Marion Doull

Appraising the evidence: applying sex- and gender-based analysis (SGBA) to Cochrane systematic reviews on cardiovascular diseases.

OBJECTIVE To examine the use of sex- and gender-based analysis (SGBA) in systematic reviews of cardiovascular health in order to strengthen the evidence base for clinical practice and policy. METHODS To determine the current status of SGBA in systematic reviews, an appraisal tool was developed by the research team and applied by an independent reviewer to a random sample of 38 Cochrane systematic reviews. The sample was drawn from reviews addressing interventions for cardiovascular diseases (CVD). A random sample of Cochrane reviews in cardiovascular health was selected from the Cochrane Library, Issue 3, 2001, to Issue 3, 2007. The main outcome measure was the number of reviews that included analysis of sex or gender or both. RESULTS Our findings showed that SGBA was generally absent in the sampled reviews. Data were rarely disaggregated by sex; only 2 of 38 reviews reported any sex or gender research gaps. Only one quarter of the reviews included a rationale as to why any subgroup analyses by sex were or were not completed. None of the 38 reviews met all of the appraisal tool criteria. As well, we found that where sex or gender was mentioned, the terms were used interchangeably. CONCLUSIONS Despite increasing evidence over the past decade documenting that sex and gender frequently matter in CVD, this study demonstrated that SGBA was rarely considered in systematic reviews. We suggest this omission has important implications for assuring the quality of research and of evidence-based policy and practice and for achieving equitable health outcomes for women and men. To build a robust evidence base for future work in cardiovascular health, we propose that the methodologies of systematic reviews and of SGBA be refined and synchronized to enhance the collection, synthesis, and analysis of evidence for decision making.

The challenges of including sex/gender analysis in systematic reviews: a qualitative survey

BackgroundSystematic review methodology includes the rigorous collection, selection, and evaluation of data in order to synthesize the best available evidence for health practice, health technology assessments, and health policy. Despite evidence that sex and gender matter to health outcomes, data and analysis related to sex and gender are frequently absent in systematic reviews, raising concerns about the quality and applicability of reviews. Few studies have focused on challenges to implementing sex/gender analysis within systematic reviews.MethodsA multidisciplinary group of systematic reviewers, methodologists, biomedical and social science researchers, health practitioners, and other health sector professionals completed an open-ended survey prior to a two-day workshop focused on sex/gender, equity, and bias in systematic reviews. Respondents were asked to identify challenging or ‘thorny’ issues associated with integrating sex and gender in systematic reviews and indicate how they address these in their work. Data were analysed using interpretive description. A summary of the findings was presented and discussed with workshop participants.ResultsRespondents identified conceptual challenges, such as defining sex and gender, methodological challenges in measuring and analysing sex and gender, challenges related to availability of data and data quality, and practical and policy challenges. No respondents discussed how they addressed these challenges, but all proposed ways to address sex/gender analysis in the future.ConclusionsRespondents identified a wide range of interrelated challenges to implementing sex/gender considerations within systematic reviews. To our knowledge, this paper is the first to identify these challenges from the perspectives of those conducting and using systematic reviews. A framework and methods to integrate sex/gender analysis in systematic reviews are in the early stages of development. A number of priority items and collaborative initiatives to guide systematic reviewers in sex/gender analysis are provided, based on the survey results and subsequent workshop discussions. An emerging ‘community of practice’ is committed to enhancing the quality and applicability of systematic reviews by integrating considerations of sex/gender into the review process, with the goals of improving health outcomes and ensuring health equity for all persons.

Sex and straight young men: Challenging and endorsing hegemonic masculinities and gender regimes

Young men are considered to have power and to be powerful in many social settings and in particular within the realm of sexual relations. This article details research that directly asks young men how they perceive, interact with, and deploy power within intimate heterosexual relationships. Semi-structured interviews were conducted with 13 Canadian-based young men (aged 17-22 years) to explore how power was understood and enacted within their intimate heterosexual relationships. A social constructionist gendered analysis was used to inductively derive themes and situate the experiences of the participants within societal discourses of hegemonic masculinities and gender regimes. Power within relationships was most often described as operating equitably, with a few participants describing the deployment of power in coercive/controlling ways. Results reveal that the use of power by men can be understood as challenging or endorsing hegemonic masculinities and traditional heterosexual gender regimes. By including young mens voices in such discussions, our research contributes important understandings and some traction towards describing what might constitute more equitable gender and power relations.

Development and evaluation of 'briefing notes' as a novel knowledge translation tool to aid the implementation of sex/gender analysis in systematic reviews: a pilot study.

Background There is increasing recognition of sex/gender differences in health and the importance of identifying differential effects of interventions for men and women. Yet, to whom the research evidence does or does not apply, with regard to sex/gender, is often insufficiently answered. This is also true for systematic reviews which synthesize results of primary studies. A lack of analysis and reporting of evidence on sex/gender raises concerns about the applicability of systematic reviews. To bridge this gap, this pilot study aimed to translate knowledge about sex/gender analysis (SGA) into a user-friendly ‘briefing note’ format and evaluate its potential in aiding the implementation of SGA in systematic reviews. Methods Our Sex/Gender Methods Group used an interactive process to translate knowledge about sex/gender into briefing notes, a concise communication tool used by policy and decision makers. The briefing notes were developed in collaboration with three Cochrane Collaboration review groups (HIV/AIDS, Hypertension, and Musculoskeletal) who were also the target knowledge users of the briefing notes. Briefing note development was informed by existing systematic review checklists, literature on sex/gender, in-person and virtual meetings, and consultation with topic experts. Finally, we held a workshop for potential users to evaluate the notes. Results Each briefing note provides tailored guidance on considering sex/gender to reviewers who are planning or conducting systematic reviews and includes the rationale for considering sex/gender, with examples specific to each review group’s focus. Review authors found that the briefing notes provided welcome guidance on implementing SGA that was clear and concise, but also identified conceptual and implementation challenges. Conclusions Sex/gender briefing notes are a promising knowledge translation tool. By encouraging sex/gender analysis and equity considerations in systematic reviews, the briefing notes can assist systematic reviewers in ensuring the applicability of research evidence, with the goal of improved health outcomes for diverse populations.

“I would have preferred more options”: accounting for non‐binary youth in health research

As a research team focused on vulnerable youth, we increasingly need to find ways to acknowledge non-binary genders in health research. Youth have become more vocal about expanding notions of gender beyond traditional categories of boy/man and girl/woman. Integrating non-binary identities into established research processes is a complex undertaking in a culture that often assumes gender is a binary variable. In this article, we present the challenges at every stage of the research process and questions we have asked ourselves to consider non-binary genders in our work. As researchers, how do we interrogate the assumptions that have made non-binary lives invisible? What challenges arise when attempting to transform research practices to incorporate non-binary genders? Why is it crucial that researchers consider these questions at each step of the research process? We draw on our own research experiences to highlight points of tensions and possibilities for change. Improving access to inclusive health-care for non-binary people, and non-binary youth in particular, is part of creating a more equitable healthcare system. We argue that increased and improved access to inclusive health-care can be supported by research that acknowledges and includes people of all genders.

Examining concepts of power and agency in research with young people

Concepts of power and agency have become increasingly prominent in the youth studies literatures and related research. A focus of the research to date has been an examination of how a better understanding of young peoples lived experiences can reveal possibilities for young peoples agency to emerge. Despite increased interest in the term agency, much less has been said about how the concept is defined and recognized in research with young people, including what the concept may entail but crucially, how the term is linked to and underpinned by the related concept of power. This paper seeks to contribute to our understanding of power and agency as utilized in research with young people. The discussion that follows identifies the possible ways in which different theoretical positions shape our understanding of how power and agency are investigated and how these understandings inform the ways we interpret young peoples perspectives and actions as holding potential for ‘agency’. Drawing on recent empirical examples, we consider how varying interpretations of power and/or agency shape not only the ways in which young peoples agentic experiences are theorized (and the related ontological and epistemological assumptions these positions imply) but also the presumed effects of that agency.

Examining the Concept of Choice in Sexual Health Interventions for Young People

Concepts of choice are often drawn upon within sexual health promotion discourses to encourage young people to take “responsibility” for and promote their own sexual health and reproductive control. A systematic literature search using predefined inclusion criteria identified peer-reviewed articles focusing on sexual health interventions for young people. Discourse analysis was used to interrogate how concepts of choice were articulated or inferred within the interventions. Of the eligible studies (n = 30), 16 were based on theories of behavioral change, suggesting a linear pathway between choice and improvements in sexual health. Studies that accounted for contextual factors were a minority (n = 6). Overall, study reports offered a limited account of the “situatedness” of young people’s opportunities to exercise choice. This reliance had a tendency to position young people as passive recipients of interventions which seemed to undermine the more active notion of “making choices” presented within these frameworks.

Are we leveling the playing field? Trends and disparities in sports participation among sexual minority youth in Canada

Purpose Sports participation and physical fitness are widely beneficial for young people, yet activity levels among young people are declining. Despite growing popular media attention on the participation of sexual minority (e.g., lesbian, gay, and bisexual) youth in sports and various campaigns to improve the often homophobic climate of sports, there is limited evidence that sexual minority youth participate in sports. Our aim was to provide a current portrait of sports participation among 3 groups of sexual minority youth (e.g., lesbian, gay, and bisexual) in British Columbia, Canada, as well as to document population trends. Methods Pooled population-level data from British Columbia, Canada (n = 99,373) were used to examine trends and disparities in sports participation among sexual minority and heterosexual youth. Age-adjusted logistic regression models were used to examine changes in participation over time and disparities in participation over time (1998–2013). Results We found an overall decline in sports participation and physical activity (PA) for all youth. Sexual minority students were less likely to participate in formal sports (with a coach) and informal sports (without a coach) compared with their heterosexual peers. The disparity in participating in informal sports between heterosexual and sexual minority youth has narrowed over time for some sexual orientation groups, whereas the disparity in participating in formal sports has widened over time in some cases. Conclusion This study provides a comprehensive examination of sports participation among sexual minority youth over the past 15 years. Despite changing societal attitudes and laudable efforts to reduce homophobia in sports, results suggest that there are continued barriers to participation for sexual minority youth. Further research is needed to understand the factors that limit sports participation for these youth and to inform program development. PA is critical to lifelong health and well-being, and thus continued efforts are needed to increase the sports participation of sexual minority youth in particular.

Trend Disparities in Emotional Distress and Suicidality Among Sexual Minority and Heterosexual Minnesota Adolescents From 1998 to 2010

BACKGROUND Sexual minority young people have demonstrated higher rates of emotional distress and suicidality in comparison to heterosexual peers. Research to date has not examined trends in these disparities, specifically, whether there have been disparity reductions or increases and how outcomes have differed over time by sex and sexual orientation group. METHODS Minnesota Student Survey data, collected from 9th and 12th graders in 3 cohorts (1998, 2004, 2010) were used to examine emotional distress and suicidality rates. Logistic regression analyses were completed to examine outcome changes over time within and across sexual orientation/sex groups. RESULTS With few exceptions, sexual minority youth are at increased risk of endorsing emotional distress and suicidality indicators in each surveyed year between 1998 and 2010. Young people with both-sex partners reported more emotional distress across all health indicators compared to their opposite-sex partnered peers. With a few exceptions, gaps in disparities between heterosexual and sexual minority have not changed from 2004 to 2010. CONCLUSIONS Disparities in emotional health persist among youth. Research is needed to advance understanding of mental health disparities, with consideration of sexual orientation differences and contextualized to sociocultural status and changes over time. Personalized prevention strategies are needed to promote adolescent mental health.