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Samari G, Wurtz HM, Abularrage TF, Sharif MZ. Structural gendered racism as conceptualized by immigrant women in the United States. Soc Sci Med 2024; 351 Suppl 1:116396. [PMID: 38825373 PMCID: PMC11149896 DOI: 10.1016/j.socscimed.2023.116396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 06/04/2024]
Abstract
RATIONALE Immigrants represent a rapidly growing proportion of the population, yet the many ways in which structural inequities, including racism, xenophobia, and sexism, influence their health remains largely understudied. Perspectives from immigrant women can highlight intersectional dimensions of structural gendered racism and the ways in which racial and gender-based systems of structural oppression interact. OBJECTIVE This study aims to show the multilevel manifestations of structural gendered racism in the health experiences of immigrant women living in New York City. METHOD Semi-structured, in-depth interviews were conducted in 2020 and 2021 with 44 cisgender immigrant women from different national origins in New York City to explore how immigrant women experienced structural gendered racism and its pathways to their health. Interviews were thematically analyzed using a constant comparative approach. RESULTS Participants expressed intersectional dimensions of structural gendered racism and the anti-immigrant climate through restrictive immigration policy and issues related to citizenship status, disproportionate immigration enforcement and criminalization, economic exploitation, and gendered interpersonal racism experienced across a range of systems and contexts. Participants weighed their concerns for safety and facing racism as part of their life course and health decisions for themselves and their families. CONCLUSIONS The perspectives and experiences of immigrant women are key to identifying multilevel solutions for the burdens of structural gendered racism, particularly among individuals and communities of non-U.S. national origin. Understanding how racism, sexism, xenophobia, and intersecting systems of oppression impact immigrant women is critical for advancing health equity.
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Affiliation(s)
- Goleen Samari
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Heather M Wurtz
- Anthropology Department, University of Connecticut, Storrs, CT, USA; Research Program on Global Health & Human Rights, Human Rights Institute, University of Connecticut, Storrs, CT, USA; Population Studies and Training Center, Brown University, Providence, RI, USA
| | - Tara F Abularrage
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Mienah Z Sharif
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Center for the Study of Racism, Social Justice and Health, University of California, Los Angeles, CA, USA
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Beccia AL, Agénor M, Baek J, Ding EY, Lapane KL, Austin SB. Methods for structural sexism and population health research: Introducing a novel analytic framework to capture life-course and intersectional effects. Soc Sci Med 2024; 351 Suppl 1:116804. [PMID: 38825380 DOI: 10.1016/j.socscimed.2024.116804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 06/04/2024]
Abstract
Accumulating evidence links structural sexism to gendered health inequities, yet methodological challenges have precluded comprehensive examinations into life-course and/or intersectional effects. To help address this gap, we introduce an analytic framework that uses sequential conditional mean models (SCMMs) to jointly account for longitudinal exposure trajectories and moderation by multiple dimensions of social identity/position, which we then apply to study how early life-course exposure to U.S. state-level structural sexism shapes mental health outcomes within and between gender groups. Data came from the Growing Up Today Study, a cohort of 16,875 children aged 9-14 years in 1996 who we followed through 2016. Using a composite index of relevant public policies and societal conditions (e.g., abortion bans, wage gaps), we assigned each U.S. state a year-specific structural sexism score and calculated participants' cumulative exposure by averaging the scores associated with states they had lived in during the study period, weighted according to duration of time spent in each. We then fit a series of SCMMs to estimate overall and group-specific associations between cumulative exposure from baseline through a given study wave and subsequent depressive symptomology; we also fit models using simplified (i.e., non-cumulative) exposure variables for comparison purposes. Analyses revealed that cumulative exposure to structural sexism: (1) was associated with significantly increased odds of experiencing depressive symptoms by the subsequent wave; (2) disproportionately impacted multiply marginalized groups (e.g., sexual minority girls/women); and (3) was more strongly associated with depressive symptomology compared to static or point-in-time exposure operationalizations (e.g., exposure in a single year). Substantively, these findings suggest that long-term exposure to structural sexism may contribute to the inequitable social patterning of mental distress among young people living in the U.S. More broadly, the proposed analytic framework represents a promising approach to examining the complex links between structural sexism and health across the life course and for diverse social groups.
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Affiliation(s)
- Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA.
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA.
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Eric Y Ding
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
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Homan P. Health consequences of structural sexism: Conceptual foundations, empirical evidence and priorities for future research. Soc Sci Med 2024; 351 Suppl 1:116379. [PMID: 38825372 PMCID: PMC11149901 DOI: 10.1016/j.socscimed.2023.116379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 06/04/2024]
Abstract
A nascent body of work has begun exploring the health consequences of structural sexism. This article provides an overview of the concept of structural sexism and an elaboration of the potential pathways connecting it to health. Next, it reviews existing measurement approaches and the current state of empirical evidence on the relationship between structural sexism and health in the United States. Finally, it highlights key priorities for future research, which include: expanding and refining measures, increasing public data availability, broadening the scope of inquiry to include a wider range of outcomes, exploring mechanisms, incorporating intersectionality, and applying a life course lens.
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Affiliation(s)
- Patricia Homan
- Florida State University, 636 West Call Street, Tallahassee, FL, 32306-1121, USA.
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Dore EC, Shrivastava S, Homan P. Structural Sexism and Preventive Health Care Use in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:2-19. [PMID: 37675877 PMCID: PMC10918039 DOI: 10.1177/00221465231194043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Preventive health care use can reduce the risk of disease, disability, and death. Thus, it is critical to understand factors that shape preventive care use. A growing body of research identifies structural sexism as a driver of population health, but it remains unknown if structural sexism is linked to preventive care use and, if so, whether the relationship differs for women and men. Gender performance and gendered power and resource allocation perspectives lead to competing hypotheses regarding these questions. This study explores the relationship between structural sexism and preventive care in gender-stratified, multilevel models that combine data from the Behavioral Risk Factor Surveillance System with state-level data (N = 425,454). We find that in states with more structural sexism, both men and women were less likely to seek preventive care. These findings support the gender performance hypothesis for men and the gendered power and resource allocation hypothesis for men and women.
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Balistreri KS. Structural Sexism and Breastfeeding in the United States, 2016-2021. Matern Child Health J 2024; 28:431-437. [PMID: 38379060 DOI: 10.1007/s10995-023-03895-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Recent studies demonstrate that structural sexism erodes women's health and impedes access to healthcare. This study extends this research to examine the relationship between structural sexism and breastfeeding initiation and duration in the United States. METHOD A multifaceted state-level structural sexism index was constructed and merged with responses from the 2016-2021 National Survey of Children's Health by state and child's birth year. For children ages six months to 5 years, the prevalence of being ever breastfed and breastfed for at least six months was measured across levels of structural sexism. Multivariable logistic regression analyzed the association of structural sexism with breastfeeding outcomes, net of individual and family characteristics. RESULTS Higher levels of structural sexism were associated with lower odds of breastfeeding initiation and lower odds of breastfeeding for at least six months net of family and child characteristics. In addition, sensitivity analyses show that variations in state breastfeeding laws did not explain these differences. DISCUSSION This study highlights structural sexism's role in limiting breastfeeding initiation and duration. Breastfeeding promotions and guidelines should consider the broader context of structural sexism.
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Barr E, Popkin R, Roodzant E, Jaworski B, Temkin SM. Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH). Transl Behav Med 2024; 14:13-22. [PMID: 37074158 DOI: 10.1093/tbm/ibad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Gender is a social and structural variable that encompasses multiple domains, each of which influences health: gender identity and expression, gender roles and norms, gendered power relations, and gender equality and equity. As such, gender has far-reaching impacts on health. Additional research is needed to continue delineating and untangling the effects of gender from the effects of sex and other biological variables. The National Institutes of Health (NIH) vision for women's health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Opportunities exist to support transdisciplinary knowledge transfer and interdisciplinary knowledge building by advancing health-related social science research that incorporates best practices from disciplines that have well-established methods, theories, and frameworks for examining the health impacts of gender and other social, cultural, and structural variables.
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Affiliation(s)
- Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Ronna Popkin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Population Dynamics Branch, National Institutes of Health, Bethesda, MD, USA
| | - Erik Roodzant
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
- Booz Allen Hamilton, McLean, VA, USA
| | - Beth Jaworski
- Office of Behavioral and Social Sciences Research, National Institutes of Health, USA
- Booz Allen Hamilton, McLean, VA, USA
| | - Sarah M Temkin
- Office of Research on Women's Health, National Institutes of Health, USA
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Monnat SM, Elo IT. Enhancing the Utility of the Health and Retirement Study (HRS) to Identify Drivers of Rising Mortality Rates in the United States. Forum Health Econ Policy 2022; 25:57-84. [PMID: 35254742 PMCID: PMC9448826 DOI: 10.1515/fhep-2021-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/07/2022] [Indexed: 01/05/2023]
Abstract
A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) highlights rising rates of working-age mortality in the United States, portending troubling population health trends for this group as they age. The Health and Retirement Study (HRS) is an invaluable resource for researchers studying health and aging dynamics among Americans ages 50 and above and has strong potential to be used by researchers to provide insights about the drivers of rising U.S. mortality rates. This paper assesses the strengths and limitations of HRS data for identifying drivers of rising mortality rates in the U.S. and provides recommendations to enhance the utility of the HRS in this regard. Among our many recommendations, we encourage the HRS to prioritize the following: link cause of death information to respondents; reduce the age of eligibility for inclusion in the sample; increase the rural sample size; enhance the existing HRS Contextual Data Resource by incorporating longitudinal measures of structural determinants of health; develop additional data linkages to capture residential settings and characteristics across the life course; and add measures that capture drug use, gun ownership, and social media use.
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Affiliation(s)
- Shannon M. Monnat
- Lerner Chair for Public Health Promotion and Lerner Center Director, Associate Professor of Sociology, Maxwell School of Citizenship and Public Affairs, Syracuse University, 426 Eggers Hall, Syracuse, NY13244, USA
| | - Irma T. Elo
- Professor and Chair of Sociology and Chair of the Graduate Group in Demography, University of Pennsylvania, 229 McNeil Building, Philadelphia, PA, USA
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Killian AC, Carter AJ, Reed RD, Shelton BA, Qu H, McLeod MC, Orandi BJ, Cannon RM, Anderson D, MacLennan PA, Kumar V, Hanaway M, Locke JE. Greater community vulnerability is associated with poor living donor navigator program fidelity. Surgery 2022; 172:997-1004. [PMID: 35831221 PMCID: PMC9633042 DOI: 10.1016/j.surg.2022.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Community-level factors contribute to living donor kidney transplantation disparities but may also influence the interventions aimed to mitigate these disparities. The Living Donor Navigator Program was designed to separate the advocacy role from the patient in need of transplantation-friends/family are encouraged to participate as the patients' advocates to identify living donors, though some of the patients participate alone as self-advocates. Self-advocates have a lower living donor kidney transplantation likelihood compared to the patients with an advocate. We sought to evaluate the relationship between the patients' community-level vulnerability and living donor navigator self-advocacy as a surrogate for program fidelity. METHODS This single-center, retrospective study included 110 Living Donor Navigator participants (April 2017-June 2019). Program fidelity was assessed using the participants' advocacy status. Measures of community vulnerability were obtained from the Centers for Disease Control and Prevention Social Vulnerability Index. Modified Poisson regression was used to evaluate the association between community-level vulnerability and living donor navigator self-advocacy. RESULTS Of the 110 participants, 19% (n = 21) were self-advocates. For every 10% increase in community-level vulnerability, patients had 17% higher risk of self-advocacy (adjusted relative risk 1.17, 95% confidence interval: 1.03-1.32, P = .01). Living in areas with greater unemployment (adjusted relative risk: 1.18, 95% confidence interval: 1.04-1.33, P = .01), single-parent households (adjusted relative risk: 1.23, 95% confidence interval: 1.06-1.42, P = .006), minority population (adjusted relative risk: 1.30, 95% confidence interval: 1.04-1.55, P = .02), or no-vehicle households (adjusted relative risk: 1.17, 95% confidence interval: 1.02-1.35, P = .02) were associated with increased risk of self-advocacy. CONCLUSION Having a greater community-level vulnerability was associated with poor Living Donor Navigator Program fidelity. The potential barriers identified using the Social Vulnerability Index may direct resource allocation and program refinement to optimize program fidelity and efficacy for all participants.
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Affiliation(s)
- A Cozette Killian
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/CozetteKale
| | - Alexis J Carter
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/carteraj21
| | - Rhiannon D Reed
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/rhiruns
| | - Brittany A Shelton
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Haiyan Qu
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - M Chandler McLeod
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Babak J Orandi
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Robert M Cannon
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Douglas Anderson
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Paul A MacLennan
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Michael Hanaway
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Jayme E Locke
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL.
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