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Erica S. Breslau, Ph.D., M.P.H. is a scientific program director in the Applied Cancer Screening Research Branch, in the Behavioral Research Program within the Division of Cancer Control and Population Sciences at the National Cancer Institute. Dr. Breslau’s research interests focus on women’s oncology issues in general, and specifically as they pertain to the social, behavioral, and psychological influences associated with breast, gynecological and colorectal cancer screening. Recent efforts include ensuring that research is able to inform and improve the quality of health services among women disproportionately affected with breast and cervical cancer through the dissemination of evidence-based intervention approaches. She has conducted population-based research in the area of infectious diseases, including HIV/AIDS and sexually transmitted diseases in military populations, and has implemented large-scale health promotion approaches to improve the adoption of prevention practices. Dr. Breslau received her Ph.D. in Public Health from The Johns Hopkins Bloomberg School of Public Health, and her Master’s in Public Health from Tulane University, School of Public Health and Tropical Medicine.Vasilikie Demos is a Professor of Sociology at the University of Minnesota-Morris. She has studied ethnicity and gender in the United States and is currently completing a monograph on her study of Kytherian Greek women based on interviews in Greece and among immigrants in the United States and Australia. With Marcia Texler Segal, she is co-editor of the Advances in Gender Research series and Ethnic Women: A Multiple Status Reality (General Hall, 1994). She is a past president of Sociologists for Women in Society and of the North Central Sociological Association, and has been an Honorary Visiting Professor at the University of New South Wales in Australia.Heather Hartley is an Assistant Professor of Sociology at Portland State University. Dr. Hartley’s research interests include the sociology of health and medicine, the sociology of gender, the sociology of sexualities, and political sociology. Within these general specialty areas, her work focuses on the politics of women’s health, the pharmaceutical industry and the changing distribution of power within the health care system.Beth E. Jackson is a Doctoral Student in Sociology at York University in Toronto, Canada. Drawing on the traditions of feminist epistemologies and critical social studies of science, her dissertation research puts questions of epistemic authority and the nature of evidence into the specific context of public health and epidemiology. Specifically, she explores the conditions, contexts, tools and processes through which public health knowledge claims are made, by focusing on a particular technology of “population health” i.e. the National Population Health Survey (NPHS) (a longitudinal, biennial survey of the mental and physical health of Canadians and their use of health care services). Her research also speaks to policy implications of “situated” data and evidence – in this case, the implications of how “women’s health” is defined, and the extent to which a gendered analysis of health is considered in the construction and analysis of the NPHS.Jennie Jacobs Kronenfeld is a Professor in the Department of Sociology, Arizona State University. She conducts research in the areas of health policy, health across the life course, health behavior including preventive health behavior, and research into AIDS in geographically mobile populations. She has recently authored Health Care Policy: Issues and Trends (Praeger, 2002). She has conducted research in a variety of topics related to child health, including recruitment into CHIP (child health insurance program) and has published a book on the impact of school based health clinics, Schools and the Health of Children (Sage, 2000). She is a past president of Sociologists for Women in Society and past chair of the Medical Sociology Section of the American Sociological Association.Nancy Luke is an Assistant Professor of Research in the Population Studies and Training Center at Brown University and a Research Fellow in the Center for Population and Development Studies at Harvard University. Her primary research interest is the impact of social organization on health and well-being, particularly among women and adolescents. She is presently co-Principal Investigator of two research projects, both of which include collection of household survey and ethnographic data. A project in Kenya studies the influence of marriage and economic transactions on sexual behavior in an area of high HIV/AIDS prevalence, and a project in India examines women’s empowerment in a context where norms sanction intimate partner violence. She has also collaborated with numerous non-governmental organizations on research projects pertaining to reproductive health and gender equity in developing countries. Dr. Luke has a Ph.D. in Demography and Sociology from the University of Pennsylvania and an M.A. from Johns Hopkins School of Advanced International Studies.Deborah Parra-Medina, Ph.D., M.P.H., is Assistant Professor at the University of South Carolina with joint appointments in the Department of Health Promotion, Education and Behavior (HPEB) and Women’s Studies. She received her Ph.D. in Epidemiology at the UC San Diego, an M.P.H. in Health Promotion at San Diego State University and a B.A. in Social Science at UC Berkeley. She has extensive experience working with under-served communities, having worked in several chronic disease prevention and control efforts including cancer screening, tobacco control, weight loss and nutrition. Her research based on a participatory action model emphasizes the intersections of race, class and gender and the influence of socio-cultural environment on adaptive and maladaptive health behaviors. This perspective is exemplified in her current research. She is Principle Investigator of the SC American Legacy Empowerment (SCALE) Evaluation Project that is examining how to effectively engage youth as agents for social change within the context of tobacco prevention and control. Dr. Parra-Medina was recently awarded a pilot study grant from NCI, the broad goal of this project is to foster individual and organizational empowerment among the emerging Hispanic population in South Carolina in relation to cancer prevention and health promotion through the development of the South Carolina Hispanic Health Coalition: Partnership for Cancer Prevention (PCP).Colleen Reid recently completed her Ph.D. in Interdisciplinary Studies in health promotion research at the University of British Columbia in Vancouver, Canada. Her doctoral dissertation was a feminist action research project with a group of women on low income. Together they examined the relationship between exclusion and health, the women’s varied discourses of poverty and health, and the promises and challenges of engaging in feminist action research. Dr. Reid has also been involved in community health research projects with organizations including the Vancouver YWCA, AIDS Vancouver, Literacy B.C., and the B.C. Centre of Excellence for Women’s Health.Elianne Riska is von Willebrand-Fahlbeck Professor of Sociology at Åbo Akademi University, Finland since 1985. She has been Chairperson of the Department of Sociology 1985–1997 and Director of the Institute of Women’s Studies at Åbo Akademi University 1986–1993. Elianne Riska received her Ph.D. in Sociology at the State University of New York at Stony Brook in 1974. She was an Assistant Professor and an Associate Professor of Sociology in the Department of Sociology and College of Human Medicine at Michigan State University from 1974 to 1981. She was Academy Professor of the Academy of Finland 1997–2002. She is currently the President of the Research Committee of the Sociology of Health (RC15) of the International Sociological Association (2002–2006). Her most recent books are Gender, Work and Medicine (Sage, 1993), Gendered Moods (Routledge, 1995) and Medical Careers and Feminist Agendas: American, Scandinavian, and Russian Women Physicians (Aldine de Gruyter, 2001).Marcia Texler Segal is Associate Vice-Chancellor for Academic Affairs, Dean for Research and a Professor of Sociology at Indiana University Southeast. Her research and consulting focus on education and on women in Sub-Saharan Africa and on ethnic women in the United States. With Vasilikie Demos, she is co-editor of the Advances in Gender Research series and Ethnic Women: A Multiple Status Reality (General Hall, 1994). She is a past president of the North Central Sociological Association and past chair of the American Sociological Association Sections on Sex and Gender and Race, Gender and Class.Lynn Weber is a Director of the Women’s Studies Program and Professor of Sociology at the University of South Carolina. For the 2002–2003 year, she is Visiting Professor in the Consortium for Research on Race, Gender, and Ethnicity and the Department of Women’s Studies at the University of Maryland. Her research and teaching explore the intersections of race, class, gender, and sexuality particularly as they are manifest in women’s health, in the process of upward social mobility and work, and in the creation of an inclusive classroom environment. In 2001 and 2002, she published two books, Understanding Race, Class, Gender, and Sexuality: A Conceptual Framework and Understanding Race, Class, Gender, and Sexuality: Case Studies (NY: McGraw-Hill) which are intended to move the field of intersectional scholarship ahead by serving as a guide to facilitate intersectional analyses and to foster more integrative thinking in the classroom. Dr. Weber is also co-author of The American Perception of Class.

Purpose: We review theory and research to suggest how research on sexual and gender minority (SGM) population health could more completely account for social class.

Approach: First, we review theory on social class, gender, and sexuality, especially pertaining to health. Next, we review research on social class among SGM populations. Then, we review 42 studies of SGM population health that accounted for one or more components of social class. Finally, we suggest future directions for investigating social class as a fundamental driver of SGM health.

Findings: Social class and SGM stigma are both theorized as “fundamental causes” of health, yet most studies of SGM health do not rigorously theorize social class. A few studies control socioeconomic characteristics as mediators of SGM health disparities, but that approach obscures class disparities within SGM populations. Only two of 42 studies we reviewed examined SGM population health at the intersections of social class, gender, and sexuality.

Research implications: Researchers interested in SGM population health would benefit from explicitly stating their chosen theory and operationalization of social class. Techniques such as splitting samples by social class and statistical interactions can help illuminate how social class and SGM status intertwine to influence health.

Originality: We synthesize theory and research on social class, sexuality, and gender pertaining to health. In doing so, we hope to help future research more thoroughly account for social class as a factor shaping the lives and health of SGM people.

To determine gendered patterns of preventive medical care (physical and dental/optical) use among pan-ethnic U.S. Asian and Latino adults.

Using National Latino and Asian American Study (2004) data, we apply Andersen’s (1995) Behavioral Model of Health Services Use to assess how preventive care use among Asian and Latino men and women varies as a function of predisposing, enabling, and need-based characteristics. We explore whether adjustment for these factors mediates gender disparities in both physical and dental/optical check-ups, and test whether certain factors operate differently among men versus women.

A higher proportion of women reported a routine care visit last year, especially among Latinos. Adjusting for predisposing, enabling, and need-based factors explained the gender difference in reporting a dental/optician check-up, but not a physical check-up, among both Asian and Latino adults.

Our findings illustrate how gender patterns in routine care use differ by race/ethnicity, and highlight the fundamental importance of enabling characteristics (especially health insurance and having a regular doctor) for shaping routine care use between men and women, both Asian and Latino. Limitations of this chapter are that the data are cross-sectional and were collected before the implementation of the Affordable Care Act, and measures are self-reported.

This chapter focuses on Asian and Latinos because they represent the fastest growing minority populations in the United States, yet few studies have evaluated gender differences in preventative health care use among these groups.

The goal of this project is to link the analysis of gender construction to reproductive health, sexuality, and development within the postdisaster context of Nepal and thereby, inform our understandings of these linkages more broadly, as well as provide new opportunities for promoting gender equity, reproductive health, and development in areas of conflict or disaster.

Using life history narratives, I examine the intersections among reproductive health, gender, and sexuality before, during, and postdisaster.

These life history interviews shed light on how socialization processes shape and determine adolescent girls' future actions and women's life opportunities. At both the individual and state levels, issues related to gender, sexuality, and reproductive health are exacerbated in times of crisis.

Life histories provide rich, thick descriptions of social life. However, they are limited in terms of reliability and making generalizations about larger populations. This chapter engages the reader, scholars, students, practitioners, and policy makers in contemplating policy reform and initiation of context-based programs in times of natural disaster, political conflict, and other catastrophic events that disenfranchise those without agency and power.

This paper is unique in that it is the first to examine reproductive health and sexuality from the perspective of women living within a society bound by rigid gender and sexuality norms, but torn apart by natural disasters and the political and economic instability that follow in countries like Nepal.

Purpose: We respond to a call for studies of “embodied experiences of stigma in context” by investigating how transgender embodiment shapes perceived needs for access to and experiences of “sex-specific” cancer screenings (SSCS) (e.g., breast and prostate exams, Pap smears) in the North American healthcare system.

Design/Methodology/Approach: We analyze data from semistructured interviews with a diverse sample of 35 transgender-identified adults. Based on thematic narrative analysis, we explore four themes in relation to embodiment: discrimination; discomfort and hyperawareness of genitalia; strategic reframing and active management; and SSCS health care encounters as positive and gender affirming.

Findings: In relation to SSCS, transgender individuals experience discrimination, do emotion work, and actively manage situations to obtain needed health care, and sometimes forego care because barriers are insurmountable. Health care providers' responses to transgender embodiment can disrupt health care encounters, but they can also facilitate access and create opportunities for affirmation, agency, advocacy, and new forms of interaction. Embodiment- and gender-affirming interactions with health care providers, which varied by gender, emerged as key influences on participants' experiences of SSCS.

Research Limitations/Implications: Our sample primarily includes binary gender-identified individuals, and while our interview guide covered many topics, the SSCS question did not explicitly reference testicular exams.

Practical Implications: Cancer prevention and detection Cancer prevention and detection require health care professionals who are prepared for differently embodied persons. Preventive cancer screenings are not “sex-specific”; they are relevant to individuals with medically necessary needs regardless of gender identity or embodiment.

Social Implications

Originality/Value: Few medical sociologists have focused on transgender embodiment. Findings enhance our understanding of how transgender embodiment and minority stress processes influence access to needed SSCS.

This chapter provides an introduction to the volume along with a brief review of literature on gender, women’s health concerns, and other social factors in health and health care services.

Literature review.

The chapter argues for the importance of greater examination of gender, women’s health concerns, and social factors in health and health care services.

Reviews the issues of gender, women, and social factors and previews this book.

The medicalization thesis derives from a classic theme in the field of medical sociology. It addresses the broader issue of the power of medicine – as a culture and as a profession – to define and regulate social behavior. This issue was introduced into sociology 50 years ago by Talcott Parsons (1951) who suggested that medicine was a social institution that regulated the kind of deviance for which the individual was not held morally responsible and for which a medical diagnosis could be found. The agent of social control was the medical profession, an institutionalized structure in society that had been given the mandate to restore the health of the sick so that they could resume their expected role obligations. Inherent in this view of medicine was the functionalist perspective on the workings of society: the basic function of medicine was to maintain the established division of labor, a state that guaranteed the optimum working of society. For 20 years, the Parsonian interpretation of how medicine worked – including sick-role theory and the theory of the profession of medicine – dominated the bourgeoning field of medical sociology.

Poor mental health in men and women is attributable to disparities in physical traits, social roles, power and health-seeking behaviours. This study aims to examine the gender differences in mental health among Pakistan and German university students and focuses on their right to seek mental health care.

Data on depression, anxiety and stress symptoms, as well as positive mental health (PMH), resilience, social support and life satisfaction, were gathered from Pakistani and German students.

In contrast to the Pakistani group, where no such gender differences were seen, women in Germany reported higher degrees of stress, anxiety and depression, as well as a lower level of overall good mental health. In comparison to German men and women, Pakistani women scored equally high on resilience. While gender had no bearing on life happiness in either Pakistan or Germany, women in both countries perceived more social support than men did.

The study’s strengths include its large sample size and battery of mental health measures. The results of partial weak measurement Invariance (MI) on the stress subscale underlined the importance of using MI in cross-cultural studies. The validity of a direct comparisons on sum score between different language versions or country samples shall be cautious. Still, there are limitations. Firstly, the authors did not differentiate gender and biological sex, and there was no group of non-binary gender. Pakistani (N = 1,840) and German (N = 7,890) students were in unequal numbers. Again, only university students were sampled, so the results cannot be generalised to older (probably less educated) populations. Self-reported data that mainly obtained via online survey were the third limitation. This design is cost-effective and easy to administer for cross-cultural survey research. However, social desirability and memory bias are common in self-report inventories. Fourthly, although English is an official language in Pakistan and the medium of instruction in education, the authors recommend future study to use questionnaires that have been translated and validated into Urdu (Pakistan’s national language) and investigate gender differences in a general population. Fifthly, this is a cross-sectional survey; the authors were not able to explore the causality or risk factors that contribute to the poor mental well-being in Pakistan students in general or the relatively worse mental health in German women. Future studies may investigate the mechanism behind the phenomena observed in this study with longitudinal or experimental design. Last but not least, Germany and Pakistan differ in so many different aspects from culture, religions and history to social structure and economic status, which make it hard to claim whether the observed differences were due to national differences, cultural differences, economic differences, gender inequality differences or other effects. It would be helpful for future studies to include more country samples with clear definitions of different “culture” aspects for a better understanding of gender differences in other countries and in different mental well-being constructs.

The current study is the first attempt to compare the gender difference patterns in positive and negative mental health between European and South Asian counties and focuses on gender-specific approaches. Although Pakistani university students reported in general worse mental well-being, the differences between the two genders in mental health (e.g. depression, anxiety, general PMH) were not as pronounced as in the German student sample. Gender comparisons in these mental health constructs would help to improve protective factors against mental illness and to develop appropriate management programmes based on cultural differences. The results suggest that the gender differences found in western countries cannot always be directly translated into the South Asian cultural framework. Our results also highlight the importance of improving the general situation of Pakistan (students) instead of focusing on one gender. At the same time, in Germany, prevention and intervention plans are more warranted for women. It could be that once the general situation in Pakistan is improved, the gender-related differences in mental health will be clearly observed.

These findings imply the significance of cultural context when inferring gender variations in mental health. Moreover, it supports the advancement of comprehensive policies to reduce gender-related mental health inequalities and focuses on the equal rights of men and women to get mental health care.

Despite health inequities experienced by Aboriginal and transgender (trans) communities, little research has explored the well-being of Aboriginal trans (gender-diverse) people. This paper aims to describe barriers to well-being in a sample of Aboriginal gender-diverse people in Ontario, Canada.

In 2009-2010, 433 trans people in Canada's most populous province participated in a multi-mode health survey. In all, 32 participants identified as First Nations, Métis, or Inuit (Aboriginal); unweighted frequencies were calculated to describe their characteristics.

Participants expressed diverse gender identities; 44 per cent identified with the pan-Aboriginal term two-spirit. High levels of poverty (47 per cent), homelessness or underhousing (34 per cent), and ever having to move due to being trans (67 per cent) were reported. In all, 61 per cent reported at least one past-year unmet health care need. Most participants had experienced violence due to being trans (73 per cent) and had ever seriously considered suicide (76 per cent). One-fifth had been incarcerated while presenting in their felt gender. Aboriginal spirituality was practiced by 44 per cent, and 19 per cent had seen an Aboriginal Elder for mental health support.

Action is needed to address the social determinants of health among Aboriginal gender-diverse people. Using principles of self-determination, there is a need to increase access to health and community supports, including integration of traditional culture and healing practices. Larger study samples and qualitative research are required.

These first published data regarding the health of Aboriginal gender-diverse Ontarians illustrate both their heterogeneity and all-too-common experiences of individual and systemic discrimination, and barriers to care. Results highlight potential impacts of colonialism and social exclusion, and suggest priorities for ameliorative action.

Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues.

In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated.

Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers’ transgender bias, others attributed barriers to providers’ limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants’ health while incarcerated.

Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women’s access to quality, gender-affirmative healthcare.

This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women’s acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.