Gender differences: examination of the 12-item bem sex role inventory (BSRI-12) in an older Brazilian population

Reconsidering tools for measuring gender dimensions in biomedical research

Sex and gender play important roles in contributing to disease and health outcomes and represent essential, but often overlooked, measures in biomedical research. The context-specific, multifaceted, and relational nature of gender norms, roles, and relations (i.e., gender dimensions) make their incorporation into biomedical research challenging. Gender scores-measures of gender dimensions-can help researchers incorporate gender into quantitative methodologies. These measures enable researchers to quantify the gendered dimensions of interest using data collected from survey respondents. To highlight the complexities of using gender scores within biomedical research, we used the application of the Bem Sex Role Inventory (BSRI) scale, a commonly used gender score, to explore gender differences in adverse events to the influenza vaccine among older adults (75+). Within this paper, we focus on the findings from our longitudinal gender score data collected over three influenza seasons (2019-20, 2020-21, and 2021-22), irrespective of adverse event data, to provide commentary on the reliability of gender scores, such as the BSRI, and the complexities of their application. Of the 162 total study participants included within the study, 69 were enrolled in all three consecutive seasons and 35 participants were enrolled in two consecutive seasons. The majority of participants had a different gender score in at least one of the years, demonstrating the nuances and fluidity of gender identity. Interpretations of BSRI data (or other gender score data) when measured against outcome data must, therefore, be time and context specific, as results are unlikely to be replicated across years.

Differences in cardiovascular risk factors associated with sex and gender identity, but not gender expression, in young, healthy cisgender adults

Background

Sex differences exist in cardiovascular disease risk factors including elevated blood pressure and arterial stiffness, and decreased endothelial function in males compared to females. Feminine gender expression may be associated with elevated risk of acute coronary syndrome. However, no study has investigated the associations between sex, gender identity, and gender expression and cardiovascular disease risk factors in young adults.

Methods

One hundred and thirty participants (22 ± 3 years) underwent assessments of hemodynamics, arterial stiffness [pulse wave velocity (PWV)], and brachial artery endothelial function (flow-mediated dilation; %FMD). Participants completed a questionnaire capturing sex category (50 male/80 female), gender identity category (49 men/79 women/2 non-binary), and aspects of gender expression assessed by the Bem Sex Role Inventory-30 (39 androgynous/33 feminine/29 masculine/29 undifferentiated). Sex/gender identity category groups were compared using unpaired t-tests and gender expression groups compared using one-way ANOVAs.

Results

Resting systolic and mean arterial pressure (p < 0.01) were elevated in males vs. females. Central PWV was elevated in males [median (interquartile range): 6.4 (1.8) vs. 5.8 (2.2) m/s, p = 0.02]; however, leg and arm PWV were not different between sexes. %FMD was elevated in males vs. females, after accounting for a larger baseline artery diameter in males (8.8 ± 3.3% vs. 7.2 ± 3.1%, p = 0.02); since the majority of participants were cisgender, the same results were found examining gender identity (men vs. women). There were no differences across gender expression groups (p > 0.05).

Conclusions

Sex/gender identity category, but not gender expression, influence cardiovascular risk factors (blood pressure, arterial stiffness, endothelial function) in cisgender adults; further research is needed in gender-diverse populations.

Exploring How Older Adult's Gender Role is Associated with Studied Outcomes Following an Outdoor Exercise Structure Program

This study aimed to describe the gender roles of people interested in an exercise program done on outdoor exercise structures and test if gender roles were associated with studied outcomes. Older adults aged 65+ who were not currently performing resistance training were invited to participate. Gender roles were quantified using the Bem Sex Role Inventory 30-item questionnaire (-60 [feminine] to +60 [masculine]). Outcomes included completing the 6-week intervention (Y/N) and changes in physical function (one leg stance, 30-s chair stand), strength (predicted maximal chest press and leg press, grip strength), power (knee extensor power), and overall health via the SF-36 questionnaire. Twenty-nine adults (65.5% female; median 72 years old) participated in the study, and 17 completed the intervention (58.6%). The median (interquartile) gender role score was -13.0 (-19.5 to -8.5), with no gender role difference (p = .62) between completers and non-completers. These results suggest that older adults interested in such a program portray themselves as more feminine. No association was found between gender role scores and changes in any study outcomes. In this setting, gender roles did not seem to impact the study outcomes and therefore may not need to be considered when designing an outdoor exercise structure program.

The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults

BACKGROUND

Women/females report more adverse events (AE) following immunization than men/males for many vaccines, including the influenza and COVID-19 vaccines. This discrepancy is often dismissed as a reporting bias, yet the relative contributions of biological sex and gender are poorly understood. We investigated the roles of sex and gender in the rate of AE following administration of the high-dose seasonal influenza vaccine to older adults (≥ 75 years) using an AE questionnaire administered 5-8 days post-vaccination. Participant sex (male or female) was determined by self-report and a gender score questionnaire was used to assign participants to one of four gender categories (feminine, masculine, androgynous, or undifferentiated). Sex steroid hormones and inflammatory cytokines were measured in plasma samples collected prior to vaccination to generate hypotheses as to the biological mechanism underpinning the AE reported.

RESULTS

A total of 423 vaccines were administered to 173 participants over four influenza seasons (2019-22) and gender data were available for 339 of these vaccinations (2020-22). At least one AE was reported following 105 vaccinations (25%), by 23 males and 82 females. The majority of AE occurred at the site of injection, were mild, and transient. The odds of experiencing an AE were 3-fold greater in females than males and decreased with age to a greater extent in females than males. The effects of gender, however, were not statistically significant, supporting a central role of biological sex in the occurrence of AE. In males, estradiol was significantly associated with IL-6 and with the probability of experiencing an AE. Both associations were absent in females, suggesting a sex-specific effect of estradiol on the occurrence of AE that supports the finding of a biological sex difference.

CONCLUSIONS

These data support a larger role for biological sex than for gender in the occurrence of AE following influenza vaccination in older adults and provide an initial investigation of hormonal mechanisms that may mediate this sex difference. This study highlights the complexities of measuring gender and the importance of assessing AE separately for males and females to better understand how vaccination strategies can be tailored to different subsets of the population.

Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV)-CTN 314

The Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, CTN 314, is the first Canadian cohort of people living with HIV aged 65 years and older. The cohort was established with the purpose of characterizing the multidimensional health status of this population and identifying factors influencing healthy aging. The study builds on the World Health Organization (WHO) Aging and Health conceptual framework, generating a comprehensive profile of health domains (physical, social, mental health, cognitive function, and quality of life), health determinants (biologic, personal, and environmental), and HIV-specific factors that may interact with and influence health in people aging with HIV. The data for the first 353 participants are presented, focusing on sociodemographic factors, comorbidities, coinfections, frailty, cognitive function, loneliness, and resilience using a sex/gender stratified analysis. The cohort thus far is 91% men and the median age is 70 years (range from 65 to 85). Several vulnerabilities were observed, including a high prevalence of comorbidities and frailty. Women especially faced financial insecurity and precarious social structures; a large proportion live alone and only 6% are married or in steady relationships. Identifying strategies to address these vulnerabilities will empower people aging with HIV to optimize their health, quality of life, and independence.

The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults

Background Women/females report more adverse events (AE) following immunization than men/males for many vaccines, including the influenza and COVID-19 vaccines. This discrepancy is often dismissed as a reporting bias, yet the relative contributions of biological sex and gender are poorly understood. We investigated the roles of sex and gender in the rate of AE following administration of the high-dose seasonal influenza vaccine to older adults (≥ 75 years) using an AE questionnaire administered 5-8 days post-vaccination. Participant sex (male or female) was determined by self-report and a gender score questionnaire was used to assign participants to one of four gender categories (feminine, masculine, androgynous, or undifferentiated). Sex steroid hormones and inflammatory cytokines were measured in plasma samples collected prior to vaccination to elucidate a possible biological mechanism for the AE reported. Results A total of 423 vaccines were administered to 173 participants over four influenza seasons (2019-22) and gender data were available for 339 of these vaccinations (2020-22). At least one AE was reported following 105 vaccinations (25%), by 23 males and 82 females. The majority of AE occurred at the site of injection, were mild, and transient. The odds of experiencing an AE were 3-fold greater in females than males and decreased with age to a greater extent in females than males. The effects of gender, however, were not statistically significant, supporting a central role of biological sex in the occurrence of AE. In males, estradiol was significantly associated with IL-6 and with the probability of experiencing an AE. Both associations were absent in females, suggesting a sex-specific effect of estradiol on the occurrence of AE that supports the finding of a biological sex difference. Conclusions These data support a larger role for biological sex than for gender in the occurrence of AE following influenza vaccination in older adults and provide an initial investigation of hormonal mechanisms that may mediate this sex difference. This study highlights the complexities of measuring gender and the importance of assessing AE separately for males and females to better understand how vaccination strategies can be tailored to different subsets of the population.

Gender and sexual orientation of undergraduate medical students in India: A cross-sectional study

Background

Although the potential for alternate conceptions of gender roles and sexual orientations are diverse, it is by-and-large not well tolerated. This study explores the self-reported gender-roles and sexual orientations of Indian undergraduate medical students.

Aim

To study self-reported gender role and sexual orientation of undergraduate medical students in India.

Method

One hundred twenty volunteers were included in the study consisting of 60 males and 60 females. A questionnaire comprising of a sociodemographic proforma, Bem Sex-Role Inventory (BSRI), and Epstein Sexual Orientation Inventory (ESOI) were given to each participant. The scales were scored, tabulated, and statistically analyzed.

Results

The BSRI revealed that femininity was predominant in both female and male participants, at 68.33% and 55%, respectively. The ESOI revealed that females had significantly higher opposite-sex attraction than males. Though males had higher same-sex attraction than females, the difference was not statistically significant. Females also had a significantly higher sexual orientation range and a mean sexual orientation. Sexual drive was significantly higher in males. Significantly more females supported homosexuality and bisexuality as compared to males.

Conclusion

This study helps establish that gender roles can be non-conforming. It helps ascertain that while heterosexual orientation predominates, alternate sexual orientations also exist. It paves the way for future studies and explorations to alleviate public misconceptions.

The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review

Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.

Benefits of Psychological Androgyny in Adolescence: The Role of Gender Role Self-Concept in School-Related Well-Being

It has been repeatedly shown that the extent to which individuals adopt stereotypically masculine and feminine traits in their self-concept impacts their health and well-being. This is especially important in adolescence, when developmental changes and social pressures to conform to stereotypical gender roles can affect psychological functioning. However, previous studies investigating relationship between gender role self-concept and well-being in adolescents focused mostly on general well-being rather than well-being in specific contexts. Given that school is one of the most important contexts for adolescents’ development and well-being, the aim of this study was to investigate differences between adolescents with different gender role self-concepts (masculine, feminine, androgynous and undifferentiated) in school-related well-being. In line with the new conceptualization of well-being uniting hedonic (pleasure attainment and pain avoidance) and eudemonic (self-actualization and having meaningful purpose in one’s life) approaches, the present study used a measure of school-related well-being encompassing five domains suggested in the EPOCH (Engagement, Perseverance, Optimism, Connectedness and Happiness) model as well as a superordinate well-being factor. A total of 999 Austrian adolescents (52.2% girls, M_age = 13.79, SD_age = 1.53) answered inventories assessing adolescents’ gender role self-concept (GRI-JUG) and school-related well-being (EPOCH-G-S). The results supported the androgyny model of well-being, showing clear advantages of having both positive masculine and feminine qualities in one’s self-concept for optimal levels of school-related well-being. In addition, our results indicated the strong importance of femininity in adolescence and the school context. Theoretical and practical implications are discussed.

Sex and gender associations with indicators of neurodevelopmental compromise in schizophrenia spectrum disorders

BACKGROUND

It has been proposed that sex and gender differences described in schizophrenia can be explained from a neurodevelopmental perspective.

AIM

In this study, we examined the associations of biological sex and gender role endorsement with putative indicators of neurodevelopmental compromise.

METHODS

We used the Bem Sex Role Inventory to calculate masculinity scores in 77 patients with a first episode of a schizophrenia spectrum disorder, and selected the following indicators of neurodevelopmental compromise: family history of schizophrenia, obstetric complications, premorbid functioning, neurological soft signs, and cognitive function. Secondary objectives included the moderating effects of age of onset of illness, substance use and negative symptoms on these associations.

RESULTS

There were no significant sex differences across any of the indicators of neurodevelopmental compromise. However, lower masculinity scores correlated significantly with poorer premorbid adjustment, sensory integration deficits and worse overall cognitive performance. Stepwise linear regression identified poorer premorbid adjustment in early adolescence and lower verbal learning scores as independent predictors of lower masculinity scores. In contrast to sex, gender showed several associations with indicators of neurodevelopmental compromise.

CONCLUSIONS

Lower masculinity scores may represent part of a phenotype for a neurodevelopmental anomaly that places some individuals on a pathway to schizophrenia.

Predicting attitudes towards easing COVID-19 restrictions in the United States of America: The role of health concerns, demographic, political, and individual difference factors

Despite rising cases of COVID-19 in the United States of America, several states are easing restrictions (e.g., relaxing physical distancing requirements, reopening businesses) that were imposed to limit community transmission of the virus. Individuals hold differing opinions regarding whether restrictions should continue to be imposed or lifted, evidenced, for example, by debate and protests regarding reopening of businesses and venues. Health and social psychological research suggest that perceptions of COVID-19related risk, experiences of the virus, and individual difference factors can help explain individuals' attitudes towards health initiatives and their tendency to be persuaded towards a specific course of action. The purpose of this study was to investigate what factors influence support or opposition to easing COVID-19-related restrictions. A sample of 350 United States citizens, responding to an anonymous survey, were asked about the extent to which they support/oppose easing of COVID-19-related restrictions, both generally and in relation to specific restrictions. Respondents completed measures of their experiences of COVID-19, individual difference factors, and demographic variables, including political affiliation and degree of social and economic conservatism. In a series of regression analyses, significant demographic predictors of support or opposition for easing restrictions were gender, age, ethnicity, and education, with political affiliation and degree of social and economic conservatism also predicting attitudes. Experiences related to COVID-19 that predicted attitudes were concerns for self and family, perceptions of threat posed by the virus, perceived ability to adhere to restrictions, willingness to take government direction, and belief in COVID-19-related conspiracy theories. At an individual differences level, uncertainty avoidance, collectivism, long-term orientation, masculinity, empathic concern, personal distress, reactance, and general conspiracy theory beliefs all significantly precited attitudes to easing restrictions. Understanding the factors that help explain attitudes towards COVID-19 restrictions can inform how best to position health messaging and initiatives going forward, particularly as states or countries open borders.

Construction of a femininity score in the UK Biobank and its association with angina diagnosis prior to myocardial infarction

Gender captures social components beyond biological sex and can add valuable insight to health studies in populations. However, assessment of gender typically relies on questionnaires which may not be available. The aim of this study is to construct a gender metric using available variables in the UK Biobank and to apply it to the study of angina diagnosis. Proxy variables for femininity characteristics were identified in the UK Biobank and regressed on sex to construct a composite femininity score (FS) validated using tenfold cross-validation. The FS was assessed as a predictor of angina diagnosis before incident myocardial infarction (MI) events. The FS was derived for 315,937 UK Biobank participants. In 3059 individuals with no history of MI at study entry who had an incident MI event, the FS was a significant predictor of angina diagnosis prior to MI (OR 1.24, 95% CI 1.10-1.39, P < 0.001) with a significant sex-by-FS interaction effect (P = 0.003). The FS was positively associated with angina diagnosis prior to MI in men (OR 1.37, 95% CI 1.19-1.57, P < 0.001), but not in women. We have provided a new tool to conduct gender-sensitive analyses in observational studies, and applied it to study of angina diagnosis prior to MI.

Factor structure and psychometric properties of the Muscularity-Oriented Eating Test in university women in Australia

OBJECTIVE

Toned muscularity continues to emerge as a salient aspect of women's body image. However, there is a dearth of research investigating the potentially maladaptive eating practices and related cognitions that accompany the drive for muscularity in women. This may be attributable to the limited empirical and clinical attention previously given to muscularity-oriented disordered eating and, accordingly, the lack of validated measures assessing these concerns. To address this knowledge gap, our study aimed to provide a preliminary evaluation of the factor structure and core psychometric properties of a recently developed measure of muscularity-oriented disordered eating, the Muscularity-Oriented Eating Test (MOET), in university women in Australia.

METHOD

Participants included 419 university women who completed the 15-item MOET and other self-report measures for validity evaluation as part of an online survey. Data from split-half samples were used to undertake an exploratory factor analysis and subsequent confirmatory factor analysis.

RESULTS

Factor analytic results supported a briefer (12-item), one-factor scale in this sample of university women. The internal consistency reliability and validity (convergent and discriminant) of this 12-item unidimensional MOET was supported.

DISCUSSION

Our study provides preliminary support for this modified MOET as a psychometrically sound self-report measure of muscularity-oriented disordered eating in university women in Australia, providing a useful tool for understanding maladaptive eating behaviors and cognitions concomitant to the pursuit of muscularity in this population.

The Interactions Among Sexual Orientation, Masculine and Feminine Gender Role Orientation, and Facets of Sociosexuality in Young Heterosexual and Homosexual Men

The present study investigated the functional relationships among sexual orientation, masculine and feminine gender role orientation, and sociosexual orientation in 282 heterosexual and 282 homosexual young men. Homosexual men reported significantly more pronounced sociosexual behavior (d = 0.65) and desire (d = 0.31). Furthermore, homosexual men were characterized by lower masculine (d =-0.26) and higher feminine (d = 0.38) gender role orientation. Latent variable analyses revealed that homosexual men as well as more masculine men, irrespective of their sexual orientation, had more uncommitted sexual relations and more unrestricted sociosexual attitudes. A similar pattern could be identified for sociosexual desire. While homosexual men were more unrestricted in their sociosexual desire, this also held for more feminine men in general. Overall, findings indicated that homosexual orientation is positively associated with sociosexual orientation. In addition, masculine/feminine gender role orientations exert differential influences on the three facets of sociosexuality independent of sexual orientation.

Analysis of Sexual Inhibition and Satisfaction from a Gender Perspective among University Students

University is characterized by a critical stage where students experience their sexuality, across a range of relationships. From these experiences, university students consolidate their personality and their sexual role. Factors such as age, sex, or traumatic experiences of violence or sexual abuse can affect their sexual role. The present study aims to analyze how the variables age, sex and having suffered abuse or violence may predict sexual satisfaction and inhibition. In addition, we analyze the mediating effect that sexual role plays on these relationships. For this purpose, Bem Sex Role Inventory (BSRI-12), Sociosexual Orientation Inventory (SOI-R), Inhibited Sexual Desire Test (ISD) and New Sexual Satisfaction Scale (NESS) were administered to 403 university students. The findings report that sex (β = −0.313), age (β = −0.116) and being a survivor of sexual assault (β = 0.413) are predictive of male role, but not from the female role. Also, people with more male features tend to have lower levels of commitment and inhibition than those who have more female ones.

Gender role endorsement in first-episode schizophrenia spectrum disorders

Sex (a biological distinction) and gender (a social construct) are inter-related, but semi-independent measures. The aim of our research was to compare gender role endorsement between first-episode schizophrenia spectrum disorder patients (n=77) and matched controls (n=64). The Bem Sex Role Inventory (BSRI) was used to assess masculinity and femininity scores as separate linear measures. This well-known research instrument also allowed us to examine gender as a categorical measure based on sex-specific cut-off scores calculated for controls as our normative reference sample using a median-split technique. First, we found that both masculinity and femininity scores differed between patients and controls. The distribution of gender as a categorical measure also differed between the two groups. Post-hoc testing with correction for multiple comparisons identified masculinity scores in particular as being lower in both male and female patients compared to controls of the corresponding sex. In conclusion, lower masculinity scores reported for chronic schizophrenia also affects first-episode patients with minimal prior treatment exposure irrespective of their biological sex. Future studies would do well to examine the associations of sex and gender with clinical and treatment outcomes from the perspective of the neurodevelopmental model of schizophrenia as a proposed "disorder of the self".

Gender Differences in Digital Learning During COVID-19: Competence Beliefs, Intrinsic Value, Learning Engagement, and Perceived Teacher Support

The spread of the COVID-19 pandemic quickly necessitated digital learning, which bore challenges for all pupils but especially for groups disadvantaged in a virtual classroom. As some studies indicate persistent differences between boys and girls in use of technologies and related skills, the aim of this study was to investigate gender differences in the digital learning environment students faced in spring 2020. Previous studies investigating gender differences in digital learning largely used biological sex as the only indicator of gender. This study includes both biological sex and gender role self-concept in order to investigate the role of gender in different components of this stereotyped domain in a more differentiated way. A total of 19,190 Austrian secondary school students (61.9% girls, M_age = 14.55, SD_age = 2.49, age range 10–21) participated in an online study in April 2020 and answered questions regarding their competence beliefs, intrinsic value, engagement, and perceived teacher support in digital learning during the pandemic-induced school closures. Results showed higher perceived teacher support, intrinsic value, and learning engagement among girls than boys, while no significant sex differences were found in competence beliefs regarding digital learning. Furthermore, our results indicated clear benefits of an androgynous gender role self-concept for all studied components of digital learning. Implications of the findings for theory and practice are discussed.

Spanish Women Making Risky Decisions in the Social Domain: The Mediating Role of Femininity and Fear of Negative Evaluation

Authors have empirically evidenced that cultural stereotypes influence gender-typed behavior. With the present work, we have added to this literature by demonstrating that gender roles can explain sex differences in risk-taking, a stereotypically masculine domain. Our aim was to replicate previous findings and to analyze what variables affect women making risky decisions in the social domain. A sample composed of 417 Spanish participants (281 women and 136 men), between 17 and 30 years old (M = 22.34, SD = 3.01), answered a set of self-report measures referring to femininity, fear of negative evaluation, and social risk-taking. According to the main results, sex indirectly linked to risk-taking in the social domain, through femininity and fear of negative evaluation. Specifically, women (vs. men) self-reported higher feminine traits, which were associated with increased fear of negative evaluation, which in turn was associated with less risky decisions in the social domain. Thus, we have showed the relationship between gender roles and women's behaviors in a stereotypically masculine domain (risk-taking). Our findings highlight the necessity of considering a gender-based perspective in the field of risk-taking, showing that not all women make more risky decisions in the social domain.

A systematic review of tools used to assess body image, masculinity and self-esteem in men with prostate cancer

OBJECTIVE

Masculinity, body image and self-esteem are important interlinked factors affecting prostate cancer (PCa) patients' quality of life. The aim of this systematic review was to identify and evaluate all tools measuring these domains in men with PCa.

METHODS

This review was conducted according to PRISMA guidelines with a priori protocol registered. Pubmed, Embase, Medline and Psychinfo were searched from inception to May 2020. Studies using a predefined tool which measured any body image, self-esteem or masculinity construct in men with PCa were included, as well as validation studies of these. Reliability, validity and responsiveness of tools identified were objectively evaluated against the COSMIN taxonomy of measurement properties.

RESULTS

From 1416 records screened, a final 46 studies consisting of 17 different tools were included in the systematic review. Seven tools were identified assessing body image, nine masculinity and one self-esteem, varying widely in their number of items, possible responses and domains assessed. Most tools had evaluated internal consistency through Cronbach's alpha analysis; however, structural and discriminative validity, and responsiveness were lacking for many. Additionally, only one tool identified was specifically developed and evaluated in patients with PCa: The Masculinity in Chronic Disease Inventory.

CONCLUSIONS

Numerous tools have been used for the measurement of body image, masculinity and self-esteem in men with PCa. However, few were developed specifically for these patients. More research is therefore needed to ascertain specific factors affecting these outcomes in PCa patients, so valid, reliable and clinically relevant tools can be developed.

On the Functional Relationships Among Sexual Orientation, Masculine and Feminine Gender Role Orientation, and Sociosexual Orientation in Young Heterosexual and Lesbian Women

The present study investigated the mutual interplay of sexual orientation, masculine and feminine gender role orientation, and sociosexual orientation in young women. To ensure cross-sample validity, 323 heterosexual women and 323 lesbian women, ranging in age from 18 to 29 years, were matched for possible confounding variables. Lesbian women scored significantly higher (d = 0.27) on the Desire subscale of the Revised Sociosexual Orientation Inventory, but not on the Behavior (d = 0.07) and Attitude subscales (d = 0.11). Concerning gender role orientation, heterosexual women were characterized by significantly higher scores on the Femininity scale (d = 0.20), whereas lesbian women showed more pronounced masculine gender role orientation (d = 0.16). Structural equation modeling revealed two functionally distinct relationships between sexual orientation and sociosexuality, on the one hand, and between gender role orientation and sociosexuality, on the other hand. Sociosexual desire was exclusively associated with a woman's sexual orientation with no indication of any mediating effect of gender role orientation. Sociosexual behavior was positively related to a woman's level of masculine gender role orientation, while sociosexual attitude was positively associated with masculine and negatively associated with feminine gender role orientation, irrespective of sexual orientation.

The relationship between gender roles and self-rated health: A perspective from an international study

OBJECTIVES

To examine the relationship between gender roles and self-rated health in older men and women from different contexts.

METHODS

2002 community-dwelling older adults from the International Mobility in Aging Study were recruited from 5 research sites. Gender role was measured with the 12-item Bem Sex Role Inventory, which categorized study participants into four gender roles: Masculine, Feminine, Androgynous, and Undifferentiated. Self-rated health was collapsed into a dichotomous variable (Very Good/Good and Fair/Poor/Very Poor). Prevalence risk ratios (PRR) of self-rated health relative to gender roles were estimated with Poisson regression models adjusted for all relevant confounders.

RESULTS

After complete adjustment, feminine (PRR 1.22 (95 % CI 1.01-1.49)) and undifferentiated (PRR 1.25 (95 % CI 1.05-1.50)) gender roles were associated with poorer relative self-rated health.

DISCUSSION

Gender roles confer independent risks and benefits for self-rated health in older adults.

Masculinity, femininity, and leadership: Taking a closer look at the alpha female

An extensive review and textual analysis of the academic and popular literature of the human alpha female was conducted to examine the social construction and expression of the alpha female identity in a small non-random sample of North American women (N = 398). This review revealed 2 predominant alpha female representations in the literature-one more masculine versus one more feminine-and 21 alpha female variables. In this sample of women, the "alpha female" was found to be a recognized socially constructed female identity. Univariate analysis revealed positive and highly significant differences in self-reported mean scores between alpha (N = 94) and non-alpha (N = 304) females for 10 variables including, masculine traits, leadership, strength, low introversion, self-esteem, life satisfaction, sexual experience, initiates sex, enjoys sex and playing a dominant role in sexual encounters, with alpha females scoring higher than non-alphas. The measure of masculine traits was identified as the only predictor of alpha female status as per the multiple regression model. Interestingly, both alpha and non-alpha women scored the same for the measure of feminine traits. Further, both groups scored higher for feminine traits than masculine traits. The results also revealed that neither social dominance nor sexual dominance were predictors of alpha female status which challenge academic and popularized representations of this identity. The results suggest that although the alpha female is often regarded as an exceptional and, at times, an exoticized form of femininity, like other femininities, her identity is marked by contradictions and tensions.

A Rasch Adapted Version of the 30-Item Bem Sex Role Inventory (BSRI)

As a foundational instrument in the measurement of gender, the study investigated the psychometric properties of the item scores on the 30-item Bem Sex Roles Inventory (BSRI) to address concerns raised in previous studies and to determine possible differential item functioning (DIF) by applying a Rasch measurement model on a multicultural South African sample. A quantitative cross-sectional research design with 55.3% women and 44.4% men was used. Overall, we found support for the reliability and validity of BSRI item scores, consistent with findings in North American and European contexts. The results supported the use of a 6-point response format as opposed to the original 7-point response format. The items "aggressive" (masculinity) and "loves children" (femininity) were removed. The Neutral dimension fit the data well. No DIF for the groupings of man/woman, race, and language (the latter 2 as measures of culture) were found. This study makes contributions by applying a Rasch measurement model to the BSRI, scores which have previously only been validated through classical test theory and often excludes the validation of the neutral dimension scores.

Sex, Gender Identity, and Perceived Employability Among Spanish Employed and Unemployed Youngsters

Young people find it difficult to access to the labor market, particularly in countries like Spain with a dramatically high rate of unemployment. A further problem is that this labor market is not gender-neutral. This has been demonstrated repeatedly in the literature, with women typically being at a disadvantage. This highlights the need to study issues related to employability from a gender perspective, beyond including sex as a mere control variable. This analysis is relevant given the gender biases in organizations and in society in general that hinder the advancement of gender equality in organizations. Accordingly, our aim is to study both sex (male vs. female) and four profiles of gender identity based on dimensions of masculinity and femininity (i.e., feminine, masculine, undifferentiated, and androgynous) in relation to perceived employability in an exploratory way in two samples of employed (N = 181) and unemployed (N = 246) Spanish youngsters (i.e., below 30). The results show different patterns for employed and unemployed youngsters regarding sex, gender identity and their interaction in relation to perceptions of being employable. Concerning sex, women seem more confident about their employment chances when unemployed. In contrast, men feel more confident about their employment chances within their organization than women when employed. Concerning gender identity, the androgynous gender profile in the employed sample (in both men and women) scored highest on perceived employability. Results of the sex–gender identity interaction show that being feminine associates with the highest level of perceived employability for an unemployed man and the lowest for an unemployed woman. Moreover, both unemployed men and women androgynous score the highest in perceiving employability (except feminine men). Our findings highlight that sex and gender identity do play a role in shaping employability perceptions of young men and women in different labor contexts (employment and unemployment). This reinforces the need of changes against discrimination at work and in job search from a feminist approach to arrive at a more equal society.

Sex-Specific Effects of Gender Identification on Pain Study Recruitment

Epidemiological, clinical, and laboratory studies show sex differences in pain responses, with women more sensitive to nociceptive stimulation and more vulnerable to long-term pain conditions than men. Because of evidence that men are culturally reinforced for the ability to endure (or under-report) pain, some of these findings might be explained by sociocultural beliefs about gender-appropriate behavior. One potential manifestation of these effects might be differential participation in pain studies, with men adhering to stereotypical masculine roles viewing participation as a way to demonstrate their masculinity. To test this possibility, we assessed gender identification in 137 healthy participants. At the end of the assessment, they were asked if they would like to participate in other research studies. Interested participants were then asked to participate in a study involving administration of pain-evoking stimulation. We compared individuals who agreed to participate in the pain study with those who declined. We observed a significant Sex × Participation interaction in masculine gender identification, such that men (but not women) who agreed to participate identified significantly more with masculine gender. Among masculine gender traits examined, we found that high levels of aggression and competitiveness were the strongest predictors of pain study participation. Our results suggest that men in pain studies might have higher levels of masculine gender identification than the wider male population. Taken together with previous findings of lower levels of pain sensitivity (or reporting) in masculine-identifying male participants, these results suggest an explanation for some of the sex-related differences observed in pain responses.

PERSPECTIVE

To examine whether sex and gender affect willingness to participate in pain studies, we assessed gender identification in men and women, then attempted to recruit them to participate in a pain study. Men who agree to participate in pain studies are significantly higher in masculine gender identification than men who decline to participate or women who agree to participate. Men who agreed to participate were rated particularly high in aggressiveness and competitiveness.

Assessing gender stereotypes and sexual risk practices in men who have sex with men

OBJECTIVE

To analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM).

METHODS

Cross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed.

RESULTS

Two main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partner's serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants.

CONCLUSION

The BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partner's serological status. The information obtained may be useful to define intervention and prevention programs.

Health Behaviors and Chronic Conditions Mediate the Protective Effects of Masculinity for Physical Performance in Older Adults

OBJECTIVE

We estimated the 2-year incidence of poor physical performance according to gender roles and examined mediating pathways related to health behaviors and chronic conditions.

METHOD

Data are from the International Mobility in Aging Study ( n = 1,676). The Bem Sex Role Inventory was used to classify participants into four gender roles as "masculine," "feminine," "androgynous," and "undifferentiated."

RESULTS

We found a higher incidence of poor physical performance among participants endorsing the feminine (adjusted incidence rate ratio [IRR] = 2.36, 95% confidence interval (CI) = [1.55, 3.60]) or the undifferentiated role (adjusted IRR = 2.19, 95% CI = [1.45, 3.30]) compared with the androgynous role. Smoking, physical activity, the number of chronic conditions, high body mass index, and depression were mediators of this association but not alcohol consumption.

DISCUSSION

This study provides evidence that gender roles are independently associated with physical performance. Health behaviors and chronic conditions are mediators of the relationship between gender roles and lower extremity physical function.

The Effects of Sex and Gender-Role Characteristics on Facets of Sociosexuality in Heterosexual Young Adults

The present study was designed to systematically investigate the functional relationships among biological sex; masculine and feminine gender-role characteristics; and sociosexual behavior, attitude toward, and desire for uncommitted casual sex as three facets of sociosexual orientation. For this purpose, facets of sociosexuality were assessed by the Revised Sociosexual Orientation Inventory (SOI-R) and masculine and feminine gender-role characteristics were assessed by a revised German version of the Bem Sex-Role Inventory in 499 male and 958 female heterosexual young adults. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) revealed differential mediating effects of masculine and feminine gender-role characteristics on the relationship between biological sex and the three facets of sociosexual orientation. Sociosexual behavior was shown to be primarily controlled by an individual's level of masculine gender-role characteristics irrespective of biological sex. Sociosexual desire was identified as being a sole function of biological sex with no indication for any effect of masculine or feminine gender-role characteristics, while sociosexual attitude was influenced by biological sex as well as by masculine and feminine gender-role characteristics to about the same extent.

Bem Sex Role Inventory Validation in the International Mobility in Aging Study

Cette étude, en utilisant différentes méthodes d’analyse des facteurs, a examiné la structure de mesure de l’Inventaire des rôles sexués de Bem (IRSB). La plupart des études antérieures sur la validité ont appliqué analyse factorielle exploratoire (AFE) d’examiner l’IRSB. Il s’agissait d’évaluer les propriétés psychométriques et la validité de la construction de la forme courte IRSB comprenant 12 articles dans un échantillon administré à 1,995 personnes âgées de la vague 1 de l’Initiative internationale de la mobilité en viellissement (IIMV). Nous avons utilisé l’alpha de Cronbach pour évaluer la fiabilité et la cohérence interne et une analyse factorielle confirmatoire (AFC) afin d’évaluer les propriétés psychometriques. AFE a révélé un modèle comprenant trois facteurs, qu’on a confirmé par l’AFC, puis ceci est comparé avec le modèle structurel initial de deux facteurs. Les résultats ont révélé qu’une solution à deux facteurs (instrumentalité-expression) a montré satisfaisante validité conceptuelle et un ajustement supérieur aux données, par rapport à la solution à trois facteurs. La solution à deux facteurs confirme différences attendues entre les sexes chez les personnes âgées. L’IRSB composé de 12 articles fournit un instrument bref, psychométrique et fiable dans les échantillons internationaux des personnes âgées.

Gender Roles and Physical Function in Older Adults: Cross-Sectional Analysis of the International Mobility in Aging Study (IMIAS)

OBJECTIVES

To examine the relationships between physical function and gender-stereotyped traits and whether these relationships are modified by sex or social context.

METHODS

A total of 1995 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Tirana (Albania), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). We performed a cross-sectional analysis. Study outcomes were mobility disability, defined as having difficulty in walking 400 meters without assistance or climbing a flight of stairs without resting, and low physical performance, defined as a score < 8 on the Short Physical Performance Battery. The 12-item Bem Sex Role Inventory (BSRI) was used to classify participants into four gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using site-specific medians of femininity and masculinity as cut-off points. Poisson regression models were used to estimate prevalence rate ratios (PRR) of mobility disability and poor physical performance according to gender roles.

RESULTS

In models adjusted for sex, marital status, education, income, and research site, when comparing to the androgynous role, we found higher prevalence of mobility disability and poor physical performance among participants endorsing the feminine role (PRR = 1.20, 95% confidence interval (CI) 1.03-1.39 and PRR = 1.37, CI 1.01-1.88, respectively) or the undifferentiated role (PRR = 1.23, 95% CI 1.07-1.42 and PRR = 1.58, CI 1.18-2.12, respectively). Participants classified as masculine did not differ from androgynous participants in prevalence rates of mobility disability or low physical performance. None of the multiplicative interactions by sex and research site were significant.

CONCLUSION

Feminine and undifferentiated gender roles are independent risk factors for mobility disability and low physical performance in older adults. Longitudinal research is needed to assess the mediation pathways through which gender-stereotyped traits influence functional limitations and to investigate the longitudinal nature of these relationships.

Depression, Sex and Gender Roles in Older Adult Populations: The International Mobility in Aging Study (IMIAS)

Objectives

To assess the associations between gender roles and depression in older men and women and whether gender roles are independent risk factors for depression.

Methods

International cross-sectional study of adults between 65 and 74 years old (n = 1,967). Depression was defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale (CES-D). A validated 12-item Bem Sex Role Inventory (BSRI) was used to classify participants in gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using research site medians of femininity and masculinity as cut-off points. Poisson regressions were fitted to estimate the prevalence ratios (PR) of depression for each gender role compared to the masculine role, adjusting for sex, sufficiency of income, education, marital status, self-rated health, and chronic conditions.

Results

Among men, 31.2% were androgynous, 26% were masculine, 14.4% were feminine, and 28.4% were undifferentiated; among women, the corresponding percentages were 32.7%, 14.9%, 27%, and 25.4%. Both in men and in women, depressive symptoms (CES-D≥16) were more prevalent in those endorsing the undifferentiated type, compared to masculine, feminine or androgynous groups. However, after adjusting for potential confounders, compared to the masculine group only those endorsing the androgynous role were 28% less likely to suffer from depression: PR of 0.72 (95% CI: 0.55–0.93). In fully adjusted models, prevalence rates of depression were not different from masculine participants in the two other gender groups of feminine and undifferentiated.

Conclusions

Androgynous roles were associated with lower rates of depression in older adults, independently of being a man or a woman.

The validity of the 12-item Bem Sex Role Inventory in older Spanish population: an examination of the androgyny model

The Bem Sex Role Inventory (BSRI) is the most commonly used and validated gender role measurement tool across countries and age groups. However, it has been rarely validated in older adults and sporadically used in aging and health studies. Perceived gender role is a crucial part of a person's identity and an established determinant of health. Androgyny model suggests that those with high levels of both masculinity and femininity (androgynous) are more adaptive and hence have better health. Our objectives were to explore the validity of BSRI in an older Spanish population, to compare different standard methods of measuring gender roles, and to examine their impact on health indicators. The BSRI and health indicator questions were completed by 120 community-dwelling adults aged 65+ living in Aragon, Spain. Exploratory factor analysis was performed to examine psychometric properties of the BSRI. Androgyny was measured by three approaches: geometric mean, t-ratio, and traditional four-gender groups classification. Relationships between health indicators and gender roles were explored. Factor analysis resulted in two-factor solution consistent with the original masculine and feminine items with high loadings and good reliability. There were no associations between biological sex and gender roles. Different gender role measurement approaches classified participants differently into gender role groups. Overall, androgyny was associated with better mobility and physical and mental health. The traditional four groups approach showed higher compatibility with the androgyny model and was better able to disentangle the differential impact of gender roles on health.