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Gender-related variables for health research

Mathias W. Nielsen, Marcia L. Stefanick, Diana Peragine and 10 more

Biology of Sex Differences · 2021 · CC BY

doi:10.1186/s13293-021-00366-3

Abstract

Background. In this paper, we argue for Gender as a Sociocultural Variable (GASV) as a complement to Sex as a Biological Variable (SABV). Sex (biology) and gender (sociocultural behaviors and attitudes) interact to influence health and disease processes across the lifespan—which is currently playing out in the COVID-19 pandemic. This study develops a gender assessment tool—the Stanford Gender-Related Variables for Health Research—for use in clinical and population research, including large-scale health surveys involving diverse Western populations. While analyzing sex as a biological variable is widely mandated, gender as a sociocultural variable is not, largely because the field lacks quantitative tools for analyzing the influence of gender on health outcomes.

Methods. We conducted a comprehensive review of English-language measures of gender from 1975 to 2015 to identify variables across three domains: gender norms, gender-related traits, and gender relations. This yielded 11 variables tested with 44 items in three US cross-sectional survey populations: two internet-based (N = 2051; N = 2135) and a patient-research registry (N = 489), conducted between May 2017 and January 2018.

Results. Exploratory and confirmatory factor analyses reduced 11 constructs to 7 gender-related variables: caregiver strain, work strain, independence, risk-taking, emotional intelligence, social support, and discrimination. Regression analyses, adjusted for age, ethnicity, income, education, sex assigned at birth, and self-reported gender identity, identified associations between these gender-related variables and self-rated general health, physical and mental health, and health-risk behaviors.

Conclusion. Our new instrument represents an important step toward developing more comprehensive and precise survey-based measures of gender in relation to health. Our questionnaire is designed to shed light on how specific gender-related behaviors and attitudes contribute to health and disease processes, irrespective of—or in addition to—biological sex and self-reported gender identity. Use of these gender-related variables in experimental studies, such as clinical trials, may also help us understand if gender factors play an important role as treatment-effect modifiers and would thus need to be further considered in treatment decision-making.

Supplementary Information. The online version contains supplementary material available at 10.1186/s13293-021-00366-3.

References 85

  1. 1.

    Wizemann TM, Pardue M-L. Exploring the biological contributions to human health: does sex matter? 2001.

    Not in our library

  2. 2.

    Klein SL, Schiebinger L, Stefanick ML, Cahill L, Danska J, de Vries GJ, Kibbe MR, McCarthy MM, Mogil JS, Woodruff TK, Zucker I. Opinion: sex inclusion in basic research drives discovery. PNAS. 2015;112(17):5257-5258.

    Not in our library10.1073/pnas.1502843112

  3. 3.

    Gender, Sex and Health Research Guide: A tool for CIHR applicants. Canadian Institutes of Health Research. 2010. http://www.cihr-irsc.gc.ca/e/50836.html. Accessed 19 Jan 2021.

    Not in our library

  4. 4.

    Fact sheet: Gender Equality in Horizon 2020. European Commission. 2013. https://ec.europa.eu/programmes/horizon2020/sites/horizon2020/files/FactSheet_Gender_2.pdf. Accessed 19 Jan 2021.

    Not in our library

  5. 5.

    NOT-OD-15-102: Consideration of sex as a biological variable in NIH-funded research 2015. https://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-102.html. Accessed 28 Aug 2020.

    Not in our library

  6. 6.

    Madsen TE, Bourjeily G, Hasnain M, Jenkins M, Morrison MF, Sandberg K, Tong IL, Trott J, Werbinksi J, McGregor A. Sex-and gender-based medicine: the need for precise terminology. Gend Genome. 2017;1:122-128.

    Not in our library10.1089/gg.2017.0005

  7. 7.

    Kuhlmann E, Annadale E. Gender and healthcare. 2010.

    Not in our library

  8. 8.

    Hunt K, Annadale E. Gender and health: major themes in health and social welfare. 2012.

    Not in our library

  9. 9.

    Hunt K, Lewars H, Emslie C, Batty GD. Decreased risk of death from coronary heart disease amongst men with higher ‘femininity’ scores: a general population cohort study. Int J Epidemiol. 2007;36:612-620.

    Not in our library10.1093/ije/dym022

  10. 10.

    Pelletier R, Khan NA. Sex versus gender-related characteristics: which predicts outcome after acute coronary syndrome in the young? J Am Coll Cardiol. 2016;67:127-135.

    Not in our library10.1016/j.jacc.2015.10.067

  11. 11.

    Pelletier R, Ditto B, Pilote L. A composite measure of gender and its association with risk factors in patients with premature acute coronary syndrome. Psychosom Med. 2015;77(5):517-526.

    Not in our library10.1097/psy.0000000000000186

  12. 12.

    Bem SL. The measurement of psychological androgyny. J Consult Clin Psychol. 1974;42(2):155.

    Not in our library10.1037/h0036215

  13. 13.

    Schiebinger L. The mind has no sex? Women in the origins of modern science. 1989.

    Not in our library10.1126/science.246.4936.1502

  14. 14.
    Gender norms and social norms: differences, similarities and why they matter in prevention science · 2019
    No notice
  15. 15.

    Wood W, Eagly AH. Two traditions of research on gender identity. Sex Roles. 2015;73(11):461-473.

    Not in our library10.1007/s11199-015-0480-2

  16. 16.

    Wood W, Eagly AH, Leary MR, Hoyle RH. Gender identity. Handbook of individual differences in social behavior. 2009;109-125.

    Not in our library

  17. 17.

    Connell R. Gender, health and theory: conceptualizing the issue, in local and world perspective. Soc Sci Med. 2012;74(11):1675-1683.

    Not in our library10.1016/j.socscimed.2011.06.006

  18. 18.

    Schiebinger L, Klinge I, Sánchez de Madariaga I, Paik HY, Schraudner M, Stefanick M. Term: Gender. Gendered Innovations in Science, Health & Medicine, Engineering, and Environment. 2021.

    Not in our library

  19. 19.

    Tannenbaum C, Ellis RP, Eyssel F, Zou J, Schiebinger L. Sex and gender analysis improves science and engineering. Nature. 2019;575:137-146.

    Not in our library10.1038/s41586-019-1657-6

  20. 20.

    Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, Zewdie D, Darmstadt GL, Greene ME, Hawkes S, Heise L, Henry S, Heymann J, Klugman J, Levine R, Raj A, Gupta GR. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019;393(10189):2440-2454.

    Not in our library10.1016/s0140-6736(19)30652-x

  21. 21.

    Connell RW, Pearse R. Gender: in world perspective. 2014.

    Not in our library

  22. 22.

    Cook N. Gender relations in global perspective: essential readings. 2007.

    Not in our library

  23. 23.

    Hyde JS, Bigler RS, Joel D, Tate CC, van Anders SM. The future of sex and gender in psychology: five challenges to the gender binary. Am Psychol. 2019;74(2):171-193.

    Not in our library10.1037/amp0000307

  24. 24.

    Lee PH, Stewart SM, Lun VMC, Bond MH, Yu X, Lam TH. Validating the Concord Index as a measure of family relationships in China. J Fam Psychol. 2012;26(6):906-915.

    Not in our library10.1037/a0029994

  25. 25.

    Jackson FM. The development of a race and gender-specific stress measure for African-American women: Jackson, Hogue, Phillips contextualized stress measure. Ethn Dis. 2005;15(4):594-600.

    Not in our library

  26. 26.

    Wong YJ, Shea M, LaFollette JR, Hickman SJ, Cruz N, Boghokian T. The inventory of subjective masculinity experiences: development and psychometric properties. J Mens Stud. 2011;19(3):236-255.

    Not in our library10.3149/jms.1903.236

  27. 27.

    Zuckerman M. The development of an affect adjective check list for the measurement of anxiety. J Consult Psychol. 1960;24(5):457-462.

    Not in our library10.1037/h0042713

  28. 28.

    Gillespie BL, Eisler RM. Development of the feminine gender role stress scale: a cognitive-behavioral measure of stress, appraisal, and coping for women. Behav Modif. 1992;16(3):426-438.

    Not in our library10.1177/01454455920163008

  29. 29.

    Mahalik JR, Locke BD, Ludlow LH, Diemer MA, Scott RP, Gottfried M, Freitas G. Development of the conformity to masculine norms inventory. Psychol Men Masculinity. 2003;4(1):3.

    Not in our library10.1037/1524-9220.4.1.3

  30. 30.

    Mahalik JR, Morray EB, Coonerty-Femiano A, Ludlow LH, Slattery SM, Smiler A. Development of the conformity to feminine norms inventory. Sex Roles. 2005;52(7–8):417-435.

    Not in our library10.1007/s11199-005-3709-7

  31. 31.

    Levant R, Richmond K, Cook S, House AT, Aupont M. The femininity ideology scale: factor structure, reliability, convergent and discriminant validity, and social contextual variation. Sex Roles. 2007;57(5–6):373-383.

    Not in our library10.1007/s11199-007-9258-5

  32. 32.

    Spence JT, Helmreich RL, Stapp J. The Personal Attributes Questionnaire: a measure of sex role stereotypes and masculinity-femininity. 1978.

    Not in our library

  33. 33.

    Hathaway SR, McKinley JC. Minnesota Multiphasic Personality Inventory; manual (revised). 1951.

    Not in our library

  34. 34.

    Storms MD. Sex role identity and its relationships to sex role attributes and sex role stereotypes. J Pers Soc Psychol. 1979;37(10):1779-1789.

    Not in our library10.1037/0022-3514.37.10.1779

  35. 35.

    Sugihara Y, Katsurada E. Gender role development in Japanese culture: diminishing gender role differences in a contemporary society. Sex Roles. 2002;47(9):443-452.

    Not in our library10.1023/a:1021648426787

  36. 36.

    Berzins JI, Welling MA, Wetter RE. A new measure of psychological androgyny based on the Personality Research Form. J Consult Clin Psychol. 1978;46(1):126.

    Not in our library10.1037/0022-006x.46.1.126

  37. 37.

    Berger A, Krahé B. Negative attributes are gendered too: conceptualizing and measuring positive and negative facets of sex-role identity. Eur J Soc Psychol. 2013;43(6):516-531.

    Not in our library

  38. 38.

    Basu J. Development of the Indian Gender Role Identity Scale. J Indian Acad Appl Psychol. 2010;36(1):25-34.

    Not in our library

  39. 39.

    O’Neil JM, Helms BJ, Gable RK, David L, Wrightsman LS. Gender-Role Conflict Scale: college men’s fear of femininity. Sex Roles. 1986;14(5–6):335-350.

    Not in our library

  40. 40.

    Thompson EH, Pleck JH. The structure of male role norms. Am Behav Sci. 1986;29(5):531-543.

    Not in our library10.1177/000276486029005003

  41. 41.

    Pleck JH, Sonenstein FL, Ku LC. Masculinity ideology: its impact on adolescent males’ heterosexual relationships. J Soc Issues. 1993;49(3):11-29.

    Not in our library10.1111/j.1540-4560.1993.tb01166.x

  42. 42.

    Arciniega GM, Anderson TC, Tovar-Blank ZG, Tracey TJG. Toward a fuller conception of machismo: development of a traditional machismo and caballerismo scale. J Couns Psychol. 2008;55(1):19-33.

    Not in our library10.1037/0022-0167.55.1.19

  43. 43.

    Mosher DL, Sirkin M. Measuring a macho personality constellation. J Res Pers. 1984;18(2):150-163.

    Not in our library10.1016/0092-6566(84)90026-6

  44. 44.

    Murnen SK, Bryne D. Hyperfemininity: measurement and initial validation of the construct. J Sex Res. 1991;28(3):479-489.

    Not in our library10.1080/00224499109551620

  45. 45.

    Levant RF, Good GE, Cook SW, O’Neil JM, Smalley KB, Owen K, Richmond K. The Normative Male Alexithymia Scale: measurement of a gender-linked syndrome. Psychol Men Masculinity. 2006;7(4):212-224.

    Not in our library10.1037/1524-9220.7.4.212

  46. 46.

    Burk LR, Burkhart BR, Sikorski JF. Construction and preliminary validation of the Auburn Differential Masculinity Inventory. Psychol Men Masculinity. 2004;5(1):4-17.

    Not in our library10.1037/1524-9220.5.1.4

  47. 47.

    Rummell CM, Levant RF. Masculine gender role discrepancy strain and self-esteem. Psychol Men Masculinity. 2014;15(4):419-426.

    Not in our library10.1037/a0035304

  48. 48.

    Janey BA, Kim T, Jampolskaja T, Khuda A, Larionov A, Maksimenko A, Sharapov D, Shipilova A. Development of the Russian Male Norms Inventory. Psychol Men Masculinity. 2013;14(2):138-147.

    Not in our library10.1037/a0028159

  49. 49.

    Wong YJ, Horn AJ, Gomory AM, Ramos E. Measure of men’s perceived inexpressiveness norms (M2PIN): scale development and psychometric properties. Psychol Men Masculinity. 2013;14(3):288.

    Not in our library10.1037/a0029244

  50. 50.

    Krosnick JA. Survey research. Annu Rev Clin Psychol. 1999;50(1):537-567.

    Not in our library10.1146/annurev.psych.50.1.537

  51. 51.

    Caprara GV, Steca P, Zelli A, Capanna C. A new scale for measuring adults’ prosocialness. Eur J Psychol Assess. 2005;21(2):77-89.

    Not in our library10.1027/1015-5759.21.2.77

  52. 52.

    Lippa R. Gender, nature, and nurture. 2005.

    Not in our library

  53. 53.
    Subjective caregiver burden: validity of the 10-item short version of the Burden Scale for Family Caregivers BSFC-s · 2014
    No notice
  54. 54.

    American Time Use Survey Tables. US Department of Labor, Bureau of Labor Statistics. 2017. https://www.bls.gov/tus/tables.htm. Accessed 4 June 2018.

    Not in our library

  55. 55.

    Karasek R, Theorell T. Healthy work: stress, productivity, and the reconstruction of working life. 1990.

    Not in our library

  56. 56.

    Ryckman RM, Hammer M, Kaczor LM, Gold JA. Construction of a Hypercompetitive Attitude Scale. J Pers Assess. 1990;55(3–4):630-639.

    Not in our library10.1207/s15327752jpa5503&4_19

  57. 57.

    Dohmen T, Falk A, Huffman D, Sunde U, Schupp J, Wagner GG. Individual risk attitudes: measurement, determinants, and behavioral consequences. J Eur Econ Assoc. 2011;9(3):522-550.

    Not in our library10.1111/j.1542-4774.2011.01015.x

  58. 58.

    Oyserman D, Coon HM, Kemmelmeier M. Rethinking individualism and collectivism: evaluation of theoretical assumptions and meta-analyses. Psychol Bull. 2002;128(1):3-72.

    Not in our library10.1037/0033-2909.128.1.3

  59. 59.

    Bakker W, van Oudenhoven JP, van der Zee KI. Attachment styles, personality, and Dutch emigrants’ intercultural adjustment. Eur J Personal. 2004;18(5):387-404.

    Not in our library10.1002/per.515

  60. 60.

    Clark MS, Oullette R, Powell MC, Milberg S. Recipient’s mood, relationship type, and helping. J Pers Soc Psychol. 1987;53(1):94-103.

    Not in our library10.1037/0022-3514.53.1.94

  61. 61.

    Triandis HC, Bontempo R, Villareal MJ, Asai M, Lucca N. Individualism and collectivism: cross-cultural perspectives on self-ingroup relationships. J Pers Soc Psychol. 1988;54(2):323-338.

    Not in our library10.1037/0022-3514.54.2.323

  62. 62.

    Ferguson E. Personality is of central concern to understand health: towards a theoretical model for health psychology. Health Psychol Rev. 2013;7(Suppl 1):S32-S70.

    Not in our library10.1080/17437199.2010.547985

  63. 63.

    Baron-Cohen S, Wheelwright S. The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord. 2004;34(2):163-175.

    Not in our library10.1023/b:jadd.0000022607.19833.00

  64. 64.

    Mayer JD, Salovey P, Caruso DR. Emotional intelligence: new ability or eclectic traits? Am Psychol. 2008;63(6):503-517.

    Not in our library10.1037/0003-066x.63.6.503

  65. 65.

    Salovey P, Mayer JD, Goldman SL, Turvey C, Palfai TP, Pennebaker JW. Emotional attention, clarity, and repair: exploring emotional intelligence using the trait meta-mood scale. Emotion, disclosure and health. 1995;125-154.

    Not in our library

  66. 66.

    Houston JM, McIntire SA, Kinnie J, Terry C. A factorial analysis of scales measuring competitiveness. Educ Psychol Meas. 2002;62(2):284-298.

    Not in our library10.1177/0013164402062002006

  67. 67.

    Investigators ENRICHD. Enhancing recovery in coronary heart disease (ENRICHD) study intervention: rationale and design. Psychosom Med. 2001;63(5):747-755.

    Not in our library

  68. 68.

    Drinking Levels Defined. National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2011. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking. Accessed 23 Oct 2019.

    Not in our library

  69. 69.

    Velicer WF. Determining the number of components from the matrix of partial correlations. Psychometrika. 1976;41(3):321-327.

    Not in our library10.1007/bf02293557

  70. 70.

    Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88(3):588-606.

    Not in our library10.1037/0033-2909.88.3.588

  71. 71.

    Cheung GW, Rensvold RB. Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model. 2002;9(2):233-255.

    Not in our library10.1207/s15328007sem0902_5

  72. 72.

    Yuan K-H, Bentler PM. On Chi-square difference and z tests in mean and covariance structure analysis when the base model is misspecified. Educ Psychol Meas. 2004;64(5):737-757.

    Not in our library10.1177/0013164404264853

  73. 73.

    Hu PLT, Bentler M. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1-55.

    Not in our library10.1080/10705519909540118

  74. 74.

    Gerbing DW, Hamilton JG. Viability of exploratory factor analysis as a precursor to confirmatory factor analysis. Struct Equ Model. 1996;3(1):62-72.

    Not in our library10.1080/10705519609540030

  75. 75.

    Chen F, Bollen KA, Paxton P, Curran PJ, Kirby JB. Improper solutions in structural equation models: Causes, consequences, and strategies. Sociol Methods Res. 2001;29(4):468-508.

    Not in our library10.1177/0049124101029004003

  76. 76.

    Gaskin J, Lim J. Master validity tool. AMOS Plug In; Gaskination’s StatWiki. 2016.

    Not in our library

  77. 77.

    Bagozzi RP, Yi Y. On the evaluation of structural equation models. J Acad Mark Sci. 1988;16(1):74-94.

    Not in our library10.1007/bf02723327

  78. 78.

    Parent MC, Moradi B. Confirmatory factor analysis of the conformity to feminine norms Inventory and Development of an Abbreviated Version: The Cfni-45. Psychol Women Q. 2010;34(1):97-109.

    Not in our library10.1111/j.1471-6402.2009.01545.x

  79. 79.

    Parent MC, Moradi B. An abbreviated tool for assessing conformity to masculine norms: Psychometric properties of the Conformity to Masculine Norms Inventory-46. Psychol Men Masculinity. 2011;12(4):339-353.

    Not in our library10.1037/a0021904

  80. 80.

    Crimmins EM, Kim JK, Solé-Auró A. Gender differences in health: results from SHARE, ELSA and HRS. Eur J Pub Health. 2011;21(1):81-91.

    Not in our library10.1093/eurpub/ckq022

  81. 81.

    Centers for Disease Control and Prevention. Vital signs: binge drinking prevalence, frequency, and intensity among adults-United States, 2010. MMWR Surveill Summ. 2012;61:14-19.

    Not in our library

  82. 82.

    Cherepanov D, Palta M, Fryback DG, Robert SA. Gender differences in health-related quality-of-life are partly explained by sociodemographic and socioeconomic variation between adult men and women in the US: evidence from four US nationally representative data sets. Qual Life Res. 2010;19:1115-1124.

    Not in our library10.1007/s11136-010-9673-x

  83. 83.

    Schiebinger L, Klinge I. Gendered innovations 2: how inclusive analysis contributes to research and innovation. 2020.

    Not in our library

  84. 84.

    Tadiri CP, Raparelli V, Abrahamowicz M, Kautzy-Willer A, Kublickiene K, Herrero M-T, Norris CM, Pilote L, COINGFWD Consortium. Methods for prospectively incorporating gender into health sciences research. J Clin Epidemiol. 2021;129:191-197.

    Not in our library10.1016/j.jclinepi.2020.08.018

  85. 85.

    Garg N, Schiebinger L, Jurafsky D, Zou J. Word embeddings quantify 100 years of gender and ethnic stereotypes. Proc Natl Acad Sci USA. 2018;115(16):E3635-E3644.

    Not in our library10.1073/pnas.1720347115

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