Gender Identity Research Articles

Processing cataphoric they amidst pronominal innovation

AbstractWhen they encounter a cataphoric pronoun during real-time sentence processing, the comprehender begins searching actively for a feature-matched noun that can supply its reference. The present study investigates individual variation in this active search procedure, leveraging an ongoing change in the pronoun system of North American English. The types of referents compatible with the they-series of pronouns is expanding, with an increasing number of speakers allowing definite singular referents: especially but not exclusively when referring to someone with a nonbinary gender identity. Sociolinguistic work shows that the speakers who most accept innovative usages of singular they tend to be younger, or to be non-cisgender (e.g. transgender, nonbinary). Recruiting participants representing diverse ages and gender identities, the present experiment tracked reading times of sentences involving cataphora. Results shows that cataphoric they is processed differently than cataphoric s/he, across the board. There is a significant processing cost to reading a plural noun that follows cataphoric s/he, indicating that singular cataphors evoke strong number expectations. However, the cost of reading a singular noun after they is smaller and emerges later; they seems to evoke weak number expectations. Individual differences show that those expectations are especially weak for younger participants, perhaps reflecting a higher baseline familiarity with singular they. On the other hand, course-grained gender identity (cis vs. non-cis) does not seem to be a reliable predictor of how cataphoric they is processed. Integrating insights from sociolinguistics and psycholinguistics, this study offers a novel view into ongoing language change and its manifestation in real-time processing measures.

Shaping of the Woman Constituency in Indian Elections: Evidence from the NES Data

This article studies the patterns of women’s vote in the Lok Sabha elections in India in 2024. It draws upon the National Election Studies (NES) data of 2024 and of previous years to address three key questions related to women’s vote in Indian elections. The first is about the extent of Indian women’s political participation in the wake of increased turnout of women voters and the closing of the gender gap. The second question is about the extent of women’s support to the Bhartiya Janata Party (BJP) as their favoured party. In the absence of conclusive evidence on gender-wise patterns of vote, there have been several tentative and speculative analyses regarding the increasing support of women voters to the BJP both at the regional and national elections, especially since 2014. The article uses the unique window of the NES data sets to understand and decipher women’s support for the BJP and other political parties on a timeline. Finally, from within the confines of the empirical evidence provided by the NES data sets, it also tries to address a rather nuanced question of the arrival of women’s agency in the electoral democracy in India. With the help of the NES data sets, it tries to understand whether women vote mainly as women, prioritizing their gendered identities over other kinds of identities, and whether their voting patterns indicate the arrival of an autonomous women’s constituency in Indian democracy.

Inclusive School Policies and Practices and the Well-Being of LGBTQ + Students in Portugal

Abstract Introduction The school context can be particularly problematic for youth who identify as lesbian, gay, bisexual, trans, and queer or who hold other sexual and gender-minoritized identities (LGBTQ +). To address this issue, LGBTQ + inclusive policies and practices have been implemented in many schools around the world. Methods A cross-sectional sample of 989 LGBTQ + and cisheterosexual high school students residing in Portugal completed an anonymous online survey in 2020/21. Participants were asked about their perceptions of LGBTQ + inclusive policies and practices in their school, namely, an inclusive curriculum, comprehensive policies, and information and support regarding sexual orientation and gender identity in their school. We further examined associations between these perceptions and LGBTQ + student well-being (depression, resilience, and self-esteem). Results Perceptions of the existence of an inclusive school curriculum were lower among LGBTQ + students compared to their cisheterosexual peers. In addition, LGBTQ + students who perceived the curriculum as less inclusive were more likely to report higher levels of depression and lower levels of resilience and self-esteem. Conclusions The findings suggest that LGBTQ + students perceive the school curriculum to be less inclusive, and this is associated with poorer well-being. Policy Implications Concrete policies and practices that improve school climate and promote the well-being of LGBTQ + students are paramount. These may include awareness-raising activities for students and discussion of LGBTQ + issues in the classroom. Therefore, cultural competency training for school staff is essential.

Changed Reality, Changed Positions: The Case Study of Eritrean Women Refugees in Times of Global Pandemic

ABSTRACTThis article examines the emerging position of women refugees during a global crisis. On the basis of an empirical study of the Eritrean community in Tel Aviv, Israel, I analysed the ways in which gender identity is formulated and recreated following the social and economic restrictions of the Covid‐19 pandemic. In contrast to previous literature which has highlighted men's central position in forced migrant communities, I suggest viewing the global pandemic as an accelerator of women's presence in two circles of belonging: the family unit and the Eritrean community. I argue that structural changes imposed by the pandemic have established new gender roles and divisions of power, positioning women as a source of authority and a subject of choice. As a significant proportion of Eritrean men lost their income during the pandemic, they were forced to adopt a different role within the family unit. Eritrean women, on the other hand, managed to keep their jobs and became the family's sole provider. In addition to increasing their family's economic dependence on them, Eritrean women also became central figures in their community through the creation of new social networks designed to satisfy the emotional and economic needs of its members. This has enabled women refugees to reinforce their social mobility and become relatively autonomous.

“Thriving at the Margins”: Understanding Workplace Mistreatment and the Impostor Phenomenon Among Latina Faculty in STEM

ABSTRACT Impostor phenomenon among Latina faculty in science, technology, engineering, and mathematics (STEM) is understudied. Latinas hold only 1.7% of all STEM-related jobs, experiencing both mistreatment (conscious and unconscious; physical, and mental forms of harassment and violence) and impostor phenomenon (feeling like a fraud and the inability to internalize success). Using Crenshaw’s theory of intersectionality, this exploratory study examined how Latina STEM faculty related their impostor phenomenon with interpersonal mistreatment. This qualitative study examined the intersectionality of multiple identities: professional, personal, and cultural, related to their impostor experiences, among 13 participants. One-on-one phone interviews were analyzed inductively. Thematic analysis revealed that interviewees experienced explicit or implicit messaging at work; mistreatment of colleagues and students; and the internalization of mistreatment. Multiple identities (cultural identity as Latina, gender identity, and professional identity as STEM faculty) intersected, contributing to feelings of being marginalized. This is the first study to examine how Latina faculty thrive at the margins, being told that they do not belong in STEM and their minority background got them the position. This study positions impostor phenomenon as more than an internal feeling and critically examines power structures that keep minorities at the periphery.

Cognitive-Functional Approaches to Transgender Language: Understanding Gender through Mental Representations

This study employs cognitive-functional linguistic approaches to examine the mental representations of gender in contemporary transgender literature. By analysing a corpus of transgender narratives, we investigate how cognitive mechanisms such as conceptual metaphors, image schemas, and categorisation processes contribute to the linguistic construction and expression of gender identity. Our findings reveal prevalent conceptual metaphors like ‘gender as a journey’ and ‘identity as a construction,’ which provide insights into the cognitive framing of transgender experiences. Image schemas, particularly those related to containment and transformation, emerge as significant in describing gender transitions. The study also uncovers unique categorisation patterns and prototype effects in gender-related language, reflecting the complex and fluid nature of gender identities. These cognitive-functional patterns not only illuminate the mental representations underlying transgender language but also offer a deeper understanding of how language shapes and is shaped by gender experiences. The research contributes to both transgender studies and cognitive linguistics, demonstrating the potential of this interdisciplinary approach in exploring gender identity through language. Our findings have implications for fostering more inclusive language practices and enhancing communication about gender diversity.

Theorizing the Role of Sex Educators in the Resistance and Reification of Epistemic Injustices Related to the Sexual Expression of People with Intellectual Disability.

People with intellectual disability face a variety of epistemic injustices-systems of knowledge and educational inequality-related to their access to sex education and perceptions of their sexuality. Sex educators are in a position to address these injustices; however, they may not be fully aware of their own epistemic ethics. Furthermore, there is little theoretical understanding of how sex educators provide instruction within an environment that exhibits hostility toward the sexual expression of those with intellectual disability. This grounded theory study of interviews with 58 people who taught sex education to people with intellectual disability sought to understand the role of educators in perpetuating and resisting epistemic injustice by utilizing sex education to either facilitate or restrict the sexual expression of people with disabilities. We identified four micro-contexts: centralizing capacity to consent, emphasizing risk, desexualizing (through) sex education, and acknowledging gender identity. In each micro-context, we explore mechanisms of how educators were either allied in support of autonomy (person-centered values, expertise, access to curricular resources, self-advocates as teachers and partners, subversiveness, and de-problematizing normative sexual behavior) or reified sexual stigmas (fear of sexual abuse and sexual perpetration, conscripting to asexuality, the paternalistic service system, and complex ethical dilemmas) in the context of hostility to sex education and sexual expression. These findings have implications for promoting prosocial sexual expression and access to sex education for people with intellectual disability.

Beyond the Binary: Exploring the Lived Experiences of Gender Dysphoric Adolescents in Indonesia

Introduction: Gender dysphoria among adolescents is increasingly recognized globally, yet research on the lived experiences of transgender youth in Indonesia remains limited. This study aimed to explore the unique challenges, coping mechanisms, and support needs of Indonesian adolescents navigating gender dysphoria within a sociocultural context characterized by traditional gender norms and limited access to specialized healthcare. Methods: In-depth, semi-structured interviews were conducted with 15 adolescents (aged 13-19) who identified as experiencing gender dysphoria. Participants were recruited through LGBTQ+ youth organizations and community centers in Jakarta and Surabaya. Data were analyzed using thematic analysis to identify key themes and patterns within their narratives. Results: Four major themes emerged: (1) Early Recognition and Internal Conflict: Participants described an early awareness of their gender identity incongruence, often accompanied by feelings of confusion, shame, and fear due to societal expectations and potential rejection. (2) Navigating Disclosure and Social Support: Coming out to family and peers was a significant challenge, with varied responses ranging from acceptance to rejection. Support networks, primarily found within online communities and LGBTQ+ organizations, played a crucial role in fostering resilience. (3) Barriers to Accessing Healthcare: Participants reported significant obstacles in accessing gender-affirming care, including limited availability of specialized healthcare providers, financial constraints, and lack of family support. (4) Resilience and Hope for the Future: Despite the challenges, participants expressed resilience, hope, and a strong desire to live authentically. They emphasized the importance of self-acceptance, peer support, and advocacy for greater understanding and acceptance of gender diversity in Indonesia. Conclusion: This study provides valuable insights into the experiences of gender dysphoric adolescents in Indonesia. Findings highlight the urgent need for increased awareness, improved access to gender-affirming care, and supportive interventions to promote the well-being of this vulnerable population.

Ethical considerations for non-procreative uterus transplantation.

The growing demand for uterus transplantation (UTx) invites continued philosophical evaluation of the function of UTx (and what constitutes its 'success'), as well as the recipient eligibility for UTx. Currently, UTx caters to partnered, cisgender women of childbearing age looking to get pregnant and give birth to a biogenetically related child. The medical justification for this-the treatment of uterine infertility-explains the primacy of this practice. However, this dominant conceptualization of UTx does not necessarily capture the diverse needs for which both cis- and transgender women might take interest in UTx that are not strictly procreative, such as bodily integrity and gender identity reasons. In this paper, I argue that non-procreative motivations for uterus acquisition ought to be taken seriously as a matter of non-discrimination and consistency.

Exploring eating disorder risk among Thai transfeminine youth: a comparative study with cisgender females.

Adolescents, particularly vulnerable during puberty, often face heightened concerns about dieting and body image. Transfeminine youth, especially in Asian cultures, are understudied in this context. This study investigates eating disorder risks among Thai transfeminine youth and compares to cisgender females, focusing on the association with body dissatisfaction. This study aims to explore 3 objectives: (1) to assess and compare the prevalence of eating disorder risks between Thai transfeminine youth and cisgender females; (2) to examine the link between body dissatisfaction and eating disorder risks; (3) to identify risk factors associated with abnormal eating disorder screening outcomes. This is a cross-sectional comparative study conducted between September 2021 and October 2022. The study questionnaire includes Thai version of the Eating Attitude Test-26 (EAT-26) to assess the risks of eating disorders and Thai version of the Body Image Concern Inventory (BICI) to assess body dissatisfaction. The questionnaire was distributed through social media platforms to transfeminine and cisgender females, aged 12-25 years. The correlation between eating disorder risks and body dissatisfaction was analyzed with linear regression, while the comparisons between transfeminine individuals and cisgender female groups were analyzed with Wilcoxon rank-sum test. The study included 241 transfeminine individuals and 388 cisgender females, median age 19.0 years (interquartile range [IQR] 18-21) and 18 years (IQR 16-20), respectively. Ninety (37.3%) transfeminine individuals had an EAT-26 score ≥ 20, suggesting concerns for dieting and eating behaviors, compared to 70 (18%) cisgender females (p < 0.001). Risk factors for EDs included obesity (odds ratio [OR] 3.22, confidence interval [CI] 1.36-7.6) and low income (OR 3.66, CI 1.59-8.4). Protective factors were negligible exercise (OR 0.24, CI 0.09-0.66), gender identity disclosure (OR 0.27, CI 0.1-0.77), and high levels of happiness (OR 0.85, CI 0.73-0.98). There is a significant correlation between the positive eating behavior screening and the body dissatisfaction scores. Transfeminine youths show significantly higher concerns about dieting, body weight, and eating behaviors than their cisgender females, highlighting the unique challenges they face. These results emphasize the needs for targeted screening, health care access for treatment and support for eating disorders in transfeminine youths.

Religiosity, perceived family support, and gender disclosure of LGBTQ + medical students in Thailand.

The well-being of LGBTQ + medical students can be influenced by religiosity, family support, and the disclosure of their gender identity or sexual orientation. These factors have frequently been overlooked and warrant further consideration in creating a supportive environment for all students. This multicenter study investigated two main outcomes including the differences in religiosity and perceived family support between LGBTQ + and non-LGBTQ + medical students in Thailand, and the gender disclosure to family among LGBTQ + medical students. It was conducted among students from five medical schools across Thailand, using online questionnaires during the academic year 2021-2022. Data were collected on demographic characteristics, religiosity, gender identity/sexual orientation disclosure to family, and perceived family support. Comparisons between groups were conducted using chi-square test and Wilcoxon rank-sum test. Of the 1,322 participants, 31.2% identified themselves as LGBTQ+, among whom 81.8% were Buddhists. The proportion of non-religious LGBTQ + students was significantly higher (vs. non-LGBTQ+; 15.0% vs. 8.4%, respectively; p = 0.001). However, there was no statistical difference in religiosity between LGBTQ + and non-LGBTQ + students as well as between LGBTQ + subgroups. Although, 74% of LGBTQ + students reported good family support, significantly more LGBTQ + students perceived poor family support (vs. non-LGBTQ+, 7.0% vs. 4.7%; p = 0.002). Regarding the disclosure of gender identity or sexual orientation to the family, the majority of LGBTQ + individuals indicated either a non-disclosure or uncertainty. There were significant associations between perceived family support and the likelihood of disclosing one's identity to family members, as better perceived support was associated with higher disclosure rates. No statistically significant difference in religiosity was found between LGBTQ + and non-LGBTQ + students. The majority of LGBTQ + medical students reported receiving good family support; however, among those who perceived their family's support to be lacking, there was a greater tendency to conceal their gender identity from their families. For future studies, it is crucial to investigate whether this concealment extends to other spheres of their lives and to assess the potential impact on their well-being, including mental health and quality of life.

Mindful eating and diet quality among U.S. adults with lower incomes.

Mindful eating, a practice that encourages attention to sensations and awareness during the eating experience, has shown effectiveness in inducing positive behavioral changes. Mindful eating practices have been examined in relation to energy intake (i.e., quantity of food) but to a lesser extent to the quality of that food, hence, it is crucial to comprehensively understand the association between mindful eating and diet quality. The objective of this study is to examine the association between mindful eating and diet quality among United States (U.S.) adults with lower incomes and to examine heterogeneity in the associations by gender identity. This study employs a cross-sectional study design. In December 2022, a national convenience sample of 1,798 U.S. adults with lower incomes, recruited through Prime Panels, completed a web-based survey. Diet quality was measured using the 30-day Prime Diet Quality Score screener (ranges from 0-126). A higher score reflects higher diet quality. Associations between the Mindful Eating Questionnaire (MEQ) (ranges from 1-4) and its four factors (Awareness, External Cues, Emotional Response, and Distraction) in relation to diet quality were examined using multivariable regression models, adjusting for sociodemographic covariates. The mean MEQ score was 2.30; the mean PDQS-30D score was 50.2. The associations between MEQ scores and PDQS-30D scores were significantly modified by gender identity. Among men, a higher MEQ score reflecting more mindful eating (β=3.81, 95% CI: 2.19, 5.43) was associated with higher PDQS-30D scores. In addition, a higher Awareness factor score (β=3.21, 95% CI: 2.48, 3.93), a higher External Cues factor score indicating less response to external cues (β=0.76, 95% CI: 0.01, 1.52), and a higher Distraction factor score indicating less distraction (β=1.09, 95% CI: 0.28, 1.90) were all associated with higher PDQS-30D scores. Among women, a higher Awareness factor score was associated with higher PDQS-30D scores (β=2.50, 95% CI: 1.78, 3.22); and a higher Emotional response factor score (i.e., eating less in response to emotional eating) was associated with lower PDQS-30D scores (β=-0.85, 95% CI: -1.58, -0.12). Mindful eating and its factors are associated with a higher diet quality among U.S. adults with lower incomes, particularly among men. Future longitudinal and intervention studies are warranted to better understand these associations among adults with lower incomes, as an understudied population in the mindful eating literature.

Empowered by the Experience: Playing as Female Characters in Video Games

Research on female video game characters often investigates negative outcomes of playing as stereotyped characters. Yet, video games increasingly offer people opportunities to play as capable, prominent female characters that may be meaningful and promote positive outcomes (e.g., feelings of empowerment). This manuscript shares the results of a mixed methods survey of individuals (&lt;em&gt;N&lt;/em&gt; = 751) recruited via online forums who recalled their experiences playing as female game characters. We analyzed qualitative response data using a traditional, top-down approach to identify themes. We focus our analysis and discussion on the results of a human-derived analysis, which indicated both positive and negative dimensions of experiences that participants found meaningful. Participants reported that taking on the role of a female character was often very important to them, but the reason for this significance varied across players. Often, these reasons involved their own gender identities and the context in which the gameplay occurred (e.g., online multiplayer). We consider findings as evidence of eudaimonic media effects.

Heterogeneous Associations Between Pandemic-Induced Socioeconomic Hardships and COVID-19 Vaccine Uptake by Sexual Orientation and Gender Identity: A Nationally Representative Analysis in the United States

Background/Objectives: Socioeconomic hardship during the COVID-19 pandemic was associated with lower vaccine uptake. Since the pandemic has exacerbated socioeconomic challenges faced by sexual and gender minority populations, including employment income loss, housing instability, food insufficiency, and household expense difficulty, this study investigated the disparities in COVID-19 vaccine uptake among these populations. Methods: Using the U.S. Census Bureau Household Pulse Survey, a nationally representative sample of 1,767,966 individuals (6% gay or lesbian, 4.2% bisexual, 1.6% something else, and 90.6% heterosexual respondents), we quantified the COVID-19 vaccine uptakes among sexual and gender minorities, as well as the effect measure modifications by socioeconomic hardships. Results: Despite higher vaccine uptake rates among sexual and gender minorities compared to their heterosexual counterparts, socioeconomic hardships triggered by the pandemic among these populations were associated with decreased vaccine uptake. Importantly, the effect measure modifications by socioeconomic hardships were more pronounced among sexual and gender minority status compared to heterosexual individuals. Conclusions: These results highlight the critical need to address socioeconomic hardships among sexual and gender minorities to enhance vaccine uptake, along with the pre-existing and exacerbated social and economic disadvantages during the COVID-19 pandemic.

Anti-Black racism in Canadian health care: a qualitative study of diverse perceptions of racism and racial discrimination among Black adults in Montreal, Quebec.

Racism has been shown to impact the health of Black persons through its influence on health care, including its expression through implicit biases in provider training, attitudes, and behaviours. Less is known about the experiences of racism in contexts outside of the USA, and how race and racism interact with other social locations and systems of discrimination to shape Black patients' experiences of racism in health care encounters. To help address this gap, this study examined diverse Black individuals' perceived experiences of, and attitudes towards, anti-Black racism and racial discrimination in Canadian health care, specifically in Montreal, Quebec. This descriptive qualitative study adopted a social constructionist approach. Employing purposive maximal variation and snowball sampling strategies, eligible study participants were: self-identified Black persons aged 18 years and older who lived in Montreal during the COVID-19 pandemic, who could speak English or French, and who were registered with the Quebec medical insurance program. In-depth interviews were conducted, and a Framework Analysis approach guided the systematic exploration and interpretation of data using an intersectionality lens. We interviewed 32 participants, the majority of whom were women (59%), university educated (69%), and modestly comfortable financially (41%), but diverse in terms of age (22 to 79 years), country of origin, and self-defined ethnicity. We identified five major themes demonstrating substantial variations in perceived racism in health care that are influenced by unique social locations such as gender identity, age, and immigration history: (1) no perceptions of racism in health care, (2) ambiguous perceptions of racism in health care, (3) perceptions of overt interpersonal racism in health care, (4) perceptions of covert interpersonal racism in health care (including the downplaying of health concerns, stereotyping, and racial microaggressions), and (5) perceptions of systemic racism in health care. Perceptions of anti-Black racism and racial discrimination in Canadian health care are complex and may include intra-racial group differences. This study begins to address the dearth of empirical research documenting experiences of anti-Black racism in health care in Quebec, highlighting a continued need for serious consideration of the ways in which racism may manifest in the province, as well as a need for anti-racist advocacy. Advancing racial health equity requires greater sensitivity from providers and decision makers to variations in Black patients' health care experiences, towards ensuring that they have access to high quality and equitable health care services.

Men's mourning experiences for the death of a loved one: An integrative review.

To analyze the current state of knowledge regarding men's mourning experiences following the death of a loved one. An integrative review was conducted using quantitative, qualitative, and mixed-methods studies published in English or Spanish between 2017 and 2022 that investigated men's mourning experiences. Studies focused on grief in participants with different sexes or gender identities, maladaptive grief, persistent complex bereavement disorder, prolonged grief disorder, bereavement over pets, or losses other than a human death were excluded. Additionally, reviews, books, theses, editorials, and opinion pieces were not included. The search was conducted in CINAHL, PubMed, and Scopus in 2023. JBI tools were used for quality appraisal, and the analysis employed the constant comparative method. Our analysis of eight English-language documents with evidence levels IV-VI, informed by the Socioecological Model of Men's Grief, revealed that factors at individual, interpersonal, community, and public policy sublevels interact significantly to shape men's grief experiences. Themes emerged along a continuum of intuitive and instrumental coping responses, including adaptive and maladaptive coping strategies, loneliness and social support needs, the influence of societal constructions of masculinity and the grieving process in men. Men's mourning experiences are complex and multifaceted, influenced by diverse expressions of masculinity and the interaction of various contextual factors. The Mental Health Nursing Process should prioritize understanding and addressing the unique experiences of bereaved men.

Understanding Minoritized Educators’ Experiences with Secondary Trauma During COVID-19

This mixed-methods study examined the ways that K-12 educators with minoritized racial/ethnic identities and/or gender identities as well as sexualities experienced secondary trauma during the COVID-19 pandemic. Through a national survey of 1,194 K-12 educators and 24 follow-up interviews, we found that BIPOC and LGBQ+ educators experienced greater rates of childhood trauma, which was correlated with a greater risk of secondary trauma for all individuals in our sample. Additionally, educators with minoritized gender identities reported greater rates of experiencing secondary trauma. Qualitative interviews with minoritized educators added to these findings, revealing the necessity of structural support for educators as opposed to a sole focus on self-care, inadequacy of trauma-related professional development, and minoritized educators’ commitment to improving the lives of their students who have experienced trauma as a result of their own traumatic experiences. These results have implications for educational administrators and policymakers regarding the interconnectedness of trauma and identity.

Academic Physician and Trainee Occupational Well-Being by Sexual and Gender Minority Status.

Few studies have explored the association between sexual and gender minority (SGM) status and occupational well-being among health care workers. To assess the prevalence of burnout, professional fulfillment, intent to leave, anxiety, and depression by self-reported SGM status. This cross-sectional survey study collected data from October 2019 to July 2021, from 8 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. The survey, including questions on SGM status, was administered to attending physicians and trainees. Statistical analyses were performed from June 1, 2023, to February 29, 2024. SGM status was determined via self-reported sexual orientation and gender identity. Primary outcomes measured were the Professional Fulfillment Index (burnout and professional fulfillment), intent to leave, and self-reported anxiety and depression using the Patient-Reported Outcomes Measurement Information System short-form 4-item measure. Of 20 541 attendings and 6900 trainees, 8376 attendings and 2564 trainees responded and provided SGM status. Of these respondents, 386 attendings (4.6%) and 212 trainees (8.3%) identified as SGM. Compared with their non-SGM peers, SGM attendings had a lower prevalence of professional fulfillment (133 of 386 [34.5%] vs 3200 of 7922 [40.4%]) and a higher prevalence of burnout (181 of 382 [47.4%] vs 2791 of 7883 [35.4%]) and intent to leave (125 of 376 [33.2%] vs 2433 of 7873 [30.9%]) (all P < .001). Compared with their non-SGM peers, SGM trainees had a lower prevalence of professional fulfillment (63 of 211 [29.9%] vs 833 of 2333 [35.7%]) and a higher prevalence of burnout (108 of 211 [51.2%] vs 954 of 2332 [40.9%]) (both P < .001). After adjusting for age and race and ethnicity, SGM attendings had higher odds of burnout than their non-SGM peers (adjusted odds ratio, 1.57 [95% CI, 1.27-1.94]; P < .001). Results for burnout were similar among the SGM trainees compared with their non-SGM peers (adjusted odds ratio, 1.47 [1.10-1.96]; P = .01). In this cross-sectional survey study of academic physicians and trainees, SGM attendings and trainees had higher levels of burnout and lower levels of professional fulfillment. SGM attendings had greater intent to leave than their non-SGM peers, but trainees did not. These disparities represent an opportunity for further exploration to retain SGM health care workers.

Abstract 4137559: Assessing Veterans’ Risk of Cardiovascular Disease by Gender Identity

Background: Extant literature suggests that transgender and gender diverse (TGD) individuals experience a higher burden of CVD risk factors and psychosocial stressors than their cisgender (cis) peers. However, prior studies have been limited by self-reported outcomes or small samples. Aim: To determine whether TGD veterans have greater CVD (MI, ischemic stroke, cardiac revascularization) incidence than cis veterans using large, nationwide data. Methods: We used EHR data from the Veterans Healthcare Administration to identify veterans with &gt;2 outpatient encounters in fiscal years 2010-2019. Veterans’ gender identity was classified using natural language processing in combination with gender-affirming hormone therapy (GAHT) and a previously validated algorithm for identifying TGD individuals using ICD codes and VHA data. Of 1,105,082 veterans without prior CVD, 42,149 were classified as TGD. We examined sample characteristics by gender identity and used Cox regression to assess the association of gender identity with incident CVD. Results: TGD veterans’ mean age (years) was 46 (cis females=40; cis males=53). Cis females had the fewest CVD risk factors, followed by TGD veterans and cis males. Adjusting for age, race, and Hispanic ethnicity, TGD veterans had 1.49 [1.42-1.56] and 0.93 [0.90-0.97] times the risk of CVD compared to cis females and cis males, respectively. Upon additional adjustment for other CVD risk factors, renal function, alcohol use disorder, depression, anxiety, and sexual minority status, results remained statistically significant. Significance also held in sensitivity analyses which matched each TGD veteran to cis female and male veterans on age within 2 years. In analyses stratified by gender identity, trans feminine (HR [95% CI]: 1.26 [1.14-1.40]) and uncategorized TGD veterans (HR [95% CI]: 1.29 [1.22-1.37]) were at higher CVD risk than cis female veterans; trans masculine (HR [95% CI]: 0.85 [0.77-0.93]) and trans feminine veterans (HR [95% CI]: 0.90 [0.82-0.99]) were at lower CVD risk than cis male veterans. Among TGD veterans, GAHT receipt was associated with an 11% decrease in CVD risk. Conclusion: TGD veterans’, particularly trans feminine and uncategorized TGD veterans’, CVD risk was greater than that of cis females. Contrary to prior findings, GAHT was associated with decreased CVD risk. These results invite further study into the mechanisms by which GAHT and other factors impact CV health across and within gender identities.

Gender disparity in Canadian Institutes of Health Research funding within neurology

BackgroundDespite efforts to advance equity, diversity and inclusion, women face gender-based barriers in research, including in neurology. Compared with men, women are less likely to hold leadership positions and be...