Gender, masculinity and migration: Mexican men and reproductive health in the Californian context

'Sweden has changed me': a qualitative study exploring the sexual health needs and associated mental health aspects of young male former unaccompanied minors, asylum seekers and refugees in Region Stockholm, Sweden

OBJECTIVES

Sexual health needs of young refugees and asylum-seeking men are seldom explored or addressed, adversely affecting their mental and physical well-being. By interviewing young male former unaccompanied minors, refugees and asylum seekers in Stockholm, Sweden, this study aimed to get a deeper understanding of what they needed to achieve a positive and respectful approach to sexuality, romantic and consensual relationships. Additionally, we explored how their sexual health needs were related to their mental health, as well as the factors influencing both.

DESIGN

An exploratory qualitative study using semi-structured interviews was employed. Theoretical sampling was used for participant selection. Analysis of the data was performed using constructivist grounded theory.

SETTING

The study took place in Stockholm, Sweden.

PARTICIPANTS

A total of 32 young male (aged 16-28) former unaccompanied minors, asylum seekers and refugees from Afghanistan, Eritrea and Syria were interviewed.

RESULTS

Our analysis showed that our participants' sexual and mental health needs followed a process of individual change. One core category described the different stages of the process: 'On my way, but not there yet'. It contains four subcategories: 'being on the move: the migration journey'; 'newly arrived: contrasting old and new values and learning new concepts'; 'navigating relationships, love and sex'; and 'the respectful man'. We identified six key factors that influenced their sexual and mental health needs: attending school/receiving accurate sexual information, support to adapt, experiencing enjoyable relationships, restrictive parental values, exposure to stigma/discrimination and the negative image of young male refugees.

CONCLUSIONS

This study highlighted that the sexual health needs and related mental health aspects of young former unaccompanied minors, asylum seekers and refugees change over time and are influenced by contextual factors. Educational interventions aiming to improve the well-being of this population must address both sexual and mental health aspects, including issues related to gender norms, relationships, sex and consent.

Measuring Men's Gender Norm Beliefs Related to Contraception: Development of the Masculine Norms and Family Planning Acceptance Scale

Male partner resistance is identified as a key factor that influences women's contraceptive use. Examination of the masculine norms that shape men's resistance to contraception-and how to intervene on these norms-is needed. To assess a gender-transformative intervention in Kenya, we developed and evaluated a masculinity-informed instrument to measure men's contraceptive acceptance-the Masculine Norms and Family Planning Acceptance (MNFPA) scale. We developed draft scale items based on qualitative research and administered them to partnered Kenyan men (n = 150). Item response theory-based methods were used to reduce and psychometrically evaluate final scale items. The MNFPA scale had a Cronbach's α of 0.68 and loaded onto a single factor. MNFPA scores were associated with self-efficacy and intention to accept a female partner's use of contraception; scores were not associated with current contraceptive use. The MNFPA scale is the first rigorously developed and psychometrically evaluated tool to assess men's contraceptive acceptance as a function of male gender norms. Future work is needed to test the MNFPA measure in larger samples and across different contexts. The scale can be used to evaluate interventions that seek to shift gender norms to increase men's positive engagement in pregnancy spacing and prevention.

The role of gender and power dynamics in injection initiation events within intimate partnerships in the US-Mexico border region

Women's initiation into injection drug use often establishes a pattern of risk following first injection. This study explored sources of gendered power dynamics in injection initiation experiences for people who inject drugs. A qualitative subsample from two prospective community-recruited cohorts of people who inject drugs in San Diego and Tijuana provided data on the contexts surrounding injection initiation processes. Intimate partnerships were identified in initiation; sub-themes were identified drawing on three concepts within the theory of gender and power. With reference to sexual division of labour, men were often responsible for access to resources in partnerships across both contexts, although there were limited accounts of women obtaining those resources. Extending the structure of power, women in San Diego reported that initiation events involving an intimate partner occurred from a position of vulnerability but expressed greater agency when providing initiation assistance. With regard to structure of cathexis, social norms proscribing injection initiation among women exist, particularly in Tijuana. Gendered power dynamics are a multifaceted component of injection initiation events, especially for women in intimate partnerships. These results stress the need for nuance in understanding the intersection of risk, gender and harm reduction within injection initiation events across socio-cultural contexts.

Impact of sports participation on incidence of bone traumatic fractures and health-care costs among adolescents: ABCD - Growth Study

Objective: To analyze the risk of bone traumatic fractures according to the engagement in sports, as well as to identify the potential impact of sports participation and traumatic fractures on health-care costs among adolescents. Methods: This is a longitudinal 12-month study of 285 adolescents of both sexes in Brazil. We assessed the occurrence of traumatic fractures and health-care services (hospitalizations, medicine use, medical consultations, and exams) by phone contact every month for 12 months. Adolescents were divided into four groups according to sport characteristics: non-sport (n = 104), non-impact sport (swimming [n = 34]), martial arts (n = 49 [judo, karate, kung-Fu]) and impact sports (n = 98 [track-and-field, basketball, gymnastics, tennis, and baseball]). Results: The incidence of new fractures was 2.1%. The overall costs accounted during the 12-month follow-up were U$ 3,259.66. Swimmers (US$ 13.86) had higher health-care costs than non-sport (US$ 1.82), martial arts (US$ 2.23), and impact sports (US$ 2.32). Conclusion: swimming seems to be related to higher health-care costs among adolescents.

The association between religiosity and pregnancy acceptability among Latino/a young adults: does generational status matter?

The US Latino/a population is considered to be at high risk for unintended pregnancy; some research indicates that Latino/a parents are more likely to express happiness about an unintended pregnancy than other racial/ethnic groups. Associations between pregnancy attitudes and factors such as religiosity and nativity have also been documented in the Latino/a population, but existing research is sparse, dated and primarily focused on women of Mexican heritage. This study sought to expand this literature by examining the relationship between religiosity and pregnancy acceptability and assessing effect modification by generational status and gender in a national sample of young Latino/a cisgender women and men of various ancestral backgrounds currently in relationships. In multivariable logistic regression models, there was a positive association between importance of religion and pregnancy acceptability for both men and women; being highly or moderately religious was associated with elevated odds of finding a pregnancy acceptable. Effect modification by generational status was significant for women, but not for men. Results suggest that religiosity, gender and generational status have differential influences on and relationships to pregnancy orientations for Latina women and Latino men and should be considered in the design and delivery of family planning care for Latino/a clients.

Correlates of condomless anal sex among men who have sex with men (MSM) in Tijuana, Mexico: The role of public sex venues

Condomless anal sex between male partners is the primary risk factor for HIV transmission among men who have sex with men (MSM). Correlates of condomless anal sex have been well-studied in developed countries, but they have received less attention in lower-to-middle income countries (LMIC), where MSM are often subject to stigma, discrimination, intolerance, and even the criminalization of same sex behavior. In Mexico, a LMIC where traditional views on homosexuality are common, HIV prevalence among MSM is high (16.9%), yet little research has been conducted on the correlates of condomless anal sex in this high-risk population. The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior. Eligibility requirements were: biologically male, 18 years of age or older, resident of Tijuana, and self-reported anal or oral sex with a male partner in the past year. Participants completed an interviewer-administered, demographic and psychosocial survey, and were tested for HIV and syphilis. A hierarchical multiple linear regression model was tested to identify correlates of condomless anal sex. Thirty-eight percent of participants (N = 76) reported condomless anal sex with a male partner in the past 2 months. Higher levels of condomless anal sex were associated with higher levels of depressive symptoms, greater sexual compulsivity, and more frequent seeking out of sex partners in a public venue in the past 2 months. In view of these findings, we recommend the development of multi-level, “combination” interventions, which in the Mexican context should include enhanced condom promotion and distribution, improved availability and access to mental health treatment and counseling services, and expanded HIV/STI testing in public venues.

Defining Information Quality Into Health Websites: A Conceptual Framework of Health Website Information Quality for Educated Young Adults

Background

Today’s health care environment encourages health care consumers to take an active role in managing their health. As digital natives, young educated adults do much of their health information management through the Internet and consider it a valid source of health advice. However, the quality of information on health websites is highly variable and dynamic. Little is known about the understandings and perceptions that young educated adults have garnered on the quality of information on health websites used for health care–related purposes.

Objective

To fill this gap, the aim of this study was to develop a conceptual framework of health website information quality with quality dimensions (ie, criteria) and associated quality drivers (ie, attributes) specified in the context of young educated adults’ use of health websites for health care–related purposes. This aim was achieved by (1) identifying information quality dimensions of health websites from the perspective of young educated adults; (2) identifying the importance ratings of these quality dimensions; and (3) constructing a framework of health website information quality with quality dimensions and associated drivers specified in the context of young educated adults’ use of health websites for health care–related purposes.

Methods

The study employed both qualitative and quantitative methods. Methods included semistructured group interviews and an individual quality assessment exercise grounded in visiting various websites and responding to Likert scale questions regarding the importance ratings of information quality dimensions and open-ended questions with specifying website quality drivers. Study participants included junior and senior undergraduate and graduate students in business, allied health, and public health majors. Qualitative, open-coding procedures were used to develop the conceptual framework reflecting the participants’ means of assessing information quality on health websites.

Results

Five dimensions of information quality for health websites were identified: Completeness of information, Understandability of information, Relevance of information, Depth of information, and Accuracy of information. Completeness of information and Understandability of information were rated as the two most important quality dimensions by the study participants. Results indicated that these five information quality dimensions for health websites were supported by the following main driver themes: Content, Design, Links, Consumer resources, Search functionality, Supporting references, User focus, Content FAQ, Open access, Policy statements, and Site performance.

Conclusions

This study contributes to the literature by developing a health website information quality conceptual framework with quality dimensions and associated drivers specified for a young educated adult population. The detailed quality drivers supporting the corresponding quality dimensions provide a rich picture of young educated adults’ perceptions on health website information quality. This framework can be used to guide the development of health websites, as well as the foundation for a means to evaluate health information from existing health websites with young educated adults as the target audience.

Refugees, asylum-seekers and undocumented migrants and the experience of parenthood: a synthesis of the qualitative literature

OBJECTIVE

To synthesize the recent qualitative literature and identify the integrative themes describing the parenthood experiences of refugees, asylum-seekers and undocumented migrants.

METHODS

We searched seven online databases for the period January 2006 to February 2017. We included English and French published peer-reviewed articles and graduate-level dissertations, which qualitatively examined the parenthood experiences of refugees, asylum-seekers and undocumented migrants. We summarized study characteristics and performed a thematic analysis across the studies.

RESULTS

One hundred thirty eight studies met inclusion criteria. All but three were conducted in high-income countries, mainly in the US. Migrants studied were mostly undocumented from Latin America and refugees from Sub-Saharan Africa. Almost all studies (93%) included mothers; about half (47%) included fathers; very few (5%) included extended family members. We identified three integrative themes: 1) experiencing hardship and/or loss in the context of precarious migration and past traumas; 2) building resilience and strength by bridging language, norms and expectations; and 3) living transnationally: obligations, challenges and resources. Each theme contributed to shaping the parenthood experience; the transnationalism theme intersected with the themes on hardship and loss and resilience and strength.

CONCLUSION

More research is needed with fathers, extended family members, asylum-seekers and in the LMIC context. A transnational lens needs to be applied to programs, policies and future research for refugee, asylum-seeker and undocumented migrant parents. Addressing transnational concerns (family separation and reunification), acknowledging transnational resources, fostering a transnational family identity and conducting transnational and longitudinal studies are potentially pivotal approaches for this sub-population of parents.

Masculinities on transnational journeys: sexual practices and risk management among male Chinese immigrants to Canada

Recent critical studies of men and masculinities have encouraged greater consideration of global, international and transnational perspectives and processes. Drawing on interview data from a larger research study of transnationalism and HIV risk through the experiences of recent male Chinese immigrants to Canada, this article examines the intersection of masculinity, sexual practice and the HIV risk in a transnational context. As a gendered strategy, transnational mobility is not only employed by men to cope with the challenges of masculinity enactment encountered in Canada, but also to facilitate sexual activities back in China. By highlighting particular risk factors arising from transnational spaces these men inhabit, the paper reveals the interactive and interconnected effects that such experiences have on Chinese immigrant men's particular behavioural patterns associated with HIV risk, as well as their capacity to respond to this risk.

Exploring intergenerational changes in perceptions of gender roles and sexuality among Indigenous women in Oaxaca

The south of Mexico has traditionally faced disproportionate social, health and economic disadvantage relative to the rest of the country, due in part to lower levels of economic and human development, and barriers faced by Indigenous populations. The state of Oaxaca, in particular, has one of the highest proportions of Indigenous people and consistently displays high rates of maternal mortality, sexually transmitted infections and teenage pregnancy. This study examines how social values and norms surrounding sexuality have changed between two generations of women living in Indigenous communities in Oaxaca. We conducted semi-structured in-depth interviews with 19 women from two generational cohorts in 12 communities. Comparison views of these two cohorts suggest that cultural gender norms continue to govern how women express and experience their sexuality. In particular, feelings of shame and fear permeate the expression of sexuality, virginity continues be a determinant of a woman's worth and motherhood remains the key attribute to womanhood. Evidence points to a transformation of norms, and access to information and services related to sexual health is increasing. Nonetheless, there is still a need for culturally appropriate sex education programmes focused on female empowerment, increased access to sexual health services, and a reduction in the stigma surrounding women's expressions of sexuality.