation identities; persons with minoritized racial and ethnic backgrounds; persons with lower socioeconomic status (SES); and persons with mental health concerns. In addition to experiencing commercial tobacco-related health disparities, these groups are also underrepresented in tobacco research, including TUD treatment studies. Importantly, there is wide variation in how and whether researchers are identifying variation within these priority groups. Best practices for measuring and reporting sex, gender identity, sexual orientation, race, ethnicity, SES, and mental health concerns in TUD treatment research are needed. This paper provides information about measurement challenges when including these groups in TUD treatment research and specific recommendations about how to measure these groups and assess potential disparities in outcomes. The goal of this paper is to encourage TUD treatment researchers to use measurement best practices in these priority groups in an effort to conduct meaningful and equity-promoting research. Increasing the inclusion and visibility of these groups in TUD treatment research will help to move the field forward in decreasing tobacco-related health disparities. Implications: Tobacco-related disparities exist for a number of priority groups including, among others, women, individuals with minoritized sexual and gender identities, individuals with minoritized racial and ethnic backgrounds, individuals with lower SES, and individuals with mental health concerns. Research on TUD treatments for many of these subgroups is lacking. Accurate assessment and consideration of these subgroups will provide needed information about efficacious and effective TUD treatments, about potential mediators and moderators, and for accurately describing study samples, all critical elements for reducing tobacco-related disparities, and improving diversity, equity, and inclusion in TUD treatment research.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sarah D Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah S Dermody
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA,USA
| | - Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raina D Pang
- Department of Preventive Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Rachel L Rosen
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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Kalichman SC, Shkembi B, Eaton LA. Finding the Right Angle: A Geometric Approach to Measuring Intersectional HIV Stigma. AIDS Behav 2022; 26:27-38. [PMID: 34424389 DOI: 10.1007/s10461-021-03437-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/31/2022]
Abstract
Intersectionality has emerged as theoretically and practically important to advancing HIV stigma research. However, few psychometric measures capture the intricacies of intersectional stigma. Grounded in the HIV stigma framework and contemporary theories of intersectionality, this paper describes a novel approach to conceptualizing the measurement of intersectional stigma. Taking the notion of an intersection literally, that is the point at which two or more lines meet and form a union, we offer a geometric conceptualization for developing a psychometric instrument to measure intersectional stigma. Ratings of stigmatized attributes, such as stigma ascribed to gender, race, sexual orientation, and HIV status are assessed on independent scales to calculate their intersection using the Pythagorean Theorem, c = [Formula: see text] (a2 + b2) and its extension to multiple stigmatized attributes d = [Formula: see text] (a2 + b2 + c2). Data from a sample of Black /African American women living with HIV were used to test the concept of a geometric approach to measuring intersectional enacted stigma and intersectional anticipated stigma. Findings from the test of concept were encouraging and warrant further scale development research.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA.
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
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Brown JEH, Young JL, Martinez-Martin N. Psychiatric genomics, mental health equity, and intersectionality: A framework for research and practice. Front Psychiatry 2022; 13:1061705. [PMID: 36620660 PMCID: PMC9812559 DOI: 10.3389/fpsyt.2022.1061705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
The causal mechanisms and manifestations of psychiatric illness cannot be neatly narrowed down or quantified for diagnosis and treatment. Large-scale genome-wide association studies (GWAS) might renew hope for locating genetic predictors and producing precision medicines, however such hopes can also distract from appreciating social factors and structural injustices that demand more socially inclusive and equitable approaches to mental healthcare. A more comprehensive approach begins with recognizing that there is no one type of contributor to mental illness and its duration that should be prioritized over another. We argue that, if the search for biological specificity is to complement the need to alleviate the social distress that produces mental health inequities, psychiatric genomics must incorporate an intersectional dimension to models of mental illness across research priorities, scientific frameworks, and clinical applications. We outline an intersectional framework that will guide all professionals working in the expanding field of psychiatric genomics to better incorporate issues of social context, racial and cultural diversity, and downstream ethical considerations into their work.
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Affiliation(s)
- Julia E H Brown
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer L Young
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Care-giver wellbeing: exploring gender, relationship-to-care-recipient and care-giving demands in the Canadian Longitudinal Study on Aging. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The three-way intersection of gender, relationship-to-care-recipient and care-giving demands has not, to our knowledge, been examined in relation to the wellbeing of family care-givers. We explore inequalities in depressive symptoms and life satisfaction, comparing wives, husbands, daughters and sons providing very-intensive care (36+ hours/week) with those providing less care and disparities between these groups in the factors related to disadvantage. Data from the Canadian Longitudinal Study on Aging (N = 5,994) support the existence of differences between the groups. Very-intensive care-giving wives report the most depressive symptoms and lowest life satisfaction; less-intensive care-giving sons report the fewest depressive symptoms, and less-intensive care-giving daughters report the highest life satisfaction. However, group differences in life satisfaction disappear among very-intensive care-givers. Drawing on Intersectionality and Stress Process theories, data from regression analyses reveal a non-significant gender–relationship–demand interaction term, but, health, socio-economic and social support resources play a strong mediating role between care demand and wellbeing. Analyses of the eight groups separately reveal diversity in the care-giving experience. Among less-intensive care-givers, the mediating role of resources remains strong even as differences are evident. Among very-intensive care-givers, the role of resources is less and differences in wellbeing between the groups are magnified. Policy implications emphasise the imperative to personalise services to meet the varied needs of care-givers.
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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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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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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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39
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Rotz S, Rose J, Masuda J, Lewis D, Castleden H. Toward intersectional and culturally relevant sex and gender analysis in health research. Soc Sci Med 2021; 292:114459. [PMID: 34736805 DOI: 10.1016/j.socscimed.2021.114459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/16/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
Current institutional frameworks in sex- and gender-based analysis (SGBA) are promising, but significant gaps remain in their relation to recent developments in research praxis. In this paper we draw from our own experiences with a national health research funding agency, the Canadian Institutes of Health Research (CIHR), to critically examine the uptake and implementation of its current frameworks and practices of sex and gender analysis in health research. We conducted semi-structured interviews with a cohort of 18 health researchers alongside an institutional policy analysis to show how sex and gender have been understood, integrated, and addressed within the agency and initiative. Our findings reveal that attention to date has focused on representation (human and data) while deeper justice issues that are attentive to intersectionality, positionality and reflexivity-remain ambiguous. Finally, we discuss possible strategies for institutions to improve the uptake of knowledge, training, and policy to better support intersectional and culturally-relevant frameworks across the diverse research community.
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Affiliation(s)
- Sarah Rotz
- Faculty of Environmental and Urban Change, York University, Toronto, Ontario, Canada.
| | - Johnathan Rose
- Health, Environments, and Communities (HEC) Lab, Queen's University, Canada.
| | - Jeff Masuda
- School of Kinesiology and Health Studies and Department of Geography, Queen's University, Canada.
| | - Diana Lewis
- Department of Geography and Environment/Indigenous Studies Program, Western University, Canada.
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40
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Kelly C, Kasperavicius D, Duncan D, Etherington C, Giangregorio L, Presseau J, Sibley KM, Straus S. 'Doing' or 'using' intersectionality? Opportunities and challenges in incorporating intersectionality into knowledge translation theory and practice. Int J Equity Health 2021; 20:187. [PMID: 34419053 PMCID: PMC8379861 DOI: 10.1186/s12939-021-01509-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
Intersectionality is a widely adopted theoretical orientation in the field of women and gender studies. Intersectionality comes from the work of black feminist scholars and activists. Intersectionality argues identities such as gender, race, sexuality, and other markers of difference intersect and reflect large social structures of oppression and privilege, such as sexism, racism, and heteronormativity. The reach of intersectionality now extends to the fields of public health and knowledge translation. Knowledge translation (KT) is a field of study and practice that aims to synthesize and evaluate research into an evidence base and move that evidence into health care practice. There have been increasing calls to bring gender and other social issues into the field of KT. Yet, as scholars outline, there are few guidelines for incorporating the principles of intersectionality into empirical research. An interdisciplinary, team-based, national health research project in Canada aimed to bring an intersectional lens to the field of knowledge translation. This paper reports on key moments and resulting tensions we experienced through the project, which reflect debates in intersectionality: discomfort with social justice, disciplinary divides, and tokenism. We consider how our project advances intersectionality practice and suggests recommendations for using intersectionality in health research contexts. We argue that while we encountered many challenges, our process and the resulting co-created tools can serve as a valuable starting point and example of how intersectionality can transform fields and practices.
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Affiliation(s)
- Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Room S108-E - 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.
| | | | - Diane Duncan
- Accelerating Change Transformation Team (ACTT), Alberta Medical Association, Edmonton, Alberta, Canada
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Room S108-E - 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Sharon Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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41
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Merz S, Jaehn P, Mena E, Pöge K, Strasser S, Saß AC, Rommel A, Bolte G, Holmberg C. Intersectionality and eco-social theory: a review of potentials for public health knowledge and social justice. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1951668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sibille Merz
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Potsdam and Cottbus, Germany
| | - Emily Mena
- , Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Kathleen Pöge
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Unit 34 - HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
| | - Sarah Strasser
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Anke-Christine Saß
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Alexander Rommel
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Gabriele Bolte
- , Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Potsdam and Cottbus, Germany
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Pitt SC. Words Do Matter: Improving Surgical Research Through Appropriate Use of Sex, Gender, Race, and Ethnicity Terminology. J Am Coll Surg 2021; 233:319-320. [PMID: 34304823 DOI: 10.1016/j.jamcollsurg.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/11/2023]
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43
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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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Gullo G, Cucinella G, Perino A, Gullo D, Segreto D, Laganà AS, Buzzaccarini G, Donarelli Z, Marino A, Allegra A, Maranto M, Carosso AR, Garofalo P, Tomaiuolo R. The Gender Gap in the Diagnostic-Therapeutic Journey of the Infertile Couple. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126184. [PMID: 34201025 PMCID: PMC8227607 DOI: 10.3390/ijerph18126184] [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: 04/13/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022]
Abstract
Medical procreation impairs both the biological and psychological lives of couples. However, male and female attitudes to infertility are different and require a different approach during the IVF journey. Thus, the gender impact assessment (GIA) method was used to analyse original studies present in the literature. We found some gender-related differences and, subsequently, possible outcomes of intervention to improve healthy reproduction management and prevent infertility. In particular, it became apparent that there was the need for an in-depth male infertility assessment and a gender-specific follow-up.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Antonio Perino
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Domenico Gullo
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
| | - Daniela Segreto
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
| | - Giovanni Buzzaccarini
- Department of Women’s and Children’s Health, Padova Hospital, University of Padova, 35128 Padova, Italy
- Correspondence:
| | - Zaira Donarelli
- Psychology Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy;
| | - Angelo Marino
- Reproductive Medicine Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy; (A.M.); (A.A.)
| | - Adolfo Allegra
- Reproductive Medicine Unit, Andros Day Surgery Clinic-Palermo, 90144 Palermo, Italy; (A.M.); (A.A.)
| | - Marianna Maranto
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.); (A.P.); (M.M.)
| | - Andrea Roberto Carosso
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy;
| | - Piernicola Garofalo
- Technical Panel on Gender Medicine-Sicily Regional Health Service, 90143 Palermo, Italy; (D.G.); (D.S.); (P.G.)
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45
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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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Lim H, Jung E, Jodoin K, Du X, Airton L, Lee EY. Operationalization of intersectionality in physical activity and sport research: A systematic scoping review. SSM Popul Health 2021; 14:100808. [PMID: 34136631 PMCID: PMC8182115 DOI: 10.1016/j.ssmph.2021.100808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/12/2022] Open
Abstract
Participation in and opportunities for physical activity (PA) and sports (PA inclusively hereafter) are known to vary across individuals with different social positions. Intersectionality theory may help us to better understand the complex processes of multiple interlocking systems of oppression and privilege shaped by intersections of individuals’ social categories. The objectives of this systematic scoping review were (1) to summarize the findings of articles examining PA claimed operationalization of intersectionality and (2) to identify the scope and gaps pertaining to the operationalization of intersectionality in PA research. A search was conducted in September 2019 in seven electronic databases (e.g., SPORTDiscus, Scopus, Web of Science) for relevant research articles written in English. Key search terms included “intersectionality” AND “physical activity” OR “sport”. Database searches, data screening and extraction, and narrative synthesis were conducted between September 2019 and May 2020. Of 16564 articles identified, 45 articles were included in this review. The majority of included articles used qualitative methods (n = 41), with two quantitative and two mixed-methods articles. The most frequently observed intersectional social position was sex/gender + race/ethnicity (n = 11), followed by sex/gender + race/ethnicity + sexuality (n = 6) and sex/gender + race/ethnicity + religion (n = 6). Most qualitative studies (n = 38) explicitly claimed operationalization of intersectionality as a key theoretical framework, and over half of these studies (n = 27) implicitly used intra-categorical intersectionality. Two quantitative studies were identified which examined a number of intersections simultaneously using inter-categorical intersectionality. Complex processes of individual and social-structural level factors that drive inequalities in PA opportunities and participation could be better elucidated with the operationalization of intersectionality theory. Intersectionality theory may serve as a useful framework in both qualitative and quantitative investigations. Advancement in quantitative intersectionality is critical in order to produce knowledge that could inform more inclusive PA promotion efforts. Intra-categorical intersectionality is commonly used in most qualitative investigations. Inter-categorical intersectionality is used in quantitative research. Utilizing multiplicative statistical models may advance quantitative intersectionality. Investigating varying axes of marginalization beyond sex/gender + race/ethnicity is important. Intersectionality is useful in better understanding disparities in physical activity.
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Affiliation(s)
- Heejun Lim
- School of Kinesiology and Health Studies, Queen's University, SKHS Building 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Eun Jung
- School of Kinesiology and Health Studies, Queen's University, SKHS Building 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Kaila Jodoin
- School of Kinesiology and Health Studies, Queen's University, SKHS Building 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - XiaoWei Du
- School of Kinesiology and Health Studies, Queen's University, SKHS Building 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Lee Airton
- Faculty of Education, Duncan MacArthur Hall, Queen's University, Kingston, ON K7M 5R7, Canada.,Department of Gender Studies, D508 Mackintosh-Corry Hall, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Eun-Young Lee
- School of Kinesiology and Health Studies, Queen's University, SKHS Building 28 Division Street, Kingston, ON K7L 3N6, Canada.,Department of Gender Studies, D508 Mackintosh-Corry Hall, Queen's University, Kingston, ON K7L 3N6, Canada
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47
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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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48
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Axelsson Fisk S, Lindström M, Perez-Vicente R, Merlo J. Understanding the complexity of socioeconomic disparities in smoking prevalence in Sweden: a cross-sectional study applying intersectionality theory. BMJ Open 2021; 11:e042323. [PMID: 33574148 PMCID: PMC7880088 DOI: 10.1136/bmjopen-2020-042323] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Socioeconomic disparities in smoking prevalence remain a challenge to public health. The objective of this study was to present a simple methodology that displays intersectional patterns of smoking and quantify heterogeneities within groups to avoid inappropriate and potentially stigmatising conclusions exclusively based on group averages. SETTING This is a cross-sectional observational study based on data from the National Health Surveys for Sweden (2004-2016 and 2018) including 136 301 individuals. We excluded people under 30 years of age, or missing information on education, household composition or smoking habits. The final sample consisted on 110 044 individuals or 80.7% of the original sample. OUTCOME Applying intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA), we investigated the risk of self-reported smoking across 72 intersectional strata defined by age, gender, educational achievement, migration status and household composition. RESULTS The distribution of smoking habit risk in the population was very heterogeneous. For instance, immigrant men aged 30-44 with low educational achievement that lived alone had a prevalence of smoking of 54% (95% CI 44% to 64%), around nine times higher than native women aged 65-84 with high educational achievement and living with other(s) that had a prevalence of 6% (95% CI 5% to 7%). The discriminatory accuracy of the information was moderate. CONCLUSION A more detailed, intersectional mapping of the socioeconomic and demographic disparities of smoking can assist in public health management aiming to eliminate this unhealthy habit from the community. Intersectionality theory together with AIHDA provides information that can guide resource allocation according to the concept proportionate universalism.
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Affiliation(s)
- Sten Axelsson Fisk
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Lindström
- Unit for Social Medicine and Health Policy, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
| | - Raquel Perez-Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
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Alvidrez J, Greenwood GL, Johnson TL, Parker KL. Intersectionality in Public Health Research: A View From the National Institutes of Health. Am J Public Health 2021; 111:95-97. [PMID: 33326274 DOI: 10.2105/ajph.2020.305986] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jennifer Alvidrez
- Jennifer Alvidrez is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Gregory L. Greenwood is with the Division of AIDS Research, National Institute of Mental Health, National Institutes of Health. Tamara Lewis Johnson is with the Office of Disparities Research and Workforce Diversity, National Institute of Mental Health, National Institutes of Health. Karen L. Parker is with the Sexual & Gender Minority Research Office, Office of the Director, National Institutes of Health
| | - Gregory L Greenwood
- Jennifer Alvidrez is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Gregory L. Greenwood is with the Division of AIDS Research, National Institute of Mental Health, National Institutes of Health. Tamara Lewis Johnson is with the Office of Disparities Research and Workforce Diversity, National Institute of Mental Health, National Institutes of Health. Karen L. Parker is with the Sexual & Gender Minority Research Office, Office of the Director, National Institutes of Health
| | - Tamara Lewis Johnson
- Jennifer Alvidrez is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Gregory L. Greenwood is with the Division of AIDS Research, National Institute of Mental Health, National Institutes of Health. Tamara Lewis Johnson is with the Office of Disparities Research and Workforce Diversity, National Institute of Mental Health, National Institutes of Health. Karen L. Parker is with the Sexual & Gender Minority Research Office, Office of the Director, National Institutes of Health
| | - Karen L Parker
- Jennifer Alvidrez is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Gregory L. Greenwood is with the Division of AIDS Research, National Institute of Mental Health, National Institutes of Health. Tamara Lewis Johnson is with the Office of Disparities Research and Workforce Diversity, National Institute of Mental Health, National Institutes of Health. Karen L. Parker is with the Sexual & Gender Minority Research Office, Office of the Director, National Institutes of Health
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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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