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Concept: Intersectionality

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Previous studies of men’s breast size preferences have yielded equivocal findings, with studies variously indicating a preference for small, medium, or large breasts. Here, we examined the impact of men’s oppressive beliefs in shaping their female breast size ideals. British White men from the community in London, England (N = 361) viewed figures of women that rotated in 360° and varied in breast size along five levels. They then rated the figure that they found most physically attractive and also completed measures assessing their sexist attitudes and tendency to objectify women. Results showed that medium breasts were rated most frequent as attractive (32.7 %), followed by large (24.4 %) and very large (19.1 %) breasts. Further analyses showed that men’s preferences for larger female breasts were significantly associated with a greater tendency to be benevolently sexist, to objectify women, and to be hostile towards women. These results were discussed in relation to feminist theories, which postulate that beauty ideals and practices in contemporary societies serve to maintain the domination of one sex over the other.

Concepts: Estrogen, Gender, Sociology, Breast, Sexism, Feminism, Intersectionality, Feminist theory

29

In the present work, we examined associations between oppressive, sexist beliefs and consideration of cosmetic surgery for oneself and also endorsement of cosmetic surgery for one’s romantic partner. A total of 554 German-speaking volunteers from the community, mainly in Austria, completed measures of consideration of cosmetic surgery and three measures of sexist attitudes, while a subset of participants in romantic relationships completed a measure of endorsement of cosmetic surgery for their partners along with the measures of sexism. Preliminary analyses showed that women and single respondents were more likely to consider having cosmetic surgery than men and committed respondents, respectively. Further analyses showed that consideration of cosmetic surgery for oneself was significantly associated with sexist attitudes, particularly hostile attitudes to women. In addition, among participants in a relationship, sexist attitudes were associated with endorsement of cosmetic surgery for one’s partner. These results indicate that attitudes to cosmetic surgery for oneself and one’s partner are shaped by gender-ideological belief systems in patriarchal societies. Possible implications for understanding the motivations for having cosmetic surgery, among both single respondents and couples, are discussed.

Concepts: Belief, Gender, Sociology, Sexism, Feminism, Misogyny, Patriarchy, Intersectionality

4

Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation of intersectionality can promote the creation of evidence that is directly useful in population-level interventions such as policy changes, or that is specific enough to be applicable within the social contexts of affected communities.

Concepts: Scientific method, Medicine, Demography, Sociology, Quantitative research, Population health, Intersectionality, Oppression

2

This essay brings together intersectionality and institutional approaches to health inequalities, suggesting an integrative analytical framework that accounts for the complexity of the intertwined influence of both individual social positioning and institutional stratification on health. This essay therefore advances the emerging scholarship on the relevance of intersectionality to health inequalities research. We argue that intersectionality provides a strong analytical tool for an integrated understanding of health inequalities beyond the purely socioeconomic by addressing the multiple layers of privilege and disadvantage, including race, migration and ethnicity, gender and sexuality. We further demonstrate how integrating intersectionality with institutional approaches allows for the study of institutions as heterogeneous entities that impact on the production of social privilege and disadvantage beyond just socioeconomic (re)distribution. This leads to an understanding of the interaction of the macro and the micro facets of the politics of health. Finally, we set out a research agenda considering the interplay/intersections between individuals and institutions and involving a series of methodological implications for research - arguing that quantitative designs can incorporate an intersectional institutional approach.

Concepts: Scientific method, Sociology, Emergence, Law, Individual, Institution, Social structure, Intersectionality

2

Intersectionality has emerged as an important framework for understanding and responding to health inequities by making visible the fluid and interconnected structures of power that create them. It promotes an understanding of the dynamic nature of the privileges and disadvantages that permeate health systems and affect health. It considers the interaction of different social stratifiers (e.g. ‘race’/ ethnicity, indigeneity, gender, class, sexuality, geography, age, disability/ability, migration status, religion) and the power structures that underpin them at multiple levels. In doing so, it is a departure from previous health inequalities research that looked at these forms of social stratification in isolation from one another or in an additive manner. Despite its potential use and long history in other disciplines, intersectionality is uncommonly used in health systems research in low- and middle-income countries (LMICs). To orient readers to intersectionality theory and research, we first define intersectionality and describe its role in public health, and then we review resources on intersectionality. We found that applications in public health mostly increased after 2009, with only 14 out of 86 articles focused on LMICs. To arrive at 10 best resources, we selected articles based on the proportion of the article that was devoted to intersectionality, the strength of the intersectionality analysis, and its relevance to LMICs. The first four resources explain intersectionality as a methodology. The subsequent six articles apply intersectionality to research in LMIC with quantitative and qualitative analysis. We provide examples from India, Swaziland, Uganda and Mexico. Topics for the studies range from HIV, violence and sexual abuse to immunization and the use of health entitlements. Through these 10 resources, we hope to spark interest and open a needed conversation on the importance and use of intersectional analysis in LMICs as part of understanding people-centred health systems.

Concepts: Health care, Scientific method, Health economics, Sociology, System, Quantitative research, Population health, Intersectionality

2

A growing body of literature has highlighted the increased prevalence of body image concerns and associations with health outcomes among gay and bisexual men (GBM). Little research, however, has examined the link between body image and social oppression for ethnoracialized GBM. Using an intersectionality lens and qualitative inductive analysis, data were collected through focus groups and interviews with GBM (n=61) who identify with one of four ethnoracial groups (Black, East/Southeast Asian, South Asian, Latino/Brazilian). Three main themes emerged: (1) body image idealization in gay/bisexual male culture, (2) negotiating a racialized body image, and (3) negotiating the impact of body image on relationship with self and others. The study results highlighted how multiple forms of oppression (e.g., racism, sexism) intersected with one another to impact the body image and overall well-being among ethnoracialized GBM.

Concepts: Focus group, Gender, Qualitative research, Lens, The Link REIT, Intersectionality, Oppression

0

Examining interactions between numerous interlocking social identities and the systems of oppression and privilege that shape them is central to health inequalities research. Multilevel models are an alternative and novel approach to examining health inequalities at the intersection of multiple social identities. This approach draws attention to the heterogeneity within and between intersectional social strata by partitioning the total variance across two levels.

Concepts: Health care, Structure, Sociology, Model, Multilevel model, Intersectionality

0

People with mental illness are often members of multiple stigmatized social groups. Therefore, experienced disadvantage might not be determined solely by mental illness stigma. Nevertheless, most available research does not consider the effects and implications of membership in multiple stigmatized social groups among people with mental illness. Reflecting on intersectionality theory, the authors discuss two intersectional effects determining disadvantage among people with mental illness who are members of multiple stigmatized social groups, namely double disadvantage and prominence. To be effective, interventions to reduce disadvantage experienced by people with mental illness need to be flexible and targeted rather than universal in order to address the implications of intersectionality. Whereas education-based approaches usually assume homogeneity and use universal strategies, contact-based interventions consider diversity among people with mental illness.

Concepts: Sociology, Mental illness, Determinacy, Intersectionality

0

Intercultural Queer couples are growing at an extensive rate in the United States, exemplifying diversity across multiple dimensions (e.g., race, ethnicity, sexuality, affectional identity, gender identity) while experiencing multiple converging forms of oppression (e.g., racism, heterosexism, genderism). Given the dearth of conceptual and empirical literature that unifies both dimensions related to intercultural and Queer, applied practices and research contend with a unilateral approach focusing exclusively on either intercultural or Queer couples. Intersectionality theory has revolutionized critical scholarship to determine overlapping forms of oppression, decenter hegemonic structures of power relations and social contexts, and enact a social justice agenda. This article addresses the following aims: (a) an overview of the gaps eliciting unilateral approaches to intercultural Queer couples; (b) an illustration of intersectionality’s theoretical underpinnings as a critical approach; and

Concepts: Scientific method, United States, Sociology, Gender role, Race, Heteronormativity, Transgender, Intersectionality

0

Harassment scholarship increasingly attends to the intersectional nature of harassment and its function within systems of domination. However, little of this work includes disability. In-depth interviews with 24 adults on the autism spectrum in the USA demonstrate the intersections of gender, sexuality and (dis)ability in the construction of deviant embodiments as targets for harassment. These intersections also shape how participants made sense of these experiences of violence. Participants' disability characteristics were often read as gender or sexual variance, with harassers relying on sexist and heterosexist constructs to frighten, demean or humiliate them for disability characteristics. Participant experiences demonstrate the cisgender basis of ‘able-bodied’ identity as well as the ‘able-bodied’ basis of cisgender and heterosexual identities and experiences. The interdependency of gender, sexuality and (dis)ability embodiment point to how it is critical for scholars and activists to account for the role of gender and heterosexist harassment in ableist oppression and disability harassment in (hetero)sexist oppression, as well as the limits of current US law enforcement structures in providing redress for harassment.

Concepts: Gender, Sociology, Autism, Gender role, Discrimination, Transgender, Heterosexuality, Intersectionality