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Beyond a Catalogue of Differences: a Theoretical Frame and Good Practice Guidelines for Researching Sex/Gender in Human Health
Abstract
Extensive medical, public health, and social science research have focused on cataloguing male-female differences in human health. Unfortunately, much of this research unscientifically and unquestionably attributes these differences to biological causes--as exemplified in the Institute of Medicine's conclusion that "every cell has a sex." In this manuscript we theorize the entanglement of sex and gender in human health research and articulate good practice guidelines for assessing the role of biological processes--along with social and biosocial processes--in the production of non-reproductive health differences between and among men and women. There are two basic tenets underlying this project. The first is that sex itself is not a biological mechanism and the second is that "sex" and "gender" are entangled, and analyses should proceed by assuming that measures of sex are not pristine, but include effects of gender. Building from these tenets--and using cardiovascular disease as a consistent example--we articulate a process that scientists and researchers can use to seriously and systematically assess the role of biology and social environment in the production of health among men and women. We hope that this intervention will be one further step toward understanding the complexity and nuance of health outcomes, and that this increased knowledge can be used to improve human health.
... Borrowing the idea of entanglement from other fields, Springer et al. (2012) describe how sex and gender are interwoven in ways that often do not allow their effects to be disaggregated. Thus, sex and gender are not "pristine categories" with clearly divisible biologic and social effects. ...
... Thus, sex and gender are not "pristine categories" with clearly divisible biologic and social effects. As a category, sex is not itself a biological mechanism (Springer et al. 2012), and sex hormones, often assumed to be the dimension of sex that plays a causal role, are also impacted by gender-based social context (Hyde et al. 2019) and structural factors. Recent scholarship has expanded on this idea of gender/sex as an entangled phenomenon (DuBois and Shattuck-Heidorn 2021; van Anders 2024). ...
... We may ask whether the complexity of studying sex and gender, given their entanglement (Springer et al. 2012), is already uncapturable, and whether it is truly necessary to then also consider sex and gender in the context of race, ethnicity, age, sexual orientation, class, and other categories of difference across which social power is structured. Acknowledging this fundamental structuring of power, and the ways it becomes embodied in individuals whose lives are shaped by these systems of power, produces a situation of fact. ...
Intersectionality is a theoretical framework emerging from US Black, Chicana, and Indigenous feminisms that considers the interlocking nature of processes of oppression across sex/gender, race/ethnicity, sexual orientation, social class, and other social positions. While not originating in applications to research methodology, its core ideas are apparent in Black feminist sociological, legal, and other forms of scholarship even prior to the emergence of the word intersectionality nearly 35 years ago. Since that time, social scientists have provided thinking tools with which to better incorporate intersectional thinking. These include Patricia Hill Collins’s ideas of relationality through the addition of categories of diference, such as adding race and ethnicity to sex and gender, and Leslie McCall’s diferentiation between anti-, intra-, and intercategorical approaches to intersectional complexity. Given intersectionality’s core foci on social power, inequity, and social context, what happens when we add intersectionality into the feld of sex/gender complexity and entanglement is explored, along with its meaning for research methods. In doing so, a new concept of intersectional entanglement is developed and explored, rooted in Collins’s ideas of relationality and embodied through a wide range of biopsychosocial processes. Some research design considerations and questions for sex and gender scholars in the context of intersectional entanglement are outlined.
... Thus, there is a need for new approaches that adequately capture this complexity of sex/gender and its diversity beyond binary categories [3,[9][10][11]. To highlight the entanglement of sex and gender, we use the term sex/gender for a nonbinary category, that has multiple, interwoven biological and social dimensions, as it is also conceptualised in the embodiment theory [2,12,13] (see glossary). An intersectionality perspective, which means considering the intersection of sex/gender with other social categories (e.g. ...
... The term sex/gender stresses out this entanglement of the biological and social dimensions. [12,13] ...
... To highlight this entanglement, as it is also conceptualised in embodiment theory, the term "sex/gender" could be used. [2,9,13,75] ...
Background
There is a growing awareness of the need to adequately integrate sex and gender into health-related research. Although it is widely known that the entangled dimensions sex/gender are not comprehensively considered in most studies to date, current publications of conceptual considerations and guidelines often only give recommendations for certain stages of the research process and - to the best of our knowledge - there is a lack of a detailed guidance that accompanies each step of the entire research process. The interdisciplinary project “Integrating gender into environmental health research” (INGER) aimed to fill this gap by developing a comprehensive checklist that encourages sex/gender transformative research at all stages of the research process of quantitative health research. In the long term this contributes to a more sex/gender-equitable research.
Methods
The checklist builds on current guidelines on sex/gender in health-related research. Starting from important key documents, publications from disciplines involved in INGER were collected. Furthermore, we used a snowball method to include further relevant titles. The identification of relevant publications was continued until saturation was reached. 55 relevant publications published between 2000 and 2021 were identified, assessed, summarised and included in the developed checklist. After noticing that most publications did not cover every step of the research process and often considered sex/gender in a binary way, the recommendations were modified and enriched based on the authors’ expertise to cover every research step and to add further categories to the binary sex/gender categories.
Results
The checklist comprises 67 items in 15 sections for integrating sex/gender in quantitative health-related research and addresses aspects of the whole research process of planning, implementing and analysing quantitative health studies as well as aspects of appropriate language, communication of results to the scientific community and the public, and research team composition.
Conclusion
The developed comprehensive checklist goes beyond a binary consideration of sex/gender and thus enables sex/gender-transformative research. Although the project INGER focused on environmental health research, no aspects that were specific to this research area were identified in the checklist. The resulting comprehensive checklist can therefore be used in different quantitative health-related research fields.
... 26,27 Rather, sex is a multidimensional, constructed continuum of chromosomal, gonadal, fetal and pubertal hormonal, internal reproductive, external genital, and brain sex [27][28][29] that is directly inf luenced by gender throughout the life course. [10][11][12]14,15,[30][31][32] The existence and lived experiences of intersex people, or people with variations in sex characteristics (VSC), 33,34 and of transgender people (through hormonal and/or surgical changes) further challenge this binary. 35 While the conf lation of gender and sex is common, 36 these concepts are neither interchangeable nor completely separate-they are entangled. ...
... These practices misidentify trans people as cisgender and vice versa, lower power to detect differences, and bias prevalence and risk estimates for trans populations, even when large inequities between groups exist. 32 Note that the safety of trans and intersex people is paramount, and recruitment and reporting practices that could inadvertently out or identify them must be avoided. Inadvertent identification is especially likely if there are very few trans people in the study or if they live in a setting that criminalizes them. ...
... Gender and sex have been theorized, conceptualized, and operationalized in public health and epidemiology for over two decades; 10,11,14,32,46 some of this discourse includes trans and other gender identities. 12,38 Health researchers and agencies have recommended inclusive measures, 5,47-49 but measuring gender and sex has no gold standard, perhaps since these variables depend on time and context. ...
Accurately measuring gender and sex is crucial in public health and epidemiology. Iteratively reexamining how variables—including gender and sex—are conceptualized and operationalized is necessary to achieve impactful research. Reexamining gender and sex advances epidemiology toward its goals of health promotion and disease elimination. While we cannot reduce the complexities of sex and gender to simply an issue of measurement, striving to capture these concepts and experiences accurately must be an ongoing dialogue and practice—to the benefit of the field and population health. We assert that epidemiology must counteract misconceptions and accurately measure gender and sex in epidemiology. We aim to summarize existing critiques and guiding principles in measuring gender and sex that can be applied in practice.
... However, it has also perpetuated stereotypes, such as portraying women's clothing and adornment as temptations for male priests. These stereotypes fail to recognise the diverse biological differences (Springer, Mager-Stellman & Jordan-Young 2012:1818 related to cleanliness, acceptance, spirituality and diseases associated with femininity and monthly cycles, which can significantly impact women's psychology in public settings notwithstanding sexual orientation (Jones 2023). Consequently, women may seek spiritual remedies from religious leaders because of social rejection or lack of religious knowledge and skills to address their presenting problems. ...
... To ensure there is SnG representation and diversity in religious and spiritual settings, the inclusion of SnG in RE classes becomes an important part of socialisation. The process of socialisation influences how men and women receive religious care, 'as [SnG is] a domain of complex phenomena that are simultaneously biological and social' (Springer et al. 2012(Springer et al. :1818 impacts spirituality, allowing religion to modify lifestyle and behaviour in society. Despite recognising the significance of integrating SnG into the RE syllabus, questions remain regarding the content and modality of implementation in Zimbabwe's FAREME and FRS syllabus. ...
This article reviews and assesses the Family, Religious and Moral Education (FAREME) syllabus’ treatment of sex-and-gender (SnG) perspectives. Family, Religious and Moral Education lacks sufficient SnG socialisation perspectives, and we propose to use the Theory of Change (ToC) to integrate these issues. Results suggest that 10% quantitative integration of SnG content and objectives across all FAREME levels as well as qualitative combination of SnG differences can empower learners to become advocates for SnG equality and respectful religious practices in Zimbabwean schools. This study is informed by qualitative research methodology. The ToC is the theoretical framework used to support the unbiased integration of SnG-related issues into this qualitative study of the FAREME syllabus. Theory of Change helps identify, select, place, mentor and monitor how SnG issues are holistically integrated into the school syllabus. The review process advocates for a 10% quantitative integration target of SnG content and objectives across all levels, considering there are only 10 cross-cutting issues in the FAREME syllabus. Moreover, the study emphasises the qualitative combination of biological and socio-cultural differences within religious phenomena throughout the syllabus. This approach allows learners to develop a comprehensive understanding of SnG perspectives. Contribution: The application of ToC facilitates the assessment and review process, providing systematic approaches to model and integrate inclusive perspectives and dimensions of SnG into the FAREME syllabus.
... Neurofeminism challenges assumptions regarding the existence (Eliot et al. 2021;Joel 2021), origin (Fine 2010;Joel 2012;Jordan-Young and Karkazis 2019;Saguy et al. 2021), and operationalization (Joel and Fausto-Sterling 2016;Maney 2016; Sanchis-Segura and Wilcox 2024) of sex differences in the brain and interrogates the validity of translating sex differences observed in nonhuman animal models into explanations for human gender/sex realities (Eliot and Richardson 2016;Gungor et al. 2019). To date, neurofeminism has produced critiques (Kuria 2014;Llaveria Caselles 2021;Walsh and Einstein 2020), research frameworks (Hyde et al. 2019;Joel 2021;Rippon et al. 2014;Springer et al. 2012), methodologies (Brown et al. 2022), epistemologies (Roy 2018), and neuroscientific knowledge (Joel et al. 2015;Perović et al. 2021; van Anders 2024) that coalesce to advance a sociopolitically located understanding of gender/sex realities within the brain, body, and mind. The neurofeminist perspective also recognizes that the social location of a researcher and discipline inform the characterization of complex phenomena, which in turn informs the development or use of scientific methods and practices. ...
... Gender/sex entanglement signifies that gendered experiences inform the development and functioning of biological systems, including sex-associated traits (Rippon et al. 2014;Springer et al. 2012). For instance, stressful experiences, parental care, and interpersonal closeness are all domains of experience that display gender-related differences, and all have also been shown to alter circulating levels of gonadal hormones (Brown et al. 2009;Pletzer et al. 2021;van Anders et al. 2012). ...
From the discovery of the gonadal neuroendocrine axis to projects mapping gender/sex diferences in brain and behavior, research in neuroscience has laid the foundation in biosciences for the investigation of sex and, to a lesser degree, gender. Given its role in sex and gender research, neuroscience has also been a central site of critical engagement by feminist science scholars, giving rise to neurofeminism, a subfeld where neuroscience and feminist perspectives on science intersect. To date, neurofeminism has produced critiques, research frameworks, methodologies, epistemologies, and neuroscientifc knowledge that coalesce to advance complex and emancipatory understandings of brain, body, and mind. This chapter aims to demonstrate the instrumental role of neurofeminist research and perspectives in producing alternative operationalizations of sex and gender, particularly with respect to their interrelation. First, a critical overview of dominant and emerging models for investigating sex and gender in neuroscience is provided to highlight benefts of approaching sex and gender as biosocially entangled. Second, the neurofeminist perspective on sex and gender entanglement is further characterized through a series of examples from human and nonhuman animal research. Consideration is then given to potential challenges associated with the neurofeminist approach to entanglement. Finally, the generative potential of neurofeminist science scholarship to improve the science of sex and gender is demonstrated.
... Reasons for females/womens' inferior outcomes are likely multifactorial, including sex-specific biological factors (eg, hormonal effects on exercise performance 59 ), psychological considerations (eg, psychological readiness for RTS 94 ), and/or social factors such as gendered roles like caregiving. 19 A person's gender, related to socially constructed roles and behaviors, 75 interacts with sex and other SDoH, 86 impacting RTS. 1 Factors that result in competing time demands, such as caring responsibilities, employment, and academic demands, are pertinent to athletes and their RTS. 9 Unravelling this complex relationship, which is often overlooked in sports medicine research, 1 might afford better alignment of management strategies with the social and economic factors influencing patients' lives. ...
... We evaluated differences in RTS based on sex/ gender and explored the reporting and consideration of SDoH in RTS research. Due to the synonymous use of sex and gender (and occasional erroneous use), we could not explore the interaction of gender with sex 86 and were forced to collapse them together (sex/gender) for the race/ethnicity (SUPPLEMENTAL APPENDIX G). Notwithstanding, some details can be implied from the methods reported; 26 studies (57.8%) included professional athletes, indicating participants were paid/employed to play sport in some capacity, and 26 (57.8%) provided some detail on education level with the inclusion of high school and/or collegiate athletes. ...
OBJECTIVE: To compare return-to-sport outcomes between females/women/girls and males/men/boys undergoing hip arthroscopy and explore social and structural determinants of health that may influence return-to-sport.
DESIGN: Systematic review with meta-analysis
LITERATURE SEARCH: CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, SPORTDiscus and Web of Science from inception to February 2024.
SELECTION CRITERIA: Studies were included if they assessed return-to-sport after hip arthroscopy and analysed the influence of sex/gender on return-to-sport outcomes, or reported sex/gender stratified return-to-sport rates.
DATA SYNTHESIS: We used pooled odds ratios through a random-effects model and conducted meta-regressions to compare return-to-sport outcomes between females/women/girls and males/men/boys.
RESULTS: Forty-five studies were included, with all pooled results deemed as very low certainty evidence. Compared to males/men/boys, females/women/girls had inferior return-to-sport at the same/higher level between 1 to 3 years post-operatively (0.53, 95%CI 0.34 to 0.81, P=0.004), and at any level of sport at >3 years post-operatively (0.46, 95%CI 0.25 to 0.86, P=0.014). Sports participation decreased over time, with ~5.5% to 10% lower rates observed in females/women/girls compared to males/men/boys. The reporting of determinants was minimal, precluding further exploration of their effects.
CONCLUSION: Females/women/girls had lower odds of return-to-sport, especially during longer follow-up periods, than males/men/boys. The lack of reporting of social and structural determinants of health influencing return-to-sport outcomes makes the reasons for this disparity unclear.
... Even though such essentialism might be used for merely strategical reasons-that is, to get women's health on the map with an apparently straightforward, common sense argument about sex differences-it goes against the long-standing recognition within feminist theory that there can be no single inclusive definition or universal experience of womanhood, be it biological or social (e.g., Crenshaw, 1989;Fausto-Sterling, 1993;Spelman, 1988;Stone, 2007). Specifically, popular phrases like "female heart attacks" or "female brains" gloss over within-group variation and between-group overlap which may be clinically just as relevant as between-group differences and tend to use sex as a proxy for other more precise predictors of health outcomes (Maney, 2016;Richardson et al., 2015;Springer et al., 2012). ...
... Against this trend, we prefer the composite term "sex/gender" to highlight the entanglement of the biological and the sociocultural, believing that differences between men and women are rarely the effect of a single domain, particularly in health and illness. The fundamental interaction between the material and the experiential is discussed in more detail by Springer et al. (2012). We will occasionally use the terms "sex" and "gender," however, when the emphasis is clearly on one side of the purported nature-nurture divide (e.g., "gendered norms"). ...
Alzheimer’s disease affects more women than men and has therefore been highlighted as a women’s issue. However, there is much debate regarding the nature of this gap, with some studies pointing to sex/gender differences in longevity to explain the disparity. Against this background of empirical uncertainty, we ask how online women’s brain health campaigns position women as specifically at risk of developing the disease. Using a multimodal approach, we examine how these platforms relate womanhood to risk, prevention, and responsibility. Four main themes emerged: risk quantification, risk management, risk dispersion, and the gendering of risk. We confirm previous studies that identified a dual discourse in which Alzheimer’s is represented as both a catastrophic threat and as a fate that individuals can and must prevent. We find that both constructions are intensified on women-oriented platforms compared with nonspecific websites. Ethical implications of the individualization and gendering of risk and responsibility are discussed.
... Biology is wonderfully complex. Given its proximity to our everyday experience of life, commensurate nuance is required in open debate on extant questions in our field to ensure that full dignity is granted to all people (Springer et al., 2012). When these guardrails of respect are ignored, it is incumbent upon all scientists to speak out against the harmful rhetoric. ...
... Central to the rhetoric of the Pontes-Silva and Lopes piece is the notion of binary sex, understood as the biological underpinnings of male-female difference. While presented as a neat concept within a male-female binary, sex is multifaceted, ambiguous and inseparably entangled with the social concept of gender (Bauer, 2023;Hansen, 2023;Springer et al., 2012). For example, sex can refer to chromosome composition, genital or reproductive anatomy, sex hormone concentrations, etc. Transgender people break the artificial binary of sex upon receipt of gender-affirming medical care, including reversal of sex hormone composition through hormone replacement therapy (HRT) and/or genital remodelling through sex reassignment surgeries. ...
... Obschon das Bewusstsein für die Multidimensionalität und Variabilität von Geschlecht in der Gesundheitsforschung zunimmt, wird Geschlecht vor allem in der quantitativen, epidemiologischen Gesundheitsforschung bislang weitgehend routinemäßig über ein einziges, binäres Item erfasst, das ausschließlich zwischen den beiden distinkten Kategorien "Frau" und "Mann" unterscheidet [11,14,15]. Seit der Anpassung des Personenstandsgesetzes (PStG) im Dezember 2018 findet sich zudem vermehrt eine Ergänzung um die dritte Kategorie "divers" und die Möglichkeit keinen Eintrag zu machen. ...
... Infolge dieser vereinfachenden Kategorisierung von Geschlecht wird der Beitrag, den die einzelnen Geschlechterdimensionen für das Auftreten der zu untersuchenden gesundheitlichen Phänomene leisten, verschleiert [15,17]. Mechanismen, die den beobachteten Einflüssen des Geschlechts auf die Gesundheit zugrunde liegen, bleiben im Verborgenen und potenzielle Wechselwirkungen zwischen den einzelnen Dimensionen von Geschlecht können durch die ausschließliche Berücksichti-gungeinereinzelnenGeschlechtsvariable nicht identifiziert werden [14,18]. ...
Zusammenfassung
In der epidemiologischen Gesundheitsforschung besteht ein großer Bedarf an umfassenden Erhebungsinstrumenten, die der Multidimensionalität und Variabilität von Geschlecht gerecht werden. Das Forschungsprojekt DIVERGesTOOL griff diesen in den letzten Jahren immer deutlicher werdenden Bedarf auf. Es verfolgte das Ziel, eine anwendungsorientierte Toolbox zur Erfassung geschlechtlicher Vielfalt für die quantitative Gesundheitsforschung in Deutschland zu entwickeln.
Der Entwicklungsprozess war partizipativ angelegt, Vertreter*innen großer epidemiologischer Studien in Deutschland wurden direkt einbezogen. Im Rahmen von vier gemeinsamen Workshops wurde eine Toolbox entwickelt, die sich aus mehreren Bestandteilen zusammensetzt: Die Basis-Items sind ein grundlegendes, allgemein nutzbares Set aus drei Fragen, die sich am Two-Step-Approach orientieren. Sie werden anstelle der bisher routinemäßig in den Gesundheitswissenschaften angewendeten binären Geschlechtsvariable empfohlen. Zudem enthält die Toolbox Zusatz-Items mit beispielhaften Fragebogen-Items für spezifische Fragestellungen oder Studienpopulationen. Ergänzt wurden die Items um ausführliche Anwendungshinweise und Hintergrundinformationen. Die Toolbox steht Interessierten online kostenlos über die Website des Projektes zur Verfügung ( https://www.uni-bremen.de/divergestool-projekt/divergestool-toolbox ).
Langfristig soll die DIVERGesTOOL-Toolbox Forschende dabei unterstützen, geschlechtliche Vielfalt in die eigene Forschung zu integrieren, und somit zu mehr Geschlechtersensibilität in der Gesundheitsforschung und validen Forschungsergebnissen beitragen.
... Second, we noted how the trainings represented the rationales for the policies, for example to improve generalizability of findings or unmask variation. Third, we evaluated how the concepts "sex" and "gender" were handled, attending particularly to the extent to which sex and gender were understood to be inextricably entangled vs. dissociable [14,15]. We also noted guidance related to how sex or gender categories should be operationalized or contextualized, for example how to choose a concrete, quantifiable variable such as chromosome complement or reproductive anatomy to represent sex category vs. relying solely on undefined categories [16][17][18][19]. ...
... Examples of gendered exposures manifesting as sex differences were presented, but only as rare exceptions. Moving forward, it may be beneficial to focus less on the task of disentangling sex and gender, which recapitulates an unfruitful nature/nurture conundrum, and more on ways in which gender/sex as a single entity can be considered as complex, multidimensional, and socially embedded [14,15]. ...
Background
Recently implemented research policies requiring the inclusion of females and males have created an urgent need for effective training in how to account for sex, and in some cases gender, in biomedical studies.
Methods
Here, we evaluated three sets of publicly available online training materials on this topic: (1) Integrating Sex & Gender in Health Research from the Canadian Institutes of Health Research (CIHR); (2) Sex as a Biological Variable: A Primer from the United States National Institutes of Health (NIH); and (3) The Sex and Gender Dimension in Biomedical Research , developed as part of “Leading Innovative measures to reach gender Balance in Research Activities” (LIBRA) from the European Commission. We reviewed each course with respect to their coverage of (1) What is required by the policy; (2) Rationale for the policy; (3) Handling of the concepts “sex” and “gender;” (4) Research design and analysis; and (5) Interpreting and reporting data.
Results
All three courses discussed the importance of including males and females to better generalize results, discover potential sex differences, and tailor treatments to men and women. The entangled nature of sex and gender, operationalization of sex, and potential downsides of focusing on sex more than other sources of variation were minimally discussed. Notably, all three courses explicitly endorsed invalid analytical approaches that produce bias toward false positive discoveries of difference.
Conclusions
Our analysis suggests a need for revised or new training materials that incorporate four major topics: precise operationalization of sex, potential risks of over-emphasis on sex as a category, recognition of gender and sex as complex and entangled, and rigorous study design and data analysis.
... To start to address this, researchers must collect data from study participants about their gender experience and gender identity (Puckett et al., 2020). In addition to moving beyond strict binary conceptualizations, there is also a need to recognize the ways that gender and sex are unique but also co-constituted and entangled, as suggested by the term "gender/sex" (Fausto-Sterling, 2021;Kaiser, 2012;Springer et al., 2012; van Anders, 2022van Anders, , 2015. Achieving more accurate and contextualized understanding of the complex nature of gender/sex within behavioral neuroendocrinology necessitates shifts in how research is conducted. ...
... interpretation about experiences of enacted stigma with consideration of assigned sex at birth as well as gender identity. Our results thus clearly highlight the necessity of collecting data about multiple dimensions of gender and gender identity (Puckett et al., 2020) and making aims, hypotheses, and methodologies more transparent (DuBois and Shattuck-Heidorn, 2021;Springer et al., 2012). Rather than interpreting gender-identity based variation as reflecting a set of biologically-based differences, we interpret our findings, in tandem with the previously published literature, as reflecting the roles of masculinity in integration with gender/sex binaries in shaping lived experience. ...
... Critically, this review highlighted important mechanisms for differences in treatment outcomes, including not only physiological influences (e.g., differences in body fat distribution and hormones such as estrogen) but also sociocultural, environmental, and physiological mechanisms related to gender norms and gender identity. Unfortunately, few studies have attempted to disentangle effects by sex versus gender [74]; thus, results reported in the current review will reflect differences found by sex and gender combined. Compared to men, women lose less weight from comprehensive interventions [73,75] and bariatric surgeries [76]; however, these differences are attenuated after controlling for baseline body weight (as men typically have higher baseline body weight than women) [73,76]. ...
Purpose of Review
We aimed to summarize research on disparities in obesity treatment outcomes, access, and utilization.
Recent Findings
We identified disparities in treatment effectiveness by race/ethnicity, sex/gender, and disability status. There were equivocal results regarding whether outcomes varied by socioeconomic status (SES) and there was no evidence for a rural/urban disparity. A different pattern emerged for treatment access/utilization; disparities were identified across all groups, including race/ethnicity, SES, rurality, sex/gender/sexual and gender minority (SGM) status, and disability status. Little is known regarding how multiple marginalized identities may interact in relation to treatment outcomes or access/utilization.
Summary
Future research should adopt an intersectional framework to understand the complex interactions between an individual’s identities and obesity treatment effectiveness, access, and utilization. Moreover, the field should look beyond the individual-level, using a multi-level approach to identify barriers and strategies to promoting access to effective treatment across system/organizational and policy levels.
... As suggested by Springer, I use the term 'sex/gender' since the biologically defined 'sex', and socially constructed 'gender' are highly entangled and inseparable in health research (Springer et al., 2012). In order to not be a genderblind study, I included sex/gender of the parent as a factor to stratify by (Paper 1), and sex/gender of the child to adjust associations for (Papers 4) and test interactions for (Paper 3), although sex/gender not are included in the main aim. ...
... Bornscheuer et al. BMC Public Health (2025) 25:417 Sex and gender differences in CA exposure and impact Sex, the biological characteristics of men and women, and gender, the corresponding socially constructed norms, roles, and behaviours, influence health and other life domains across time in interaction with each other, and their respective contributions are hard to disentangle [29]. In the following, we give some examples of how sex and gender both influence outcomes in the context of CA. ...
Background
Childhood adversity places individuals in a vulnerable position, resulting in potentially enduring disadvantage across life domains like health and work. Studying the manifestation of this disadvantage is crucial for understanding which resources society can provide to mitigate or prevent it, which makes this subject a fundamental public health concern. This study investigated whether disadvantage patterns after childhood adversity differ by gender and educational level, using out-of-home care as proxy for early adversity.
Methods
We used register data from a 1953 Swedish birth cohort. Distinct profiles of socioeconomic and health disadvantage in individuals with out-of-home care experience were identified using group-based multi-trajectory modelling. Multinomial logistic regression was then used to determine whether gender and education, individually or in interaction with each other, predict group membership.
Results
In the population without history of out-of-home care, adulthood disadvantage was highly gendered, with women being more likely to experience disadvantage related to unemployment and poor health, while criminality and substance misuse was more common among men. History of out-of-home care was associated with a general increase in adulthood disadvantage, but the gender differences were largely absent. Women in this group were however less likely than men to experience disadvantage across multiple life domains (complex disadvantage OR = 0.56, p = 0.046; unemployment-related disadvantage OR = 0.51, p = 0.005). Higher level of education was associated with reduced likelihood of membership in the group marked by disabling health disadvantage (OR = 0.55, p = 0.002) and complex disadvantage (OR = 0.37, p = 0.001). An interaction term between gender and education was not significant.
Conclusions
Adulthood disadvantage was more common in the group with history of out-of-home care. The gender differences in disadvantage present in the full cohort were largely attenuated among individuals with out-of-home care history. We showed that using administrative data on outcomes across multiple life domains can provide rich descriptions of adult experiences after childhood adversity. Future research could examine gender differences in mechanisms translating into resilient or vulnerable trajectories, including the protective potential of education in relation to specific disadvantage patterns.
... According to Krieger, 10 sex refers to sex assigned at birth, which is "a biological construct premised upon biological characteristics enabling sexual reproduction", while gender is "a social construct regarding culture-bound conventions, roles, and behaviors for, as well as relations between and among, women and men and boys and girls". However, Springer et al., 11 have questioned the conceptual distinction between "sex" and "gender," contending that the two are inextricably linked, given the presence of complex phenomena that are simultaneously biological and social. Therefore, while our study adopted the term "sex" to reflect our measurement of biological sex, we wish to emphasize that biological sex has its social meaning in ...
Background
Previous suicide research has seldom examined the collective impact of multiple social identities/positions, and suicidality among sexual and gender minority adolescents remains understudied in Chinese contexts. Using intersectionality as both a theoretical and analytical framework, we investigate the combined effects of sex, gender expression, and sexual orientation on suicidal ideation and suicide attempts among secondary school students in Hong Kong.
Methods
Data from 8023 adolescents (mean age = 14.76, SD = 1.66; 44.56% girls) who participated in the 2021 wave of the Youth Sexuality Study (YSS) were included in analysis. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) estimated the prevalence of suicidal ideation and suicide attempts for adolescents across various combinations of social identities/positions (i.e., sex x gender expression x sexual orientation), assessed the extent to which these identities/positions accounted for the total variance in suicide behaviors, and examined the interactive intersectional effects (i.e., two-way or higher–level interactions) between the identities/positions.
Findings
Girls categorized as non-heterosexual with nonconforming gender expression, girls categorized as non-heterosexual with neutral gender expression, and boys categorized as non-heterosexual with nonconforming gender expression reported the highest prevalence of suicidal ideation and suicide attempts. The total variance in suicidal ideation and suicide attempts attributable to the identities/positions were 12.60% and 10.50%, respectively. However, there were no significant interactive intersectional effects.
Interpretation
Adolescents with multiple marginalized identities/positions showed the highest prevalence of suicidal ideation and suicide attempts. Comprehensive suicide prevention strategies should go beyond individual-level risk factors and promote holistic systemic changes. Intervention solely targeting one identity/position may not be sufficient.
Funding
The data used in this study is made available by Family Planning Association of Hong Kong and the Research Subcommittee for the Youth Sexuality Study 2021. The work was supported by the Department of Health of the Hong Kong SAR Government.
... Further examinations of sex differences in the development of CVD are required to improve prevention and achieve better equity in health [11]. However, in order to move beyond simple comparisons of male and female differences, examining gender (socio-cultural) in addition to sex (biological) is also required. ...
Background
Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. Examining gender (socio-cultural) in addition to sex (biological) is required to untangle socio-cultural characteristics contributing to inequities within or between sexes. This study aimed to develop a gender measure including four gender dimensions and examine the association between this gender measure and CVD incidence, across sexes.
Methods
A cohort of 9188 white-collar workers (49.9% females) in the Quebec region was recruited in 1991–1993 and follow-up was carried out 28 years later for CVD incidence. Data collection involved a self-administered questionnaire and extraction of medical-administrative CVD incident cases. Cox proportional models allowed calculations of hazard ratios (HR) and 95% confidence intervals (CI), stratified by sex.
Results
Sex and gender were partly independent, as discordances were observed in the distribution of the gender score across sexes. Among males, being in the third tertile of the gender score (indicating a higher level of characteristics traditionally ascribed to women) was associated with a 50% CVD risk increase compared to those in the first tertile (HR = 1.50; 95% CI: 1.24 to 1.82). This association persisted after adjustment for several CVD risk factors (HR = 1.42; 95% CI: 1.16 to 1.73). Conversely, no statistically significant association between the third tertile of the gender score and CVD incidence was observed in females (HR = 0.79, 95% CI: 0.60–1.05).
Conclusions
The findings suggested that males within the third tertile of the gender score were more likely to develop CVD, while females with those characteristics did not exhibit an increased risk. These findings underline the necessity for clinical and population health research to integrate both sex and gender measures, to further evaluate disparities in cardiovascular health and enhance the inclusivity of prevention strategies.
... there is still an increasing necessity to entangle sex and gender in human health research when interpreting sex differences in the prevalence and incidence of various diseases and injuries. in this study, we aimed to analyze emergencies while high-altitude mountaineering concerning its specific characteristics of female versus male emergencies and intersex differences in risk taking in consequence (Munter, 2017;posch et al., 2022;posch, Burtscher, et al., 2017;posch, ruedl, et al., 2017;Springer et al., 2012). a long time, women were considered as not capable to climb mountains and machoism in mountaineering was present. ...
Aim
High-altitude mountaineering has become more and more popular, however if female alpinists show different injury pattern is not finally elucidated.
Material and methods
A retrospective analysis was therefore conducted from the central registry of the Swiss Alpine Club (SAC) during the observational period from 2009 to 2022 concerning intersex differences of emergencies specific while high-altitude mountaineering.
Conclusions
A total of 1252 female (22%) and 4347 male (78%) emergencies while high-altitude mountaineering were elucidated. A significant difference was detected in average NACA score as proxy for the severity of an event for falls, where female cases show a significant lower severity with NACA score 3.0 ± 1.5 as compared to male cases with NACA score 3.5 ± 2.0 (p < 0.001). Furthermore, on average men have more often a fatal event. It might be suggested that men choosing routes in rougher terrain, tend to overestimate their abilities more often and have a higher willingness to take risks.
... In turn, they do not benefit from optimal prevention strategies and care [41,42]. Further examinations of sex and age differences in the CVD-attributable costs, and their underlying mechanisms, are required to improve prevention and achieve better equity in health [43], especially during the first year following the event. ...
Background
The aim was to estimate direct medical costs of men and women patients by age group related to cardiovascular diseases (coronary heart disease, strokes) in the province of Quebec, Canada from the economic perspective of the healthcare public system, encompassing five cost components: physician fees, hospitalization (hospital stay, intensive care stay), emergency visits and medication costs.
Methods
This matched case-control study involved secondary data from a longitudinal cohort study (1997–2018) of 4584 white-collar workers. Participants were followed for a four-year period. We used an incremental cost method of difference-in-difference. Descriptive analyses using frequency counts, arithmetic means, standardized differences, chi-squared tests, and Student’s T-tests were performed. Direct medical costs were estimated using mean and 95% bootstrap confidence interval.
Results
Direct medical costs per case were CAD 5351 [4649, 6053] and 221 [–229, 671] for men and 11 [–356, 377] for men and $-24 [–612, 564] for women in the third year. This decrease was observed for both men and women, with higher costs for men. Within the first year, physician fees dominated CVD-associated costs among both men and women cases younger than 65. However, hospital stay represented the costliest component among cases aged 65 and older, incurring higher costs in women compared to men. In the subsequent years, the distribution of costs showed variations according to sex and age, with either medication costs or physician fees being the predominant components, depending on the specific subgroups.
Conclusions
CVD-associated direct medical costs varied by components, sex, age, and follow-up years. Patients with CVD incurred more than twice the medical costs as compared to patients without CVD of same age and sex.
... Furthermore, there are strong arguments against understanding gender and sex as clearly delimited concepts, but rather as two aspects of a construct that bidirectionally influence each other. 84 This means that studies focusing on biological differences between men and women are relevant to discussing gender patterns but were so different that we decided to exclude them to make it easier to integrate our findings. By choosing to include only quantitative studies, we also inadvertently excluded literature on transgender and gender-non-conforming adults. ...
Background: Childhood adversity is associated with a host of negative health and socioeconomic outcomes far into adulthood. The process of avoiding such outcomes is often referred to as resilience. Mapping resilience comprehensively and across contexts is highly relevant to public health, as it is a step towards understanding environments and interventions that contribute to preventing or reversing negative outcomes after early adverse experiences.
Objectives: This review scoped out the literature on resilience factors in relation to adulthood outcomes as diverse as mental health and educational attainment. Our aim was to understand where there is untapped research potential, by examining the current evidence base on resilience factors in terms of (a) resources that can buffer the impact of childhood adversity and (b) the pathways linking adversity to long-term outcomes. Furthermore, we aimed to identify gender patterns in these resources and pathways, which has not been a primary interest of reviews on resilience to date, and which can add to our understanding of the different ways in which resilience may unfold.
Eligibility criteria: Studies had to include an adversity experienced in childhood, an outcome considered indicative of resilience in adulthood, and at least one putative resilience factor, which had to be approached via mediation or moderation analysis. We considered cohort, case–control and cross-sectional studies.
Sources of evidence: We searched PubMed, Scopus and PsycINFO and included original, peer-reviewed articles published before 20 July 2023 in English, German, French, Spanish, Dutch and Swedish.
Charting methods: All three authors collaborated on the extraction of information relevant to answering the research questions. The results were visually and narratively summarised.
Results: We included 102 studies. Traditionally anchored in the field of psychology, the resilience literature focuses heavily on individual-level resilience factors. Gender was considered in approximately 22% of included studies and was always limited to comparisons between men and women. There is no evidence that childhood adversity impacts men and women differently in the long term, but there is some evidence for gender differences in resilience factors.
Conclusions: There is untapped potential in resilience research. By considering structural-level factors simultaneously with individual-level factors, and including gender as one of the elements that shape resilience, we can map resilience as a heterogeneous, multilevel process from a public health perspective. This would complement the extensive existing literature on individual-level factors and help reframe resilience as a concept that can be intervened on at a structural level, and that is subject to societal norms and forces, such as gender. There is a lack of quantitative studies including transgender and gender-non-conforming persons.
... While scholars have attempted to explain the higher risk of anxiety in females from biological (e.g., hormone levels) or psycho-behavioral (e.g., social roles assumed) perspectives, the extent to which these factors influence gender differences in disease onset remains unclear. Prior research [62,63] also mentioned that gender differences in life or culture can, in turn, impact gene expression, so gender differences may show up differently in different samples. Therefore, gender differences in CDS and the reasons need to be discovered and confirmed in more studies. ...
Cognitive Disengagement Syndrome (CDS) is a cluster of behavioral problems that severely affect an individual's functioning. Currently, there is no consensus on the main clinical features of CDS, and further exploration in large samples is needed. Using a cluster-stratified random sampling method, 72,106 children and adolescents were recruited from five provinces in mainland China for this study. Using both the traditional two-factor scoring method and the CBCL DSM-oriented scales, we assessed individual behavioral problems from psychopathological and DSM-oriented perspectives. Network analysis was employed to explore the relationship between CDS and behavioral problems. The various networks were compared by gender and age subgroups. Among 72,106 participants (mean age, 11.49 years; minimum age, 5 years; maximum age, 16 years), there were 36,449 males (50.5%) and 35,657 females (49.5%). From a psychopathological perspective, the motor symptoms node was associated with the sad node and the withdrawn node, while the cognitive symptoms node was linked to the nervous node and the self-conscious node. In terms of gender, males had stronger associations of the motor symptoms node with the sad node and the withdrawn node than females (P = 0.043), and weaker associations of the cognitive symptoms node with the nervous node than females (P = 0.027). In terms of growth stage, the adolescent group had stronger associations of the cognitive symptoms node with the nervous node and the self-conscious node than the child group (P = 0.016, 0.001). From DSM perspective, motor symptoms node were associated with sad node, and cognitive symptoms node were related to can't concentrate node, nervous node, and worthless node. With increasing age, there was an upward trend in the strength of the cognitive and motor symptoms node. CDS is closely linked to psychological and behavioral issues, especially internalizing problems, with differences observed by gender and growth stage. The connection between CDS and the affective, anxiety, and ADH symptoms is particularly pronounced.
... t,u Along with the different terms used to capture this approach in research (e.g., sex and gender dimensionality; sex, gender and diversity analysis (SG&DA), 2 or in policies (e.g., sex and gender analysis plus (SGBA+); equity diversity and inclusion initiatives (EDI)], 3 there are also differences in recommended practices for integrating these factors into studies and the extent to which they should be applied. [4][5][6] Although many national funding institutions are lagging in enacting similar requirements, 2,7 some peer reviewed journals have begun requiring the inclusion of sex and/ or gender-specific details in manuscript submissions. 8,9 Yet, the effective integration of gender, as distinct from sex but often interacting with it, remains challenging with inconsistent uptake, practices, and results. ...
Gender equality has been a crosscutting issue in Horizon 2020 with three objectives: gender balance in decision-making, gender balance and equal opportunities in project teams at all levels, and inclusion of the gender dimension in research and innovation content. Between 2017 and 2022, the EU funded, in collaboration with national agencies, 13 transnational projects under "GENDER-NET Plus" that explored how to best integrate both sex and gender into studies ranging from social sciences, humanities, and health research. As the projects neared completion, forty researchers from these interdisciplinary teams met in November 2022 to share experiences, discuss challenges, and consider the best ways forward to incorporate sex and gender in research. Here, we summarize the reflections from this workshop and provide some recommendations for i) how to plan the studies (e.g., how to define sex and/or gender and their dimensions, rationale for the hypotheses, identification of data that can best answer the research question), ii) how to conduct them (e.g., adjust definitions and dimensions, perform pilot studies to ensure proper use of terminology and revise until consensus is achieved), and iii) how to analyze and report the findings being mindful of any real-world impact.
... The literature clearly illustrates the problematic task of distinguishing between sex (biological) and gender (social, cultural, and structural) in health and behavioral health practice, especially in the detection of differences. Researchers now propose using a composite term, "sex/gender", as a frame to examine the interactive effect of sex/gender on health outcomes (Kaiser et al., 2009;Springer et al., 2012). To address these effects, an intersectional approach, which examines how sex/gender interact at and across group, process, and structural levels, could be used to target interventions for modifiable factors, such as attitudes, beliefs, or structural constraints, or underlying social processes. ...
This chapter examines women’s behavioral health services from a public health and population health perspective. Using a global frame, we incorporate the social determinants of health (socio-structural factors) and the Sustainable Development Goals, as well as national initiatives in the United States, to create an overview of significant issues affecting behavioral health services and policy for women throughout their lifespan.
... Recent calls to reconsider fundamental definitions of the field have prompted the field to define men in men's health to include those who are male, those assigned male at birth, and those who define themselves as men (White et al., 2023). Despite the critiques of the use of sex instead of gender (Krieger, 2003;Springer et al., 2012b), the data used to inform United States health policy still primarily uses sex as a variable instead of gender. Though national data that measures gender identity separate from sex at birth would be preferable, the analyses in this paper use sex as a proxy for gender. ...
... We argue that scientific knowledge production has been built on patriarchal and misogynistic systems (Bleakley, 2014) and continues to be structured in ways that reify these historic inequities (Sharma, 2019). While research has increasingly explored how the social organization and institutionalization of gender affect health outcomes (Bates et al., 2009;Homan, 2017Homan, , 2019Springer et al., 2012;Springer et al., 2012aSpringer et al., , 2012bValdez, 2021), less research has been done on how gendered power relations impact the process of research and 'doing' science. This commentary builds on work within feminist science and technology studies that describes the institutionalization of gender in health research, and how resulting epistemic infrastructures shape scientific knowledge production (Agenjo-Calderón, 2021;McKittrick, 2006;Murphy, 2017;Valdez, 2021). ...
... The challenges in establishing causation become even much more pronounced when the factor tested cannot be directly manipulated and random assignment is not possible, as is the case when comparing S/G-related categories (Cox, 2006;Jacklin, 1981). Thus, to avoid the causality fallacy (and the essentialist statements about S/G categories frequently associated with it, see below), it is worth remembering that "Sex is not a force that produces these contrasts; it is merely a name for our total impression of the differences" (Lillie, 1939) and that S/G, especially if operationalized in two (or more) categories, is more often a moderator than a "true" factor (for an ampler discussion, see (Jacklin, 1981;Krieger, 2003;Maney, 2016;Richardson, 2022;Springer et al., 2012)). ...
... 53,54 Recommendations include recognizing that sex and gender should be operationalized based on context and the nature of the research questions 55 and that design through analysis should be grounded in transparent presentation of theory and hypotheses. 56 For example, researchers studying sex differences in reactive and diurnal cortisol profiles identified potential mechanisms of action (e.g., gonadal hormones) through careful consideration of the available scientific evidence, conceptually justified how this mechanism would lead to the observed sex differences, and found evidence supporting their hypothesis. 57 A single static binary questionnaire item is not recommended as this undermines recognition of the vast complexity of gender and sex and their interaction, and magnifies problems of exclusion and invisibilization of gender/sex diversity. ...
Adolescence begins with pubertal maturation, driven by hormones released by the brain and body. Hormonal biomarkers show that developmental processes begun in utero are reawakened at puberty. This chapter describes how useful seemingly objective hormonal biomarkers are in shedding light on adolescent development, but also how the biomarkers themselves are often misfits to psychologists' constructs for what it means to grow up. The chapter uses a social justice lens to understand when and why it is necessary to rethink what we ‘know’ about hormones to continue the self-correcting scientific process.
... Findings informed by such a framework can provide insights toward creating lasting systemic change (Schiebinger, 2014). Good practice guidelines in gender transformation, therefore, advocate for integrating an intersectional lens throughout the process of knowledge production and human capital development (Christoffersen, 2021;Springer, Stellman, & Jordan-Young, 2012). ...
... Gender is a social determinant of health, entangled with sex differences [4,5], and both gender (socially constructed roles and behaviors) and sex (the biological attributes of females and males) affect molecular and cellular processes, response to treatments, health, and disease [5]. Gender can be a barrier to health-seeking behavior where patients' anticipation of stigma can result in delays in seeking a diagnosis and, hence, treatment (e.g., lung cancer) [6]. ...
Background: The knowledge of sex and gender differences in disease are crucial for nursing students. Methods: This quasi-experimental study assesses nursing students’ motivation, awareness, and knowledge related to women’s health before and after a pathology course for first-year nursing students, using a pre–posttest design (pretest: n = 312, posttest: n = 156). Results: More than 90% of students were motivated to learn about sex and gender differences in pathology. Awareness increased significantly for the following topics: cardiovascular disease (CVD), osteoporosis, and breast cancer (BC). The knowledge level was low for CVD and high for BC, where the knowledge level increased significantly for BC. Having another first language predicted CVD (B −2.123, 95% CI −3.21 to −1.03) and osteoporosis (B −0.684, 95% CI −0.98 to −0.39) knowledge negatively, while age group (≥21 years) predicted menstruation (B 0.179, 95% CI 0.03 to 0.33) and BC (B 0.591, 95% CI 0.19 to 1.00) knowledge positively, in the total sample (pre- and postdata, n = 468). Conclusion: There is a lack of pathology knowledge among nursing students, especially related to CVD and symptoms of heart attacks in women. To ensure equality in health for women, these perspectives should be systematically integrated into the nursing students’ curriculum in the future.
This article explores evidence regarding sex and gender differences in schizophrenia and their implications for treatment. It highlights key differences in age of onset, symptom presentation, and cannabis use, while examining methodological limitations in existing research. Men tend to have an earlier onset and more severe negative symptoms, often linked to cannabis use, while women show delayed onset and are influenced by oestrogen levels. The inconsistent findings on symptom presentation underline the need for further robust research. The article emphasises tailoring treatment approaches to genderspecific needs, such as early detection and substance abuse programmes for men and hormone-focused care for women.
Background
Access to “big data” is a boon for researchers, fostering collaboration and resource-sharing to accelerate advancements across fields. Yet, disentangling complex datasets has been hindered by methodological limitations, calling for alternative, interdisciplinary approaches to parse manifold multi-directional pathways between clinical features, particularly for highly heterogeneous autism spectrum disorder (ASD). Despite a long history of male-bias in ASD prevalence, no consensus has been reached regarding mechanisms underlying sex-related discrepancies.
Methods
Applying a novel network-theory-based approach, we extracted data-driven, clinically-relevant insights from a well-characterized sample ( http://sfari.org/simons-simplex-collection ) of autistic males (N = 2175, Age = 8.9 ± 3.5 years) and females (N = 334, Age = 9.2 ± 3.7 years). Expert clinical review of exploratory factor analysis (EFA) results yielded factors of interest in sensory, social, and restricted and repetitive behavior domains. To offset inherent confounds of sample imbalance, we identified a comparison subgroup of males (N = 331) matched to females (by age, IQ). We applied data-driven causal discovery analysis (CDA) using Greedy Fast Causal Inference (GFCI) on three groups (all females, all males, matched males). Structural equation modeling (SEM) extracted measures of model-fit and effect sizes for causal relationships between sex, age-at-enrollment, and IQ on EFA-determined factors.
Results
We identified potential targets for intervention at nodes with mediating or indirect effects. For example, in the female and matched male groups, analyses suggest mitigating RRB domain behaviors may lead to downstream reductions in oppositional and self-injurious behaviors.
Conclusions
Our investigation unveiled sex-specific directional relationships that inform our understanding of differing needs and outcomes associated with biological sex in autism and may serve to further development of targeted interventions.
Background: Active transportation (AT) marks an eco-friendly mode of physical activity that is well integrable into daily life. Despite the dominance of social-ecological approaches to explaining AT, previous studies often drew on a fragmented set of variables to describe AT behavior. The concept of physical literacy (PL) comprises physical, affective, and cognitive determinants for physical activity and, therefore, enables a concentrated, theory-guided view on intraindividual determinants for AT. The goal of the present study was to examine empirical associations between PL and modes of AT (considering the influencing and moderating effect of grade and sex/gender, respectively). Methods: Within the scope of the DAPL study, data from 663 children (age: 6-13 years) from 41 classes (grades 1-6) across twelve schools in Denmark were analyzed. The school children (mean age: 9.81 years; 55 % girls) completed measurements of PL (Danish version of the CAPL-2: physical, affective, and cognitive component; total score) and self-reported their AT mode for seven days. We calculated general mixed models with the class as a random-effects factor to examine the relationship between PL and six different modes of AT. Results: Total PL as well the physical, cognitive, and affective domains of PL were not associated with overall AT (p > 0.05). However, we found significant associations of total PL (B = 0.35) and the physical domain (B = 0.21) with biking. The affective and cognitive domains of PL did not significantly correlate with any AT indicator. The present effects were not moderated by students' grade and sex/gender. Conclusions: Public health strategies should strive for a mode-tailored approach when targeting children's AT. Person-centered health and physical education must increase their efforts in promoting children's holistic biking skills to effectively foster AT behavior. The provision of holistic experiences should emphasize the integration of psychomotor and affective learning.
Background: In this study, we revised and validated the Comprehensive Autistic Trait Inventory (CATI) – a self-report inventory of autistic traits, in collaboration with autistic people. An established strength of the CATI is its ability to capture female autistic traits. Our project aimed to extend this further, to increase the inventory's accessibility, and to minimise stigma induced by deficit-based representations of autistic experience. Methods: Together with 22 individuals from the autism and autistic communities, we created the Revised Comprehensive Autistic Trait Inventory (CATI-R). Revisions included rewording items to increase clarity or reduce stigma and expanding items to capture diverse autistic experiences. Based on the revisions, we formulated a series of guidelines for developing personality-style self-report inventories of subclinical traits concerning neurodevelopmental and psychiatric divergences. The CATI-R was then validated across a large sample (n = 1439), comprising autistic (n = 375) and non-autistic participants (n = 1046), following the protocol for the original CATI. Results: We conceptually replicated the original CATI validation. A confirmatory factor analysis supported the six-subscale structure. Pearson correlations showed positive relationships between all subscales. Moreover, comparing the CATI-R with two contemporary inventories of autistic traits, we found evidence for the CATI-R's convergent validity and its ability to classify individuals as autistic or not. A measurement invariance analysis indicated that total-scale scores can be compared across genders. However, in line with current research on gender differences in autism, a repeated measures ANOVA showed subscale-specific gender differences. Accordingly, we identified different thresholds for classifying female, male, and non-binary people. Finally, a logistic regression analysis suggested that the CATI-R predicts autism particularly well in female and non-binary people. Limitations: Our study presents only initial evidence for the validity of the CATI-R that should be enriched with further analyses and types of data, including, a larger number of non-binary participants. Conclusions: This project holds significance for both research and clinical practice as it provides a trait inventory that resonates with actual autistic experience and insights for creating inventories that are sensitive, accessible, and non-stigmatising.
Amid the COVID-19 pandemic, a re-exacerbation of gender inequalities and violence against women was reported. For adequately responding to the causes of this situation and its aftermath, a detailed understanding of the gendered impacts of the pandemic and of subsequent developments is necessary. This aim may be supported by particularly using gender-sensitive modes of inquiry. Against this backdrop, we explore the methodological potential of grounded theory (GT) to explicitly guide gender-sensitive research. Given its methodological variations, we argue that an adequate handling of gender in GT can only be determined in relation to a researcher's positioning within the GT landscape. Thus, to assist readers in translating their gender sensitivity into GT practices, this article outlines various interpretations of GT elements, discussing their relation to gender. Furthermore, strategies addressing gender-related challenges are presented and underlined by, among others, studies on discrimination and violence.
Background: In this study, we revised and validated the Comprehensive Autistic Trait Inventory (CATI) – a self-report inventory of autistic traits, in collaboration with autistic people. An established strength of the CATI is its ability to capture female autistic traits. Our project aimed to extend this further, to increase the inventory's accessibility, and to minimise stigma induced by deficit-based representations of autistic experience.
Methods: Together with 22 individuals from the autism and autistic communities, we created the Revised Comprehensive Autistic Trait Inventory (CATI-R). Revisions included rewording items to increase clarity or reduce stigma and expanding items to capture diverse autistic experiences. Based on the revisions, we formulated a series of guidelines for developing personality-style self-report inventories of subclinical traits concerning neurodevelopmental and psychiatric divergences. The CATI-R was then validated across a large sample (n = 1439), comprising autistic (n = 375) and non-autistic participants (n = 1046), following the protocol for the original CATI.
Results: We conceptually replicated the original CATI validation. A confirmatory factor analysis supported the six-subscale structure. Pearson correlations showed positive relationships between all subscales. Moreover, comparing the CATI-R with two contemporary inventories of autistic traits, we found evidence for the CATI-R's convergent validity and its ability to classify individuals as autistic or not. A measurement invariance analysis indicated that total-scale scores can be compared across genders. However, in line with current research on gender differences in autism, a repeated measures ANOVA showed subscale-specific gender differences. Accordingly, we identified different thresholds for classifying female, male, and non-binary people. Finally, a logistic regression analysis suggested that the CATI-R predicts autism particularly well in female and non-binary people.
Limitations: Our study presents only initial evidence for the validity of the CATI-R that should be enriched with further analyses and types of data, including, a larger number of non-binary participants.
Conclusions: This project holds significance for both research and clinical practice as it provides a trait inventory that resonates with actual autistic experience and insights for creating inventories that are sensitive, accessible, and non-stigmatising.
In a recent issue of the Journal, Platt et al (Am J Epidemiol. 2024;193(10):1362-1371) shed new light on the potential for supportive employment benefits, including family leave, flexible work hours, and employer-provided or subsidized childcare, to mitigate the risk of depression among full-time working mothers. The authors used a longitudinal study design and rigorous methods to carefully consider potential sources of bias, and, more broadly, their article underscores the importance of employment benefits as a social determinant of mental health for working mothers. In this commentary, we discuss some of the policy context surrounding employer benefits that support parenting, particularly around paid versus unpaid family leave laws and ordinances. We consider the ways in which the policy context affects larger structural inequities and the potential implications for internal and external validity.
This article is part of a Special Collection on Mental Health.
In this article definitions of and concepts behind sex/gender-sensitive medicine (SGSM) are introduced. We evaluate why sex/gender-sensitive research is essential and how it can be sustainably implemented and nurtured to build a basis for sex/gender-sensitive clinical care. Further, statistical and clinical realities of disabled patients and patients of color are depicted, to illustrate intersectional discrimination in medical care. Practical tools are shared to guide the reader into implementing actionable change within their own clinical practice to contribute to a less discriminating experience for vulnerable populations.
The growing visibility of transgender and nonbinary people raises important sociological questions about how the structure of sex and gender is shifting and underscores necessary changes to research practice. We review what is known about emerging gender identities and their implications for sociological understandings of the relationship between sex and gender and the maintenance of the sex/gender system of inequality. Transgender and nonbinary identities are increasingly common among younger cohorts and improved survey measurements of sex and gender are expanding information about these changes. In the United States, an additional gender category seems to be solidifying in public usage even as the higher status of masculinity over femininity persists. The continuing power of the normative binary contributes to both violent backlash and characteristic patterns of discrimination against gender diverse people; yet, underlying support for nondiscrimination in the workplace is stronger than commonly recognized. New, more consistent efforts to account for gender diversity in social science research are needed to fully understand these changes.
Background
Some cardiovascular risk factors (CVRFs) that occur differently in men and women can be addressed to reduce the risk of suffering a major adverse cardiovascular event (MACE). Furthermore, the development of MACE is highly influenced by social determinants of health. Counterfactual decomposition analysis is a new methodology that has the potential to be used to disentangle the role of different factors in health inequalities. This study aimed to assess sex differences in the incidence of MACE and to estimate how much of the difference could be attributed to the prevalence of diabetes, hypertension, hypercholesterolaemia and socioeconomic status (SES).
Methods
Descriptive and counterfactual analyses were conducted in a population of 278 515 people with CVRFs. The contribution of the causal factors was estimated by comparing the observed risk ratio with the causal factor distribution that would have been observed if men had been set to have the same factor distribution as women. The study period was between 2018 and 2021.
Results
The most prevalent CVRF was hypercholesterolaemia, which was similar in both sexes, while diabetes was more prevalent in men. The incidence of MACE was higher in men than in women. The main causal mediating factors that contributed to the sex differences were diabetes and SES, the latter with an offsetting effect.
Conclusions
This result suggests that to reduce the MACE gap between sexes, diabetes prevention programmes targeting men and more gender-equal salary policies should be implemented.
Prevalence in autism spectrum disorder (ASD) diagnosis has long been strongly male-biased. Yet, consensus has not been reached on mechanisms and clinical features that underlie sex-based discrepancies. Whereas females may be under-diagnosed because of inconsistencies in diagnostic/ascertainment procedures (sex-biased criteria, social camouflaging), diagnosed males may have exhibited more overt behaviors (e.g., hyperactivity, aggression) that prompted clinical evaluation. Applying a novel network-theory-based approach, we extracted data-driven, clinically-relevant insights from a large, well-characterized sample (Simons Simplex Collection) of 2175 autistic males (Ages = 8.9±3.5 years) and 334 autistic females (Ages = 9.2±3.7 years). Exploratory factor analysis (EFA) and expert clinical review reduced data dimensionality to 15 factors of interest. To offset inherent confounds of an imbalanced sample, we identified a subset of males (N=331) matched to females on key variables (Age, IQ) and applied data-driven CDA using Greedy Fast Causal Inference (GFCI) for three groups (All Females, All Males, and Matched Males). Structural equation modeling (SEM) extracted measures of model fit and effect sizes for causal relationships between sex, age, and, IQ on EFA-selected factors capturing phenotypic representations of autism across sensory, social, and restricted and repetitive behavior domains. Our methodology unveiled sex-specific directional relationships to inform developmental outcomes and targeted interventions.
Despite Canada's leadership in the field of population health, there have been few successes in reducing the country's health inequities. There is an increasing recognition that regardless of the progress made to date, significant gaps remain in comprehending fully the root causes of inequities, including the complex ways in which the determinants of health relate, intersect and mutually reinforce one another. Calls are being made to draw on the theoretical insights of critical social science perspectives to rethink the current framing of health determinants. The aim of this paper is to contribute to the theoretical project of population health by exploring the innovative paradigm of intersectionality to better understand and respond to the ‘foundational’ causes of illness and disease, which the health determinants perspective seeks to identify and address. While intersectionality has taken hold among health researchers in the United States, the United Kingdom and Canada, the transformative potential of this approach in the context of health determinants is largely unexamined.
Book Review of
Brainstorm: the flaws in the science of sex differences by R. M. Jordan-young.
A n n e F a u s t o -S t e r l i n g The Bare Bones of Sex: Part 1—Sex and Gender H ere are some curious facts about bones. They can tell us about the kinds of physical labor an individual has performed over a lifetime and about sustained physical trauma. They get thinner or thicker (on average in a population) in different historical periods and in response to different colonial regimes (Molleson 1994; Larsen 1998). They can in-dicate class, race, and sex (or is it gender—wait and see). We can measure their mineral density and whether on average someone is likely to fracture a limb but not whether a particular individual with a particular density will do so. A bone may break more easily even when its mineral density remains constant (Peacock et al. 2002). 1 Culture shapes bones. For example, urban ultraorthodox Jewish ado-lescents have lowered physical activity, less exposure to sunlight, and drink less milk than their more secular counterparts. They also have greatly decreased mineral density in the vertebrae of their lower backs, that is, the lumbar vertebrae (Taha et al. 2001). Chinese women who work daily in the fields have increased bone mineral content and density. The degree of increase correlates with the amount of time spent in physical activity (Hu et al. 1994); weightlessness in space flight leads to bone loss (Skerry 2000); gymnastics training in young women ages seventeen to twenty-seven correlates with increased bone density despite bone resorption caused by total lack of menstruation (Robinson et al. 1995). Consider also some recent demographic trends: in Europe during the past thirty years, the number of vertebral fractures has increased three-to fourfold for women and more than fourfold for men (Mosekilde 2000); in some Thanks to the members of the Pembroke Seminar on Theories of Embodiment for a wonderful year of thinking about the process of body making and for their thoughtful response to an earlier draft of this essay. Credit for the title goes to Greg Downey. Thanks also to anonymous reviewers from Signs for making me sharpen some of the arguments. 1 Munro Peacock et al. write: "The pathogenesis of a fragility fracture almost always involves trauma and is not necessarily associated with reduced bone mass. Thus, fragility fracture should neither be used synonymously nor interchangeably as a phenotype for os-teoporosis" (2002, 303).
This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Women live longer than men and develop cardiovascular disease (CVD) at an older age. The metabolic syndrome represents a major risk factor for the development of CVD, and gender1 differences in this syndrome may contribute to gender differences in CVD.
In recent years, the metabolic syndrome has been more prevalent in men than in women. Prevalence is increasing and this increase has been steeper in women, particularly in young women, during the last decade. The contributions of the different components of the metabolic syndrome differ between genders and in different countries.
In a recent survey in Germany, 40% of the adult population had been diagnosed with disturbed glucose tolerance or type 2 diabetes. Undiagnosed diabetes was more frequent in men than in women, and risk factors for undiagnosed diabetes differed between the sexes. Worldwide, in individuals with impaired glucose tolerance, impaired fasting glucose was observed more frequently in men, whereas impaired glucose tolerance occurred relatively more often in women. Lipid accumulation patterns differ between women and men. Premenopausal women more frequently develop peripheral obesity with subcutaneous fat accumulation, whereas men and postmenopausal women are more prone to central or android obesity. In particular, android obesity is associated with increased cardiovascular mortality and the development of type 2 diabetes. Visceral adipocytes differ from peripheral adipocytes in their lipolytic activity and their response to insulin, adrenergic and angiotensin stimulation and sex hormones. Visceral fat is a major source of circulating free fatty acids and cytokines, which are directly delivered via the portal vein to the liver inducing insulin resistance and an atherogenic lipid profile. Inflammation increases cardiovascular risk particularly in women. A relatively greater increase in cardiovascular risk by the appearance of diabetes in women has been reported in many studies.
Thus, the presently available data suggest that the pathophysiology of the metabolic syndrome and its contribution to the relative risk of cardiovascular events and heart failure show gender differences, which might be of potential relevance for prevention, diagnostics, and therapy of the syndrome.
It is conventional wisdom in medical sociology and social epidemiology that in industrialized societies men die earlier than women, but that women have poorer health than men. A number of explanations for these differences have been postulated and tested (for example, different biological risks, acquired risks, reporting biases and experiences of health care). Using two recent British data sets we find that the pattern of sex differences in morbidity is more complicated than the conventional wisdom often suggests. The direction and magnitude of sex differences in health vary according to the particular symptom or condition in question and according to the phase of the life cycle. Female excess is only consistently found across the life span for psychological distress and is far less apparent, or reversed, for a number of physical symptoms and conditions. Detailed inspection of papers on gender differences published in the last decade reveals that our findings are not unique, but that a relatively undifferentiated model of consistent sex differences has nevertheless continued to predominate in the literature. We believe that the topic of gender differences in health warrants periodic re-examination.
Atherosclerosis is a complex process characterized by an increase in vascular wall thickness owing to the accumulation of cells and extracellular matrix between the endothelium and the smooth muscle cell wall. There is evidence that females are at lower risk of developing cardiovascular disease (CVD) as compared to males. This has led to an interest in examining the contribution of genetic background and sex hormones to the development of CVD. The objective of this review is to provide an overview of factors, including those related to gender, that influence CVD.
Evidence analysis from PubMed and individual searches concerning biochemical and endocrine influences and gender differences, which affect the origin and development of CVD.
Although still controversial, evidence suggests that hormones including estradiol and androgens are responsible for subtle cardiovascular changes long before the development of overt atherosclerosis.
Exposure to sex hormones throughout an individual's lifespan modulates many endocrine factors involved in atherosclerosis.
Writing about multivariate analysis is a surprisingly common task. Researchers use these advanced statistical techniques to examine relationships among multiple variables, such as exercise, diet, and heart disease, or to forecast information such as future interest rates or unemployment. Many different people, from social scientists to government agencies to business professionals, depend on the results of multivariate models to inform their decisions. At the same time, many researchers have trouble communicating the purpose and findings of these models. Too often, explanations become bogged down in statistical jargon and technical details, and audiences are left struggling to make sense of both the numbers and their interpretation. Here, Jane Miller offers much-needed help to academic researchers as well as to analysts who write for general audiences. The Chicago Guide to Writing about Multivariate Analysis brings together advanced statistical methods with good expository writing. Starting with twelve core principles for writing about numbers, Miller goes on to discuss how to use tables, charts, examples, and analogies to write a clear, compelling argument using multivariate results as evidence. Writers will repeatedly look to this book for guidance on how to express their ideas in scientific papers, grant proposals, speeches, issue briefs, chartbooks, posters, and other documents. Communicating with multivariate models need never appear so complicated again.
Reduction in arterial elasticity marks progression toward cardiovascular morbidity and mortality. Variability in arterial elasticity may help account for race/ethnic and gender differences in cardiovascular risk.
Cross-sectional study.
Whites, African Americans, Hispanics and Chinese aged 45-84 years free of clinically recognized cardiovascular disease were recruited in six US communities.
We examined 3,316 women and 3,020 men according to race/ethnicity and sex.
Large (LAE) and small artery (SAE) elasticity, derived from radial artery diastolic pulse wave contour registration in all subjects in a supine position using tonometry. LAE and SAE were adjusted for ethnicity, age, clinical site, height, heart rate, blood pressure, antihypertensive medication and body mass index, diabetes, smoking, and circulating lipids.
Much of the sex difference in arterial elasticity was explained by height. After adjustment, LAE did not differ by race/ ethnicity, but mean SAE in African Americans was 4.2 mL/mm Hg x 100 and 4.4 mL/ mm Hg x 100 in Hispanics compared to means of 4.6 mL/mm Hg x 100 in Whites, and 4.8 mL/mm Hg x 100 in Chinese.
Reduced SAE may indicate earlier vascular disease in African Americans and Hispanics than other groups.
This report presents national anthropometric reference data for the U.S. population aged 3 months and older in 1988-1994.
Data in this report are from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted on a complex, stratified, multistage probability sample of the civilian, noninstitutionalized U.S. population. A total of 31,241 persons were examined. The anthropometric measurements taken included weight, height, recumbent length, circumferences, limb lengths, joint breadths, and skinfold thicknesses. Body mass index values were computed from measured height and weight values.
The tables in this report include weighted population means, standard errors of the means, and selected percentiles of body measurement values. Because measurements varied by sex and age (and by race and ethnicity in adults), results are reported by these subgroups.
These data add to the knowledge about trends in child growth and development and are useful in monitoring overweight and obesity in the U.S. population.
Access to genuine multipartite entanglement of quantum states enables advances in
quantum information science and also contributes to the understanding of
strongly correlated quantum systems. We report the detection and
characterization of heralded entanglement in a multipartite quantum state
composed of four spatially distinct optical modes that share one photon, a
so-called W state. By randomizing the relative phase between
bipartite components of the W state, we observed the
transitions from four- to three- to two-mode entanglement with increasing phase
noise. These observations are possible for our system because our entanglement
verification protocol makes use of quantum uncertainty relations to detect the
entangled states that span the Hilbert space of interest.
Although a wealth of literature links dietary factors and coronary heart disease (CHD), the strength of the evidence supporting valid associations has not been evaluated systematically in a single investigation.
We conducted a systematic search of MEDLINE for prospective cohort studies or randomized trials investigating dietary exposures in relation to CHD. We used the Bradford Hill guidelines to derive a causation score based on 4 criteria (strength, consistency, temporality, and coherence) for each dietary exposure in cohort studies and examined for consistency with the findings of randomized trials.
Strong evidence supports valid associations (4 criteria satisfied) of protective factors, including intake of vegetables, nuts, and "Mediterranean" and high-quality dietary patterns with CHD, and associations of harmful factors, including intake of trans-fatty acids and foods with a high glycemic index or load. Among studies of higher methodologic quality, there was also strong evidence for monounsaturated fatty acids and "prudent" and "western" dietary patterns. Moderate evidence (3 criteria) of associations exists for intake of fish, marine omega-3 fatty acids, folate, whole grains, dietary vitamins E and C, beta carotene, alcohol, fruit, and fiber. Insufficient evidence (< or =2 criteria) of association is present for intake of supplementary vitamin E and ascorbic acid (vitamin C); saturated and polyunsaturated fatty acids; total fat; alpha-linolenic acid; meat; eggs; and milk. Among the dietary exposures with strong evidence of causation from cohort studies, only a Mediterranean dietary pattern is related to CHD in randomized trials.
The evidence supports a valid association of a limited number of dietary factors and dietary patterns with CHD. Future evaluation of dietary patterns, including their nutrient and food components, in cohort studies and randomized trials is recommended.
The contribution of common genetic variation to one or more established smoking behaviors was investigated in a joint analysis of two genome wide association studies (GWAS) performed as part of the Cancer Genetic Markers of Susceptibility (CGEMS) project in 2,329 men from the Prostate, Lung, Colon and Ovarian (PLCO) Trial, and 2,282 women from the Nurses' Health Study (NHS). We analyzed seven measures of smoking behavior, four continuous (cigarettes per day [CPD], age at initiation of smoking, duration of smoking, and pack years), and three binary (ever versus never smoking, < or = 10 versus > 10 cigarettes per day [CPDBI], and current versus former smoking). Association testing for each single nucleotide polymorphism (SNP) was conducted by study and adjusted for age, cohabitation/marital status, education, site, and principal components of population substructure. None of the SNPs achieved genome-wide significance (p<10(-7)) in any combined analysis pooling evidence for association across the two studies; we observed between two and seven SNPs with p<10(-5) for each of the seven measures. In the chr15q25.1 region spanning the nicotinic receptors CHRNA3 and CHRNA5, we identified multiple SNPs associated with CPD (p<10(-3)), including rs1051730, which has been associated with nicotine dependence, smoking intensity and lung cancer risk. In parallel, we selected 11,199 SNPs drawn from 359 a priori candidate genes and performed individual-gene and gene-group analyses. After adjusting for multiple tests conducted within each gene, we identified between two and five genes associated with each measure of smoking behavior. Besides CHRNA3 and CHRNA5, MAOA was associated with CPDBI (gene-level p<5.4x10(-5)), our analysis provides independent replication of the association between the chr15q25.1 region and smoking intensity and data for multiple other loci associated with smoking behavior that merit further follow-up.
In the early 1980s, my feminist friends repeatedly asked me to explain what biologists have had to say about women, and why it is that women are depicted as determined and limited by their "biological nature" in ways that men, in general, are not. Despite my years of education in biology, I had no answers to their questions. These questions led me and other biology students to found the women's group in biology. The very first ideas for this book stem from the many evenings of discussions I shared with this group. The subject of women's biology turned out to be profoundly political, and was at that time not yet subjected to any systemic feminist inquiry. We discussed our objections to the determinism and reductionism of biological theories relating to sex differences, and the implications of such theories for feminism. The women's group proved to be a very creative and productive context for developing ideas and strategies to introduce the subject of women and biology to the agenda of the university curriculum. Thanks to the efforts of this group, this issue became institutionalized as a new field in women's studies at the University of Amsterdam. The major part of the work presented in this book was done in the socially and intellectually stimulating atmosphere surrounding the establishment of this new research field. There are, inevitably, a great many people whose ideas, inspiration and support have contributed to the realization of this book: Olga Amsterdamska, Louis Boon, Teresa Brennan, Christien Brouwer, Adele Clarke, Jacqueline Cramer, Diana Long, Annemarie Mol, Nanne van der Poll, Koos Slob, Anne Fausto Sterling, Marianne van den Wijngaard, and Ineke van Wingerden. I am grateful for the help of all these colleagues and friends who have provided me with the knowledge, skills and energy that made the writing of this book into such an intellectually exciting endeavor.
Evidence has long suggested that ‘hardwiring’ is a poor metaphor for brain development. But the metaphor may be an apt one for the dominant paradigm for researching sex differences, which pushes most neuroscience studies of sex/gender inexorably towards the ‘discovery’ of sex/gender differences, and makes contemporary gender structures appear natural and inevitable. The argument we forward in this paper is twofold. In the first part of the paper, we address the dominant ‘hardwiring’ paradigm of sex/gender research in contemporary neuroscience, which is built on broad consensus that there are important ‘original’ sex differences in brain structure and function, organized by sex-differentiating prenatal hormone exposures. We explain why this consensus is both unscientific and unethical. In the second part of the paper, we sketch an alternative research program focused not on the origins of sex/gender differences but on variability and plasticity of brain/behavior. We argue that interventional experiments based on this approach will address more tractable questions, and lead to much more satisfactory results than the brain organization paradigm can provide.
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In this paper we provide a critical review of research concerned with social/environmental mechanisms that modulate human
neuroendocrine function. We survey research in four behavioral systems that have been shaped through evolution: competition,
partnering, sex, and pregnancy/parenting. Generally, behavioral neuroendocrine research examines how hormones affect behavior.
Instead, we focus on approaches that emphasize the effects of behavioral states on hormones (i.e., the “reverse relationship”),
and their functional significance. We focus on androgens and estrogens because of their relevance to sexually selected traits.
We conclude that the body of research employing a reversed or bidirectional perspective has an incomplete foundation: participants
are mainly heterosexual men, and the functionality of induced shifts in neuroendocrine factors is generally unknown. This
area of research is in its infancy, and opportunities abound for developing and testing intriguing research questions.
Popular perceptions of the effect of testosterone on "manly" behavior are inaccurate. We need to move away from such simplistic notions by treating testosterone as one component along with other physiological, psychological and sociological variables in interactive and reciprocal models of behavior. Several hormones can now be measured in saliva, removing the need for blood samples. Conceptual shifts have moved research from biological determinism to biosocial models in which the social environment plays a key role in understanding behavior-hormones associations. As a result, more social scientists are incorporating testosterone in their studies. Following a primer on testosterone, we describe testosterone's link to (a) gaining, maintaining and losing social status, (b) aggression and antisocial behavior, (c) peer and family relationships, and (d) gender similarities and differences. Research needed to take us to the next level of understanding is outlined.
Race/ethnicity, gender, and socioeconomic position are social status categories that predict the differential distribution of disease, disability, and death in society. Prior research has attended to variations in health by each of these categories, considered separately, or by two of them in combination. But health researchers seldom consider how health is distributed when these three social status categories are considered simultaneously. In this chapter, we focus on social disparities in health and underscore the complex interactions among these social categories. We begin by briefly documenting that race, gender, and socioeconomic status (SES) each matters in predicting variations in health. We then consider the complex patterns that emerge when we consider race/ethnicity, SES, and gender together. In highlighting some of the paradoxes in the health literature, we draw particular attention to members of the black middle class. We conclude with directions for future research, describing the ways in which intersectionality theory can be used to further our understanding of persistent health inequalities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This essay aims to clarify the value of developing systematic studies of ignorance as a component of any robust theory of knowledge. The author employs feminist efforts to recover and create knowledge of women's bodies in the contemporary women's health movement as a case study for cataloging different types of ignorance and shedding light on the nature of their production. She also helps us understand the ways resistance movements can be a helpful site for understanding how to identify, critique, and transform ignorance.
This article examines new forms of techno-science-society interactions, in which non-scientists work with scientists to produce and disseminate knowledge. The term “research in the wild” is coined to name a special version of this new phenomenon. The primary illustration for this new form of research is connected with the Association Française contra les Myopathies (AFM), the history of which is particularly suitable for exploring certain mechanisms at work in the co-production of scientific knowledge and social identities. The article first compares laboratory research with research in the wild, emphasizing patient interest in maintaining control over cooperation. It then notes the intimate interrelations between the construction of patient identities and the collective form of research in which they participate. Finally, it examines the role of genetics, both as it is integrated into the construction of the collective, and also into the production of mechanisms of exclusion—the reverse side of the constitution of a collective identity.
Health research has failed to adequately explore the combination of social and biological sources of differences in men's and women's health. Consequently, scientific explanations often proceed from reductionist assumptions that differences are either purely biological or purely social. Such assumptions and the models that are built on them have consequences for research, health care and policy. Although biological factors such as genetics, prenatal hormone exposure and natural hormonal exposure as adults may contribute to differences in men's and women's health, a wide range of social processes can create, maintain or exacerbate underlying biological health differences. Researchers, clinicians and policy makers would understand and address both sex-specific and non-sex-specific health problems differently if the social as well as biological sources of differences in men's and women's health were better understood.
Natural environments, or 'green spaces', have been associated with a wide range of health benefits. Gender differences in neighbourhood effects on health have been found in a number of studies, although these have not been explored in relation to green space. We conducted the first UK-wide study of the relationship between urban green space and health, and the first such study to investigate gender differences in this relationship. An ecological approach was used. Two land use datasets were used to create a proportional green space measure (% by area) at the UK Census Area Statistic ward scale. Our sample consisted of 6432 urban wards, with a total population of 28.6 million adults aged 16-64 years in 2001. We selected health outcomes that were plausibly related to green space (cardiovascular disease mortality, respiratory disease mortality and self-reported limiting long-term illness) and another that was expected to be unrelated (lung cancer mortality). Negative binomial regression models examined associations between urban green space and these health outcomes, after controlling for relevant confounders. Gender differences in these associations were observed and tested. Male cardiovascular disease and respiratory disease mortality rates decreased with increasing green space, but no significant associations were found for women. No protective associations were observed between green space and lung cancer mortality or self-reported limiting long-term illness for either men or women. Possible explanations for the observed gender differences in the green space and health relationship are gender differences in perceptions and usage of urban green spaces. We conclude that it is important not to assume uniform health benefits of urban green space for all population subgroups. Additionally, urban green space measures that capture quality as well as quantity could be more suited to studying green space and health relationships for women.
While recent data indicate that stroke prevalence in women at midlife is double that of similarly aged men in the United States, little is known about current sex-specific trends in symptomatic cardiovascular disease. This study aimed to determine sex-specific midlife prevalence of myocardial infarction (MI) and risk of future coronary heart disease.
We assessed the sex-specific MI prevalence and the Framingham coronary risk score (FCRS) among US adults aged 35 to 54 years who participated in the National Health and Nutrition Examination Surveys (NHANES), cross-sectional, nationally representative surveys, during 1988 to 1994 and 1999 to 2004.
In both epochs, men aged 35 to 54 years had a higher prevalence of MI than similarly aged women, but the gap narrowed in recent years as MI prevalence decreased among men and increased among women (2.5% vs 0.7% in NHANES 1988-1994 [P < .01] and 2.2% vs 1.0% in NHANES 1999-2004 [P < .01]). Among men, the mean FCRS showed an improving trend (8.6% in NHANES 1988-1994 vs 8.1% in NHANES 1999-2004 [P = .07]), while among women, the mean FCRS worsened (3.0% in NHANES 1988-1994 vs 3.3% in NHANES 1999-2004 [P = .02]). Temporal trends in FCRS components revealed that men had more improvements in vascular risk factors than women, but diabetes mellitus prevalence increased in both sexes.
Over the past 2 decades, MI prevalence has increased among midlife women, while declining among similarly aged men. Also, although the risk of future hard cardiovascular events remains higher in midlife men compared with midlife women, the gap has narrowed in recent years. Greater emphasis on vascular risk factor control in midlife women might help mitigate this worrisome trend.
Many studies have compared women and men for symptoms of acute myocardial infarction (AMI), but findings have been inconsistent, largely because of varying inclusion criteria, different study populations, and different methods.
The purpose of this study was to analyze gender differences in symptoms in a well-defined, population-based sample of women and men who experienced a first AMI.
Information on symptoms was collected from the medical charts of all patients with a first AMI, aged 25 to 74 years, who had taken part in the INTERGENE (Interplay Between Genetic Susceptibility and Environmental Factors for the Risk of Chronic Diseases) study. INTERGENE was a population-based research program on risk factors for cardiovascular disease. Medical charts were reviewed for each patient to determine the symptoms of AMI, and the prevalence of each symptom was compared according to sex.
The study included 225 patients with a first AMI: 52 women and 173 men. Chest pain was the most common symptom, affecting 88.5% (46/52) of the women and 94.8% (164/173) of the men, with no statistically significant difference between the sexes. Women had significantly higher rates of 4 symptoms: nausea (53.8% [28/52] vs 29.5% [51/173]; age-adjusted odds ratio [OR] = 2.78; 95% CI, 1.47-5.25), back pain (42.3% [22/52] vs 14.5% [25/173]; OR = 4.29; 95% CI, 2.14-8.62), dizziness (17.3% [9/52] vs 7.5% [13/173]; OR = 2.60; 95% CI, 1.04-6.50), and palpitations (11.5% [6/52] vs 2.9% [5/173]; OR = 3.99; 95% CI, 1.15-13.84). No significant gender differences were found in the proportions of patients experiencing arm or shoulder pain, diaphoresis, dyspnea, fatigue, neck pain, abdominal pain, vomiting, jaw pain, or syncope/lightheadedness. No significant differences were found in the duration, type, or location of chest pain. The medical charts listed numerically more symptoms in women than in men; 73.1% (38/52) of the women but only 48.0% (83/173) of the men reported >3 symptoms (age-adjusted OR = 3.26; 95% CI, 1.62-6.54).
Chest pain is the most common presenting symptom in both women and men with AMI. Nausea, back pain, dizziness, and palpitations were significantly more common in women. Women as a group displayed a greater number of symptoms than did men.
The use of synthetic progesterone-like substances in hormone replacement therapy and birth control pills has been associated with increases in cardiovascular morbidity and the prevalence of diabetes.
The primary aims of this study were to investigate whether physiologic concentrations of progesterone might also be associated with cardiovascular disease and diabetes, and to explore potential gender differences in these associations in elderly Swedish men and women.
This prospective, longitudinal study was performed in a Swedish population-based sample of opposite-sex twins aged between 71 and 80 years who were not receiving sex hormone therapy. Serum concentrations of progesterone, estradiol, C-reactive protein (CRP), and urea were measured at baseline (1996) and at 8-year follow-up (2004), and serum concentrations of cystatin and insulin were measured only at follow-up. The outcomes of interest were cardiovascular morbidity (myocardial infarction, angina pectoris, peripheral arterial disease, stroke, congestive heart failure [CHF], cardiac arrhythmia, hypertension, and thromboembolism), diabetes, and mortality throughout the observation period.
At baseline, the study sample included 230 men and 195 women (mean [SD] age, 74.6 [2.6] years). At follow-up, 132 men and 145 women (mean age, 82.4 [2.5] years) met the inclusion criteria, of whom 128 men and 112 women did so at both baseline and follow-up. Serum progesterone concentrations, which did not differ significantly from reported concentrations for the age group, were significantly associated with mortality across the observation period (P < 0.001). At follow-up, higher serum progesterone was significantly associated with the occurrence of CHF (P < 0.01); this association remained robust after adjustment for CRP, cystatin, and insulin levels.
In these elderly Swedish men and women, increased physiologic concentrations of progesterone were found to be associated with an increased prevalence of CHF, independent of inflammatory factors, markers of renal function, and insulin metabolism.
With Inclusion, Steven Epstein argues that strategies to achieve diversity in medical research mask deeper problems, ones that might require a different approach and different solutions. Formal concern with this issue, Epstein shows, is a fairly recent phenomenon. Until the mid-1980s, scientists often studied groups of white, middle-aged menâand assumed that conclusions drawn from studying them would apply to the rest of the population. But struggles involving advocacy groups, experts, and Congress led to reforms that forced researchers to diversify the population from which they drew for clinical research. While the prominence of these inclusive practices has offered hope to traditionally underserved groups, Epstein argues that it has drawn attention away from the tremendous inequalities in health that are rooted not in biology but in society. âEpsteinâs use of theory to demonstrate how public policies in the health profession are shaped makes this book relevant for many academic disciplines. . . . Highly recommended.ââChoice âA masterful comprehensive overview of a wide terrain.ââTroy Duster, Biosocieties
Women have higher 2-hour plasma glucose levels after oral glucose challenge than men. The smaller skeletal muscle mass in women may contribute to the higher postload glucose levels. The objective of this study was to test the hypothesis that the different amount of skeletal muscle mass between men and women contributed to sex difference in postload plasma glucose levels in subjects with normal glucose tolerance. Forty-seven Thai subjects with normal glucose tolerance, 23 women and 24 age- and body mass index-matched men, were studied. Body fat, abdominal fat, and appendages lean mass were measured by dual-energy x-ray absorptiometry. Skeletal muscle insulin sensitivity was determined by euglycemic-hyperinsulinemic clamp. First-phase insulin secretion and hepatic insulin sensitivity were determined from oral glucose tolerance data. beta-Cell function was estimated from the homeostasis model assessment of %B by the homeostasis model assessment 2 model. Correlation and linear regression analysis were performed to identify factors contributing to variances of postload 2-hour plasma glucose levels. This study showed that women had significantly higher 2-hour plasma glucose levels and smaller skeletal muscle mass than men. Measures of insulin secretion and insulin sensitivity were not different between men and women. Male sex (r = -0.360, P = .013) and appendages lean mass (r = -0.411, P = .004) were negatively correlated with 2-hour plasma glucose, whereas log 2-hour insulin (r = 0.571, P < .0001), total body fat (r = 0.348, P = .016), and log abdominal fat (r = 0.298, P = .042) were positively correlated with 2-hour plasma glucose. The correlation of 2-hour plasma glucose and sex disappeared after adjustment for appendages lean mass. By multivariate linear regression analysis, log 2-hour insulin (beta = 18.9, P < .0001), log 30-minute insulin (beta = -36.3, P = .001), appendages lean mass (beta = -1.0 x 10(-3), P = .018), and hepatic insulin sensitivity index (beta = -17.3, P = .041) explained 54.2% of the variance of 2-hour plasma glucose. In conclusion, the higher postload 2-hour plasma glucose levels in women was not sex specific but was in part a result of the smaller skeletal muscle mass. The early insulin secretion, hepatic insulin sensitivity, and skeletal muscle mass were the significant factors negatively predicting 2-hour postload plasma glucose levels in Thai subjects with normal glucose tolerance.
Again and again, attempts have been made to find correlates of sex/gender differences in the human brain. Despite the insistence with which differences have been stated, empirical results have not been unequivocal: evidence for and against the influence of sex in the makeup of men's and women's brains has been presented. This article focuses on the relevance of sex/gender related differences in fMRI research, especially with regard to language processing. By discussing some crucial criteria from fMRI examinations, we demonstrate the existence of paradigmatic, methodological and statistical defaults that interfere with assessing the presence or absence of sex/gender differences. These criteria are, among others, the use of contrast analyses, the function of the variable sex/gender as a co-item and the "publication bias". It is argued that dealing with the sex/gender variable will, at least to some degree, inevitably lead to the detection of differences rather than to the detection of similarities.
We have conducted a crossover, randomized, double-blind dietary trial that tested the hypothesis that gender influences the response of plasma lipids, in particular high density lipoprotein (HDL) cholesterol, to dietary fat plus cholesterol. Twenty-six men and 25 women were matched for age, low density lipoprotein (LDL) cholesterol, triglyceride, and body mass index (BMI). After a 2-week baseline low-fat (27% of calories), low-cholesterol period, subjects were given two isocaloric liquid supplements for 3 weeks each, one containing 31 g fat (56% saturated) and 650 mg cholesterol, and the other fat free. The baseline HDL2 cholesterol level was significantly higher in women: 0.41 versus 0.26 mmol/l (p less than 0.01). Importantly, women also showed a greater rise in HDL2 cholesterol concentration with the fat/cholesterol supplement: 0.09 versus 0.03 mmol/l (p less than 0.01). The greater increment in women was related to their higher baseline HDL2 cholesterol levels. With the fat and cholesterol supplement, LDL cholesterol values rose from 3.76 to 4.04 mmol/l in women and from 3.77 to 4.13 mmol/l in men. The baseline LDL cholesterol value was found to account for about 35% of the variance in the rise in LDL cholesterol level with fat and cholesterol supplementation in both men and women less than 50 years. In men only, there was a significant effect of age: the change in LDL cholesterol with the fat/cholesterol supplement was 0.16 mmol/l in those less than 50 and 0.54 mmol/l in those greater than 50 years old (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Many agricultural populations are subject to chronic or seasonal undernutrition, reproductive women and children often being most vulnerable. This paper presents quantitative and qualitative data on food consumption, food distribution practices, food taboos, garden sizes and work effort to show how Lese horticulturalist women living in the Ituri Forest of northeast Democratic Republic of Congo attempt to alleviate nutritional stress. The Lese experience an annual hunger season when approximately one quarter of the population suffer from energy deficiency. Nutritional intake is also compromised by a complex system of food taboos against meat from wild forest animals. Anthropometric data collected over several years suggest that Lese women suffer from nutritional stress more than men during the hunger season. They also have more food taboos particularly during pregnancy and lactation. Their low fertility is compounded by nutritional stress. Despite these inequities, Lese women use several strategies to improve their food intake. Since they are responsible for all household cooking, they manipulate food portions. During the hunger season, they snack frequently, and increase their consumption of palliative foods. Women with more food taboos plant larger gardens to supplement their diet with vegetable foods. Although this results in their consumption of more daily protein, they work harder compared to women with smaller gardens. Women cheat in their adherence to specific food taboos by actively discounting them, or by eating prophylactic plants that supposedly prevent the consequences (usually illness) of eating tabooed foods. In addition, women resort to subterfuge to access desirable resources. Lese women do not reduce work effort during the hunger season, but adapt physiologically by reducing resting metabolic rates during periods of weight loss. These results point to the ability of Lese women to minimize the ecological and cultural constraints on their nutrition. More data, however, are required to assess the long-term effectiveness of these strategies.
Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis. Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys. Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. When they do so, the resultant risk for cardiac events is often substantially elevated, equaling that associated with previously established risk factors for CAD, such as hypertension and hypercholesterolemia.
Men in the United States suffer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these differences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these differences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signifiers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context influence the kind of masculinity that men construct and contribute to differential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.
Interviews undertaken in a study of consumers' views on food quality were re-analysed with special reference to the narrative themes raised by consumers when describing their views on the quality of meat and meat products. Negative attitudes towards meat were frequently expressed, and with more emotion than comments about any other food. Being based on interviews made prior to the BSE crisis, the study gives evidence that the popularity of meat was in a process of decline already before this crisis. It was found that critical attitudes centred around the following four themes: the manner in which meat is produced and processed in modern agriculture and industry, the fact that meat derives from animals, the food culture associated with meat eating and the perceived unhealthiness of meat. In spite of their critical attitudes, the interviewees nevertheless consumed meat on a daily basis. This study suggests that negative attitudes towards meat are not necessarily associated with decreased meat consumption, but are associated with a tendency to re-structure meals with special reference to the role assigned to meat.
Most studies suggest that diabetes is a stronger coronary heart disease (CHD) risk factor for women than men, but few have adjusted their results for classic CHD risk factors: age, hypertension, total cholesterol level, and smoking.
To establish an accurate estimate of the odds ratio for fatal and nonfatal CHD due to diabetes in both men and women.
We compared the summary odds ratio for CHD mortality and the absolute rates of CHD mortality in men and women with diabetes. We searched the MEDLINE and Cochrane Collaboration databases and bibliographies of relevant articles and consulted experts. Studies that included a nondiabetic control group and provided sex-specific adjusted results for CHD mortality, nonfatal myocardial infarction, and cardiovascular or all-cause mortality were included. Of 4578 articles identified, 232 contained primary data, and 182 were excluded. Two reviewers recorded data on study characteristics, quality, and outcomes from 50 studies.
Sixteen studies met all inclusion criteria. In unadjusted and age-adjusted analyses, odds of CHD death were higher in women than men with diabetes. From 8 prospective studies, the multivariate-adjusted summary odds ratio for CHD mortality due to diabetes was 2.3 (95% confidence interval, 1.9-2.8) for men and 2.9 (95% confidence interval, 2.2-3.8) for women. There were no significant sex differences in the adjusted risk associated with diabetes for CHD mortality, nonfatal myocardial infarction, and cardiovascular or all-cause mortality. Absolute CHD death rates were higher for diabetic men than women in every age strata except the very oldest.
The excess relative risk of CHD mortality in women vs men with diabetes was absent after adjusting for classic CHD risk factors, but men had more CHD deaths attributable to diabetes than women.