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Gender Inequalities in Health and Social Determinants

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 49754

Special Issue Editors


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Chief Guest Editor
Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain
Interests: gender inequalities in health; gender indicators; informal caregiving; gender-based analysis in health; women’s health; gender-sensitive research; gender in public health; qualitative health research

E-Mail Website1 Website2 Website3
Guest Editor
Department of Health Psychology, University of Alicante , 03690 San Vicente del Raspeig, Alicante, Spain
Interests: gender inequalities in health and their social determinants; gender-based analysis; gender and health promotion; men’s health and masculinities; qualitative research methods

E-Mail Website1 Website2
Guest Editor
Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain
Interests: gender inequalities in health and their social determinants; gender and health promotion; sexual and reproductive health; paternity, maternity and health inequalities; gender-based analysis in health; gender and intersectionality

E-Mail Website1 Website2
Guest Editor
Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain
Interests: gender inequalities in health and their social determinants; gender indicators in health; gender and caregiving; gender and intersectionality; gender-based analysis in health; gender-sensitive research

Special Issue Information

Dear Colleagues,

Women have higher life expectancy than men in similar socioeconomic conditions, but worse health status. Women more frequently suffer from chronic disorders and higher levels of disability, while men suffer more often life-threatening illnesses that cause premature death. The framework of social determinants of health establishes that gender is linked to different structural determinants that affect health, but also it is a category that orders values, norms, practices, and behaviors that affect exposure and vulnerability to different risk factors. An example is the study of the different constructions of masculinity and their impact on health, a growing interest area in public health. Furthermore, the analysis of how social norms and stereotypes introduce gender biases in healthcare is still critical. Health systems often neglect the needs of women even though they do much to protect health of families through their role as primary caregivers. It is important to address from the intersectionality approach the interrelation of gender with other axes of inequality. These topics are invited to this Special Issue, especially those that combine different gender indicators and research methodologies. Articles focused on the unequal impact of the COVID-19 pandemic on women and men's health also deserve special attention today.

Prof. Dr. María del Mar García-Calvente
Dr. Jorge Marcos Marcos
Dr. Gracia Maroto Navarro
Dr. María del Río Lozano
Guest Editors

Manuscript Submission Information

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Keywords

  • gender inequalities in health and their social determinants
  • gender-based analysis in health
  • gender indicators in health
  • gender and healthcare disparities
  • gender biases in healthcare
  • gender and intersectionality
  • men’s health and masculinities
  • gender and caregiving
  • gender-related health policies
  • health and gender-based interventions
  • gender and health promotion
  • gender and the COVID-19 pandemic

Published Papers (15 papers)

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Research

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23 pages, 3486 KiB  
Article
Do Multiple Sex/Gender Dimensions Play a Role in the Association of Green Space and Self-Rated Health? Model-Based Recursive Partitioning Results from the KORA INGER Study
by Lisa Dandolo, Klaus Telkmann, Christina Hartig, Sophie Horstmann, Sara Pedron, Lars Schwettmann, Peter Selsam, Alexandra Schneider, Gabriele Bolte and on behalf of the INGER Study Group
Int. J. Environ. Res. Public Health 2023, 20(7), 5241; https://doi.org/10.3390/ijerph20075241 - 23 Mar 2023
Viewed by 1784
Abstract
Exposure to green space has a positive impact on health. Whether sex/gender modifies the green space–health association has so far only been studied through the use of a binary sex/gender category; however, sex/gender should be considered more comprehensively as a multidimensional concept based [...] Read more.
Exposure to green space has a positive impact on health. Whether sex/gender modifies the green space–health association has so far only been studied through the use of a binary sex/gender category; however, sex/gender should be considered more comprehensively as a multidimensional concept based on theoretical approaches. We therefore explored whether sex/gender, operationalized through multiple sex/gender- and intersectionality-related covariates, modifies the green space–self-rated health association. We collected data from participants involved in the German KORA study (Cooperative Health Research in the Region of Augsburg) in 2019. Self-rated health was assessed as a one-question item. The availability of green spaces was measured subjectively as well as objectively. The multiple sex/gender- and intersectionality-related covariates were measured via self-assessment. To analyze the data, we used model-based recursive partitioning, a decision tree method that can handle complex data, considering both multiple covariates and their possible interactions. We showed that none of the covariates operationalizing an individual sex/gender self-concept led to subgroups with heterogeneous effects in the model-based tree analyses; however, we found effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective, although they did not show the intersectional structuring of sex/gender dimensions. In one identified subgroup, those with a lower education level or a feeling of discrimination based on social position showed a positive green space–self-rated health association, while participants with a higher education level or no feeling of discrimination based on social position had a high level of self-rated health regardless of the availability of green spaces. Model-based recursive partitioning has the potential to detect subgroups exhibiting different exposure–outcome associations, with the possibility of integrating multiple sex/gender- and intersectionality-related covariates as potential effect modifiers. A comprehensive assessment of the relevance of sex/gender showed effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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14 pages, 1445 KiB  
Article
Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents
by Raffaela M. Flury, Lara Brockhus, Martin Müller, Jonathan Henssler, Aristomenis K. Exadaktylos and Jolanta Klukowska-Rötzler
Int. J. Environ. Res. Public Health 2022, 19(20), 13196; https://doi.org/10.3390/ijerph192013196 - 13 Oct 2022
Cited by 2 | Viewed by 1271
Abstract
Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems [...] Read more.
Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. Methods: We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. Results: Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05–0.21, p < 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21–0.37, p < 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65–3.83, p < 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41–0.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p < 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44–0.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04–2.72, p = 0.035). Conclusions: Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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24 pages, 434 KiB  
Article
Association of Male Partners’ Gender-Equitable Attitudes and Behaviors with Young Mothers’ Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC
by Anastasia J. Gage, Francine E. Wood, Darling Kittoe, Preethi Murthy and Rianne Gay
Int. J. Environ. Res. Public Health 2022, 19(19), 12182; https://doi.org/10.3390/ijerph191912182 - 26 Sep 2022
Cited by 1 | Viewed by 1655
Abstract
Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners’ gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes [...] Read more.
Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners’ gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes among first-time mothers aged 15–24 in Kinshasa, Democratic Republic of the Congo. Participants were 1335 couples who were successfully interviewed in the Momentum project’s 2018 baseline and 2020 endline surveys. Multivariable regression models were used to analyze predictors of postpartum FP discussion and use, shared MNH decision making, completion of the maternal health continuum of care, and exclusive breastfeeding. Male involvement in maternal health was significantly associated with FP discussion and shared decision making. Male partners’ willingness to be involved in routine childcare and shared decision making were significant positive predictors of exclusive breastfeeding. Postpartum FP outcomes were shaped by the intersection of marital status and male partners’ gender-equitable attitudes, intimate partner violence perpetration, and willingness to engage in routine childcare activities to constitute advantage for some outcomes and disadvantage for others. Interventions must use multiple measures to better understand how young mothers’ health outcomes are shaped by their male partners’ gender-related attitudes and behaviors. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
12 pages, 934 KiB  
Article
Work–Life Balance and Teleworking: Lessons Learned during the Pandemic on Gender Role Transformation and Self-Reported Well-Being
by Ana M. González Ramos and José María García-de-Diego
Int. J. Environ. Res. Public Health 2022, 19(14), 8468; https://doi.org/10.3390/ijerph19148468 - 11 Jul 2022
Cited by 12 | Viewed by 3632
Abstract
Lockdown during COVID-19 forced the emergence of a new scenario, with men and women teleworkers spending all their time at home. The purpose of this study is to address whether this situation has triggered a transformation in gender roles and self-reported well-being, comparing [...] Read more.
Lockdown during COVID-19 forced the emergence of a new scenario, with men and women teleworkers spending all their time at home. The purpose of this study is to address whether this situation has triggered a transformation in gender roles and self-reported well-being, comparing the responses of male and female respondents to the EUROFOUND April to July 2020 survey. The analysis addresses cultural differences across European regions related to diverse gender regimes, employment status, and the possibility of teleworking. It explores male and female well-being through life satisfaction, the distance between happiness and life satisfaction, and rates their feelings about work–life balance. Findings on life satisfaction display a low transformation of social roles, with women still worrying about work–life balance, while men were more affected by the health crisis. Men self-report high life satisfaction across Europe compared to women, although unexpectedly, female freelancers in Northern and Southern European had a higher life satisfaction ratio than men. Both men and women teleworkers reported difficulties with managing work–life balance at home, despite women handling core care and household tasks. These findings suggest that women would have received more support from men, as they worked harder and longer hours during the lockdown, despite their weak position in the labor market. This would seem to be a propitious setting for men to have assumed more responsibility at home, resulting in a more equal distribution of roles at home. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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17 pages, 999 KiB  
Article
Frequency, Types, and Manifestations of Partner Sexual Violence, Non-Partner Sexual Violence and Sexual Harassment: A Population Study in Spain
by Guadalupe Pastor-Moreno, Isabel Ruiz-Pérez, Luis Sordo and Jesús Henares-Montiel
Int. J. Environ. Res. Public Health 2022, 19(13), 8108; https://doi.org/10.3390/ijerph19138108 - 01 Jul 2022
Cited by 5 | Viewed by 2985
Abstract
Background: This study analyzes the frequency and sociodemographic characteristics associated with sexual violence by a partner/ex-partner (PSV), someone other than a partner or ex-partner (NPSV), or sexual harassment (SH). Methods: The study is based on the 2019 Macro-survey of Violence against Women conducted [...] Read more.
Background: This study analyzes the frequency and sociodemographic characteristics associated with sexual violence by a partner/ex-partner (PSV), someone other than a partner or ex-partner (NPSV), or sexual harassment (SH). Methods: The study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality among a sample of 9568 women age 16 or more years. Odds Ratios were calculated and multinomial logistic regression analyses were performed. Results: Forty-four women had suffered some kind of sexual violence over their lifetime, 9.2% had experienced PSV, 6.5% NPSV and 40.4% SH. More than 7% of women had been raped by a partner and 2.2% by another man. In the three groups, violence was associated with lower age and having a certified disability. NPSV and SH were significantly associated with a higher education and internet use. In NPSV, 9.2% of cases were reported to the police and 3.9% were reported to the courts. In SH, 91.7% of women told a family member or a close friend and 4.2% reported it to the police or the courts. Conclusions: A greater emphasis needs to be placed on reporting sexual violence in its various forms. Rape within intimate partnerships ought to be investigated and studied in greater depth. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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25 pages, 1644 KiB  
Article
Decision Tree Analyses to Explore the Relevance of Multiple Sex/Gender Dimensions for the Exposure to Green Spaces: Results from the KORA INGER Study
by Lisa Dandolo, Christina Hartig, Klaus Telkmann, Sophie Horstmann, Lars Schwettmann, Peter Selsam, Alexandra Schneider, Gabriele Bolte and on behalf of the INGER Study Group
Int. J. Environ. Res. Public Health 2022, 19(12), 7476; https://doi.org/10.3390/ijerph19127476 - 18 Jun 2022
Cited by 4 | Viewed by 2057
Abstract
Recently, attention has been drawn to the need to integrate sex/gender more comprehensively into environmental health research. Considering theoretical approaches, we define sex/gender as a multidimensional concept based on intersectionality. However, operationalizing sex/gender through multiple covariates requires the usage of statistical methods that [...] Read more.
Recently, attention has been drawn to the need to integrate sex/gender more comprehensively into environmental health research. Considering theoretical approaches, we define sex/gender as a multidimensional concept based on intersectionality. However, operationalizing sex/gender through multiple covariates requires the usage of statistical methods that are suitable for handling such complex data. We therefore applied two different decision tree approaches: classification and regression trees (CART) and conditional inference trees (CIT). We explored the relevance of multiple sex/gender covariates for the exposure to green spaces, measured both subjectively and objectively. Data from 3742 participants from the Cooperative Health Research in the Region of Augsburg (KORA) study were analyzed within the INGER (Integrating gender into environmental health research) project. We observed that the participants’ financial situation and discrimination experience was relevant for their access to high quality public green spaces, while the urban/rural context was most relevant for the general greenness in the residential environment. None of the covariates operationalizing the individual sex/gender self-concept were relevant for differences in exposure to green spaces. Results were largely consistent for both CART and CIT. Most importantly we showed that decision tree analyses are useful for exploring the relevance of multiple sex/gender dimensions and their interactions for environmental exposures. Further investigations in larger urban areas with less access to public green spaces and with a study population more heterogeneous with respect to age and social disparities may add more information about the relevance of multiple sex/gender dimensions for the exposure to green spaces. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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14 pages, 686 KiB  
Article
Relationship between Vehicle Safety Ratings and Drivers’ Injury Severity in the Context of Gender Disparity
by Wen Fu and Jaeyoung Lee
Int. J. Environ. Res. Public Health 2022, 19(10), 5885; https://doi.org/10.3390/ijerph19105885 - 12 May 2022
Cited by 1 | Viewed by 1522
Abstract
Previous studies have analyzed the relationship between vehicle safety ratings from impact tests and actual crash injury severity. Nevertheless, no study has investigated the relationship in the context of gender disparity. The main objective of this paper is to explore the validity of [...] Read more.
Previous studies have analyzed the relationship between vehicle safety ratings from impact tests and actual crash injury severity. Nevertheless, no study has investigated the relationship in the context of gender disparity. The main objective of this paper is to explore the validity of the 5-star ratings of the U.S. National Highway Traffic Safety Administration, which describes vehicles’ protectiveness, using actual traffic crash data by gender. Random parameter models are developed using 2015–2020 two-vehicle crash data from Maryland, United States. According to the data, over 90% of vehicles have 4–5 stars in overall, front-impact, and side-impact 5-star ratings. After controlling other factors, it is shown that woman drivers are more likely to be seriously injured in two-vehicle crashes than men drivers when using vehicles with the same 5-star safety ratings. Moreover, there is significant individual heterogeneity in the effect of vehicles with different 5-star safety ratings on driver injury severity. Using vehicles with more stars can reduce the risk of being seriously injured for most man drivers. However, the probability of woman drivers being seriously injured is reduced by approximately 5% on average by using vehicles with higher star ratings in the overall and front-impact 5-star rating, and individual heterogeneity shows a difference of nearly 50% in positive and negative effects. The overall and front-impact 5-star ratings of vehicles could not provide reasonable information as the safety performance of vehicles in traffic crashes for woman drivers. On the other hand, drivers’ residence, driving characteristics, crash types, and environmental characteristics are significantly associated with the injury severity. It is expected that the results from this study will contribute to guide a better vehicle safety design for both men and women. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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18 pages, 1240 KiB  
Article
Temporal Dimensions of Job Quality and Gender: Exploring Differences in the Associations of Working Time and Health between Women and Men
by Paula Franklin, Wouter Zwysen and Agnieszka Piasna
Int. J. Environ. Res. Public Health 2022, 19(8), 4456; https://doi.org/10.3390/ijerph19084456 - 07 Apr 2022
Cited by 3 | Viewed by 2716
Abstract
Research shows strong links between working time organization and workers’ health outcomes. Working time is also known to be highly gendered, with men and women working to different schedules. This article merges these two strands of research and takes a gender-based approach to [...] Read more.
Research shows strong links between working time organization and workers’ health outcomes. Working time is also known to be highly gendered, with men and women working to different schedules. This article merges these two strands of research and takes a gender-based approach to investigating the relationship between temporal job quality and self-reported health in Europe. First, the sixth European Working Conditions Survey (EWCS) is used to establish the relationship between temporal dimensions of job quality and health and well-being outcomes for employed women and men. This is then corroborated using larger samples and more restricted measures of job quality drawn from micro-data from the 2019–2020 EU Labor Force Survey (LFS). The analyses show that good temporal job quality is positively associated with health and subjective well-being for both women and men, but this effect is significantly stronger for women, who are also at a greater risk of exposure to low control over working time and time under-employment. The findings highlight the importance of studying the impact of working and employment conditions on health from gender perspective, and the need for further exploration of job quality due to changes in the spatio-temporal organization of work during and beyond the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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12 pages, 731 KiB  
Article
The Influence of Economic Factors on the Relationship between Partnership Status and Health: A Gender Approach to the Spanish Case
by Jordi Gumà-Lao
Int. J. Environ. Res. Public Health 2022, 19(5), 2975; https://doi.org/10.3390/ijerph19052975 - 03 Mar 2022
Cited by 2 | Viewed by 1770
Abstract
This study explores the relevance of economic factors (e.g., a household’s economic capacity and the prevailing economic context) to understand the relationship between the partnership status and the health of Spanish adult women and men (age 30–59). To do so, it draws on [...] Read more.
This study explores the relevance of economic factors (e.g., a household’s economic capacity and the prevailing economic context) to understand the relationship between the partnership status and the health of Spanish adult women and men (age 30–59). To do so, it draws on cross-sectional data from the Spanish sample of the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2005, 2010, and 2015 (i.e., before, during, and after the 2008–2012 economic recession). The results reveal dissimilar patterns of association between partnership status and both the health of, and the economic difficulties faced by Spanish women and men in each of the three years studied. Most notably, the partnership status of Spanish women has a greater impact on their likelihood of experiencing economic difficulties and poor health than does that of their male counterparts. Additionally, women are also more likely to experience economic difficulties during and after the economic recession. The disadvantageous situation of Spanish women in the public sphere is shown to have a negative impact on their ability to cope with the economic difficulties associated with the end of a union and a contextual recession. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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18 pages, 383 KiB  
Article
Caregiving and Caregiver Health 1 Year into the COVID-19 Pandemic (CUIDAR-SE Study): A Gender Analysis
by María Del Río-Lozano, Mar García-Calvente, Belén Elizalde-Sagardia and Gracia Maroto-Navarro
Int. J. Environ. Res. Public Health 2022, 19(3), 1653; https://doi.org/10.3390/ijerph19031653 - 31 Jan 2022
Cited by 8 | Viewed by 2756
Abstract
The COVID-19 pandemic has highlighted the importance of informal care and shown that women continue to shoulder the brunt of responsibilities in this area. In this study, we analyzed differences in caregiving and self-perceived health in a group of informal male and female [...] Read more.
The COVID-19 pandemic has highlighted the importance of informal care and shown that women continue to shoulder the brunt of responsibilities in this area. In this study, we analyzed differences in caregiving and self-perceived health in a group of informal male and female caregivers 1 year into the COVID-19 pandemic. We performed a cross-sectional survey of 261 informal caregivers (165 women and 96 men) in two regions of Spain using computer-assisted telephone interviewing between February and April 2021. We performed descriptive, bivariate, and multivariate analyses to calculate the odds of poor self-perceived health according to different caregiver, care recipient, and caregiving characteristics. We also analyzed the perceived effects of the pandemic on caregiving, caregiver health, and other aspects of life. Compared with male caregivers, female caregivers were more likely to experience increases in caregiving intensity and burden and a decline in self-perceived health as a result of the pandemic. Men providing high-intensity care, however, also reported deteriorated health. Men experienced fewer reductions in informal support, a factor that exerted a protective health effect. Women, by contrast, experienced a reduction in all support systems and in this case, a third-level education exerted a protective effect. Our results provide key insights that should be taken into account to design gender-based interventions aimed at supporting already stretched and burdened caregivers. A greater sharing of responsibilities and more resources are needed. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
14 pages, 382 KiB  
Article
Gender Differences in the Diagnosis of Dyslipidemia: ESCARVAL-GENERO
by Cristina Soriano-Maldonado, Adriana Lopez-Pineda, Domingo Orozco-Beltran, Jose A. Quesada, Jose L. Alfonso-Sanchez, Vicente Pallarés-Carratalá, Jorge Navarro-Perez, Vicente F. Gil-Guillen, Jose M. Martin-Moreno and Concepción Carratala-Munuera
Int. J. Environ. Res. Public Health 2021, 18(23), 12419; https://doi.org/10.3390/ijerph182312419 - 25 Nov 2021
Cited by 12 | Viewed by 2466
Abstract
Evidence shows that objectives for detecting and controlling dyslipidemia are not being effectively met, and outcomes differ between men and women. This study aimed to assess gender-related differences in diagnostic inertia around dyslipidemia. This ambispective, epidemiological, cohort registry study included adults who presented [...] Read more.
Evidence shows that objectives for detecting and controlling dyslipidemia are not being effectively met, and outcomes differ between men and women. This study aimed to assess gender-related differences in diagnostic inertia around dyslipidemia. This ambispective, epidemiological, cohort registry study included adults who presented to public primary health care centers in a Spanish region from 2008 to 2012, with dyslipidemia and without cardiovascular disease. Diagnostic inertia was defined as the registry of abnormal diagnostic parameters—but no diagnosis—on the person’s health record in a window of six months from inclusion. A total of 58,970 patients were included (53.7% women) with a mean age of 58.4 years in women and 57.9 years in men. The 6358 (20.1%) women and 4312 (15.8%) men presenting diagnostic inertia had a similar profile, although in women the magnitude of the association with younger age was larger. Hypertension showed a larger association with diagnostic inertia in women than in men (prevalence ratio 1.81 vs. 1.56). The overall prevalence of diagnostic inertia in dyslipidemia is high, especially in women. Both men and women have a higher risk of cardiovascular morbidity and mortality. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
17 pages, 718 KiB  
Article
Knowledge, Experience and Perception of Gender-Based Violence Health Services: A Mixed Methods Study on Adolescent Girls and Young Women in Tanzania
by Caroline Mtaita, Samuel Likindikoki, Maureen McGowan, Rose Mpembeni, Elvis Safary and Albrecht Jahn
Int. J. Environ. Res. Public Health 2021, 18(16), 8575; https://doi.org/10.3390/ijerph18168575 - 13 Aug 2021
Cited by 8 | Viewed by 4288
Abstract
Many adolescent girls and young women (AGYW) experience gender-based violence (GBV) in Tanzania and only few seek GBV health services following violence. The objectives of our study are (1) to evaluate knowledge of gender-based violence among AGYW, (2) to explore their perceptions of [...] Read more.
Many adolescent girls and young women (AGYW) experience gender-based violence (GBV) in Tanzania and only few seek GBV health services following violence. The objectives of our study are (1) to evaluate knowledge of gender-based violence among AGYW, (2) to explore their perceptions of and experiences with GBV health service quality and (3) to evaluate access to comprehensive GBV services. This study employed an explanatory, sequential mixed methods design in two districts of Dar es Salaam, Tanzania (Kinondoni and Temeke). A quantitative cross-sectional survey among AGYW (n = 403) between 15–24 years old was performed to assess their knowledge of GBV as well as perceptions of and experiences with GBV health services. The quantitative data was complemented by 20 semi-structured in-depth interviews with participants. Out of 403 study participants, more than three quarters (77.9%) had moderate to good knowledge of how GBV is defined and what constitutes gender-based violence. However, few participants (30.7%, n = 124) demonstrated knowledge of GBV health services offered at local health facilities. For example, only 10.7% (n = 43) of participants reported knowledge of forensic evidence collection. Additionally, of 374 participants (93% of total participants) who reported to have received GBV education sessions, only 66% accessed GBV health services (n = 247) and about half of these (52.7%, n = 130) were satisfied with these services. The study indicated that—despite good knowledge about what constituted GBV—knowledge about the roles and availability of GBV health services was limited and utilization of GBV health services remained low. Coordinated actions need to be strengthened to reach AGYW who remain unaware of GBV health services offered at health facilities by improving GBV service quality, bettering interventions aimed at reducing GBV among AGYW in Tanzania, and scaling-up integrated service models, such as GBV one-stop centers. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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18 pages, 1251 KiB  
Article
Job Stress and Mental Well-Being among Working Men and Women in Europe: The Mediating Role of Social Support
by Aziz Mensah
Int. J. Environ. Res. Public Health 2021, 18(5), 2494; https://doi.org/10.3390/ijerph18052494 - 03 Mar 2021
Cited by 31 | Viewed by 8784
Abstract
Job stress is one of the most common health issues in many organizations, particularly among women. Moreover, an increase in job stress with low social support may have an adverse effect on mental well-being. This study investigated the mediating role of social support [...] Read more.
Job stress is one of the most common health issues in many organizations, particularly among women. Moreover, an increase in job stress with low social support may have an adverse effect on mental well-being. This study investigated the mediating role of social support in the relationship between job stress and mental well-being among working men and women in Europe. A cross sectional data set from the 2015 6th European Working Conditions Survey on 14,603 men and 15,486 women from 35 countries in Europe was analyzed. The study applied Hayes process macro 4 modelling technique to estimate the direct, indirect, and total effects of job stress on mental well-being among working adults. The study further used the Hayes process macro 59 model to estimate the gender difference in the mediating effect. The results showed that job stress had a direct negative effect on mental well-being among workers in Europe (β=0.2352,p<0.05). However, there were significant gender differences in the relationship (β=0.3729,p<0.05), with women having higher effect size than men (men: β=3.9129,p<0.05 vs. women: β=4.2858,p<0.05). Furthermore, the indirect effect showed that social support mediated the relationship of job stress on mental well-being (β=0.0181, CI: 0.02120.0153). Nevertheless, the mediating effect of social support did not differ among men and women. This study provides evidence that job stress has a negative impact on mental well-being among working adults, and social support mediates this relationship. The results highlight the importance of the role of support from colleagues and supervisors at the work place, which may help reduce job stress, and improve mental well-being. Sociological and occupational health researchers should not ignore the role of gender when studying work environment and jobs in general. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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10 pages, 354 KiB  
Article
Diagnosis and Treatment of Depression in Spain: Are There Gender Inequalities?
by Andrea Cabezas-Rodríguez, Amaia Bacigalupe and Unai Martín
Int. J. Environ. Res. Public Health 2020, 17(24), 9232; https://doi.org/10.3390/ijerph17249232 - 10 Dec 2020
Cited by 11 | Viewed by 3184
Abstract
It is well known that women are more likely than men to be diagnosed with depression and to consume antidepressants. The factors related to the medicalisation of depression and their social distribution remain unclear. The aim of this study was to analyse gender [...] Read more.
It is well known that women are more likely than men to be diagnosed with depression and to consume antidepressants. The factors related to the medicalisation of depression and their social distribution remain unclear. The aim of this study was to analyse gender inequalities in the medicalisation of depression from an intersectional perspective. This was a cross-sectional study based on data from the European Health Survey relating to Spain. Gender inequalities were calculated using prevalence ratios of women compared to men with a diagnosis of depression and antidepressant use, adjusted for age, depressive symptoms, primary care visits and diagnosis of depression in the case of antidepressant use. After adjustments, the diagnosis of depression and the use of antidepressants were more prevalent in women, especially of lower socioeconomic levels. Gender inequalities in the diagnosis of depression also increased with decreasing level of education. Regarding the use of antidepressants, gender inequalities were not significant in university graduates and people of higher social. The gender inequalities found in the diagnosis and treatment of depression cannot be completely attributed to a higher level of depressive symptoms in women or their greater frequency of visits to primary care. Inequalities are greater in more vulnerable social groups. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)

Review

Jump to: Research

12 pages, 650 KiB  
Review
Have Policies Tackled Gender Inequalities in Health? A Scoping Review
by Nuria Crespí-Lloréns, Ildefonso Hernández-Aguado and Elisa Chilet-Rosell
Int. J. Environ. Res. Public Health 2021, 18(1), 327; https://doi.org/10.3390/ijerph18010327 - 05 Jan 2021
Cited by 17 | Viewed by 5110
Abstract
Gender is recognized as one of the most relevant determinants of health inequalities. This scoping review sought to identify and analyse policies, either implemented or formulated as proposals, which aimed to reduce gender inequalities in health. We searched Medline, Web of Science, and [...] Read more.
Gender is recognized as one of the most relevant determinants of health inequalities. This scoping review sought to identify and analyse policies, either implemented or formulated as proposals, which aimed to reduce gender inequalities in health. We searched Medline, Web of Science, and Scielo. Of 2895 records, 91 full text articles were analysed, and 33 papers were included. Of these papers, 22 described the process of formulation, implementation, or evaluation of policies whose aim was to reduce gender inequalities in health; six focused on recommendations, and the remaining five dealt with both issues. Our review showed that the policies aimed at reducing gender inequalities in health, either implemented or formulated as proposals, are scarce. Moreover, despite some success, overall progress has been slow. The studies show failures in design and particularly in the implementation process. We found a lack of awareness and capacity in the policy-making progress, under-financing, bureaucratization, shortage of relevant data, and absence of women’s participation in decision-making. Therefore, an emphasis on the design and implementation of gender-sensitive policies seems essential to advance gender equality in health. This scoping review gathers evidence to support the design of such policies and recommendations that can facilitate their implementation. Full article
(This article belongs to the Special Issue Gender Inequalities in Health and Social Determinants)
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