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BMJ Global Health Feb 2024Safeguarding challenges in global health research include sexual abuse and exploitation, physical and psychological abuse, financial exploitation and neglect....
Safeguarding challenges in global health research include sexual abuse and exploitation, physical and psychological abuse, financial exploitation and neglect. Intersecting individual identities (such as gender and age) shape vulnerability to risk. Adolescents, who are widely included in sexual and reproductive health research, may be particularly vulnerable. Sensitive topics like teenage pregnancy may lead to multiple risks. We explored potential safeguarding risks and mitigation strategies when studying teenage pregnancies in informal urban settlements in Nairobi, Kenya. Risk mapping was initiated by the research team that had prolonged engagement with adolescent girls and teen mothers. The team mapped potential safeguarding risks for both research participants and research staff due to, and unrelated to, the research activity. Mitigation measures were agreed for each risk. The draft risk map was validated by community members and coresearchers in a workshop. During implementation, safeguarding risks emerged across the risk map areas and are presented as case studies. Risks to the girls included intimate partner violence because of a phone provided by the study; male participants faced potential disclosure of their perceived criminal activity (impregnating teenage girls); and researchers faced psychological and physical risks due to the nature of the research. These cases shed further light on safeguarding as a key priority area for research ethics and implementation. Our experience illustrates the importance of mapping safeguarding risks and strengthening safeguarding measures throughout the research lifecycle. We recommend co-developing and continuously updating a safeguarding map to enhance safety, equity and trust between the participants, community and researchers.
Topics: Female; Pregnancy; Adolescent; Humans; Male; Pregnancy in Adolescence; Kenya; Sexual Behavior; Gender Identity; Intimate Partner Violence
PubMed: 38423546
DOI: 10.1136/bmjgh-2023-013519 -
Child Abuse & Neglect Mar 2024This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men,...
BACKGROUND
This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women).
OBJECTIVE
To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators.
PARTICIPANTS AND SETTINGS
We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019.
METHODS
Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity.
RESULTS
LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity.
CONCLUSIONS
By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.
Topics: Child; Humans; Male; Female; Suicide, Attempted; Gender Identity; Transgender Persons; Sexual and Gender Minorities; Transsexualism
PubMed: 38422580
DOI: 10.1016/j.chiabu.2024.106705 -
PloS One 2024Sexism has implications for people's physical and mental health. Thus, understanding sexism and its prevalence is key to understanding the phenomenon. In the current...
Sexism has implications for people's physical and mental health. Thus, understanding sexism and its prevalence is key to understanding the phenomenon. In the current study, 717 Colombian men and women completed the brief scales of Ambivalent Sexism toward women and men and the Gender Identity Scale. The assessment was conducted using a web-based method. Both scales, as expected, were two-dimensional. Reliability ranged from .83 to .88. Moderate and high correlations were observed with the Gender Identity Scale. Men showed higher levels of hostile and benevolent sexism toward women and benevolent sexism toward men. It was also found that the higher the level of education, the lower the rates of sexism toward men and women. The brief scales were valid and reliable for measuring hostile and benevolent sexism in Colombia.
Topics: Humans; Male; Female; Sexism; Colombia; Gender Identity; Reproducibility of Results; Affect
PubMed: 38422028
DOI: 10.1371/journal.pone.0297981 -
Journal of the International AIDS... Feb 2024
Topics: Humans; HIV Infections; Gender Identity; Transgender Persons; Longitudinal Studies
PubMed: 38421156
DOI: 10.1002/jia2.26227 -
PloS One 2024Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature...
Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010-2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic.
Topics: Humans; Female; United States; Transgender Persons; Transsexualism; Gender Identity; Social Stigma; Exercise
PubMed: 38416705
DOI: 10.1371/journal.pone.0297571 -
BMC Medical Education Feb 2024French medical graduates undertake a national examination at the end of their studies with a subsequent national ranking. Specialty is then chosen by each candidate...
BACKGROUND
French medical graduates undertake a national examination at the end of their studies with a subsequent national ranking. Specialty is then chosen by each candidate according to their ranking. This study aims to describe the attractiveness of surgical specialties and the evolution of the male-female distribution among French medical graduates (FMG) from 2017 to 2022.
METHODS
Our database included the candidates' ranking, sex and choice of specialty from 2017 to 2022. It included all French medical graduates from 2017 to 2022 and all French medical schools. A linear regression was performed to predict future trends. Dependent variables were mean rankings and the percentage of women. The independent variable was year of application. A Pearson correlation was performed to examine any relationship with mean workweek.
RESULTS
A total number of 5270 residents chose a surgical programme between 2017 and 2022. The number of residents who were assigned their desired surgical programme held stable at 878 surgical residents per year. Plastic and reconstructive surgery remained the most frequently chosen surgical programme. Thoracic and cardiovascular surgery was the least frequently chosen surgical programme between 2017 and 2022. The mean ranking for a candidate choosing a surgical programme rose significantly by 9% from 2017 to 2022 (p < 0.01). Neurosurgery exhibited the greatest fall as a surgical specialty as its rankings decreased by 163.6% (p < 0.01). Maxillo-facial surgery was the only specialty with a statistically significant increase in its rankings by 35.9% (p < 0.05). The overall proportion of women was 51.1%. Obstetrics-and-gynecology was the highest represented specialty among female candidates, with a mean of 83.9% of women. Orthopedic surgery was the lowest represented, being composed of a mean of 28.6% of women. The number of female surgical residents increased significantly over the six-year period, by 7.6% (p < 0.01).
CONCLUSIONS
More and more medical school graduates decide not to choose surgery for their residency programme. Some specialties continue to be attractive while many are losing their appeal. While there does appear to be progress towards gender equity, further investigation is necessary to assess its actual implementation.
Topics: Humans; Male; Female; Career Choice; Specialization; Gender Identity; Internship and Residency; Specialties, Surgical; Obstetrics
PubMed: 38413964
DOI: 10.1186/s12909-024-05174-y -
Archives of Sexual Behavior May 2024Adolescence is an important period for the development of gender identity. We studied the development of gender non-contentedness, i.e., unhappiness with being the...
Adolescence is an important period for the development of gender identity. We studied the development of gender non-contentedness, i.e., unhappiness with being the gender aligned with one's sex, from early adolescence to young adulthood, and its association with self-concept, behavioral and emotional problems, and adult sexual orientation. Participants were 2772 adolescents (53% male) from the Tracking Adolescents' Individual Lives Survey population and clinical cohort. Data from six waves were included (ages 11-26). Gender non-contentedness was assessed with the item "I wish to be of the opposite sex" from the Youth and Adult Self-Report at all six waves. Behavioral and emotional problems were measured by total scores of these scales at all six waves. Self-concept was assessed at age 11 using the Global Self-Worth and Physical Appearance subscales of the Self-Perception Profile for Children. Sexual orientation was assessed at age 22 by self-report. In early adolescence, 11% of participants reported gender non-contentedness. The prevalence decreased with age and was 4% at the last follow-up (around age 26). Three developmental trajectories of gender non-contentedness were identified: no gender non-contentedness (78%), decreasing gender non-contentedness (19%), and increasing gender non-contentedness (2%). Individuals with an increasing gender non-contentedness more often were female and both an increasing and decreasing trajectory were associated with a lower global self-worth, more behavioral and emotional problems, and a non-heterosexual sexual orientation. Gender non-contentedness, while being relatively common during early adolescence, in general decreases with age and appears to be associated with a poorer self-concept and mental health throughout development.
Topics: Humans; Adolescent; Male; Female; Self Concept; Young Adult; Sexual Behavior; Child; Gender Identity; Adult; Adolescent Development; Self Report; Longitudinal Studies
PubMed: 38413534
DOI: 10.1007/s10508-024-02817-5 -
BMC Psychology Feb 2024The development of children's gender roles in single-parent families is worthy of attention. It may be affected by family members' gender roles and parental...
BACKGROUND
The development of children's gender roles in single-parent families is worthy of attention. It may be affected by family members' gender roles and parental child-rearing gender-role attitudes (PCGA). PCGA will form a consistent or inconsistent intergenerational relationship between parents and children.
OBJECTIVE
This study examined the intergenerational similarities in gender roles and PCGA. Also, the intergenerational transmission of parental child-rearing gender-role attitudes (ITPCGA) in single-parent families, and the impact of various family factors on children's gender roles were comprehensively considered.
METHOD
Participants were 550 single-parent parent-adolescent dyads. The Gender-role Scale and the Parental Child-rearing Gender-role Attitude Scale were used to evaluate participants' gender-role and PCGA. Chi-square tests and logistic regression analyses were used to examine the intergenerational similarities in gender roles and PCGA, and the influencing family factors of ITPCGA and children's gender roles.
RESULTS
The intergenerational similarities of gender role types and PCGA types existed. Both parents' gender roles and family gender pairs affected ITPCGA, father-daughter families and parents' undifferentiated and sex-typed gender roles significantly predicted undesirable ITPCGA. Family gender pair, parent's gender roles and ITPCGA types affected children's gender roles. Undesirable ITPCGA significantly predicted children's undifferentiated gender roles; father-daughter families and mother-son families, parents' undifferentiated and sex-typed gender roles significantly predicted children's sex-typed gender roles, and mother-son families and parents' reversed gender roles significantly predicted children's reversed gender role.
CONCLUSIONS
This study highlights the effects of single-parent family gender pairs and parents' gender roles on ITPCGA, which influences the development of children's gender roles.
Topics: Female; Adolescent; Humans; Single-Parent Family; Gender Role; Parent-Child Relations; Parents; Gender Identity
PubMed: 38409092
DOI: 10.1186/s40359-024-01594-z -
Perspectives on Medical Education 2024Promoting the inclusion of trans and non-binary (TNB) medical trainees is a key step in building an inclusive health workforce well-positioned to provide high-quality...
"Will I be able to be myself? Or will I be forced to lie all the time?": How Trans and Non-Binary Students Balance Professionalism, Authenticity, and Safety in Canadian Medical Programs.
INTRODUCTION
Promoting the inclusion of trans and non-binary (TNB) medical trainees is a key step in building an inclusive health workforce well-positioned to provide high-quality healthcare to all patients. Existing data on the experiences of TNB physicians and trainees describe widespread challenges related to prejudice and discrimination, with most trainees concealing their gender identity for fear of discrimination. We aimed to understand how TNB medical students have experienced professionalism and professional identity formation.
METHODS
This was a secondary analysis of data gathered in a constructivist grounded theory study. The authors conducted semi-structured qualitative interviews in 2017 with seven current or recently graduated TNB Canadian medical students.
RESULTS AND DISCUSSION
From medical school application to graduation, TNB medical students reported feeling tensions between meeting expectations of professionalism, being their authentic selves, and seeking to avoid conscious and implicit biases. These tensions played out around issues of disclosure, foregrounding identity through impression management, and responding to identity exemplars. The tension between TNB trainees' desire to bring their whole selves to the practice of medicine and feeling pressured to de-emphasize their gender is ironic when considering the increased call for medical trainees from equity-seeking communities. The most commonly used behavioural frameworks of professionalism were inherited from prior generations and restrict students whose experiences and community-based knowledge are most needed. Demands of professionalism that are incompatible with authentic professional identity development place an inordinate burden on trainees whose identities have been excluded from normative concepts of the professional, including TNB trainees.
Topics: Humans; Male; Female; Professionalism; Gender Identity; Canada; Students, Medical; Medicine
PubMed: 38406648
DOI: 10.5334/pme.1199 -
International Journal of Environmental... Jan 2024Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention...
Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in "non-survival sex work" had little difficulty staying on PrEP, while those engaged in "survival sex work" struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in "survival sex work" experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care.
Topics: Humans; Female; HIV Infections; Transgender Persons; Anti-HIV Agents; Pre-Exposure Prophylaxis; Transsexualism
PubMed: 38397624
DOI: 10.3390/ijerph21020133