Examples of sex/gender sensitivity in epidemiological research: results of an evaluation of original articles published in JECH 2006–2014

Background During the last decades, sex and gender biases have been identified in various areas of biomedical and public health research, leading to compromised validity of research findings. As a response, methodological requirements were developed but these are rarely translated into research practice. The aim of this study is to provide good practice examples of sex/gender sensitive health research. Methods We conducted a systematic search of research articles published in JECH between 2006 and 2014. An instrument was constructed to evaluate sex/gender sensitivity in four stages of the research process (background, study design, statistical analysis, discussion). Results In total, 37 articles covering diverse topics were included. Thereof, 22 were evaluated as good practice example in at least one stage; two articles achieved highest ratings across all stages. Good examples of the background referred to available knowledge on sex/gender differences and sex/gender informed theoretical frameworks. Related to the study design, good examples calculated sample sizes to be able to detect sex/gender differences, selected sex/gender sensitive outcome/exposure indicators, or chose different cut-off values for male and female participants. Good examples of statistical analyses used interaction terms with sex/gender or different shapes of the estimated relationship for men and women. Examples of good discussions interpreted their findings related to social and biological explanatory models or questioned the statistical methods used to detect sex/gender differences. Conclusions The identified good practice examples may inspire researchers to critically reflect on the relevance of sex/gender issues of their studies and help them to translate methodological recommendations of sex/gender sensitivity into research practice. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0174-z) contains supplementary material, which is available to authorized users.

1 "How are sex/gender aspects considered in current research in epidemiology?"

Identification of good practice examples of sex/gender sensitive health research
Project "Epi goes Gender": Evaluation of current publications -evaluation sheet (19.06.2012) The aim of evaluating current publications in epidemiological journals is to identify positive examples of the consideration of sex/gender aspects in epidemiological literature. It is not proposed to value the publication as a whole but the evaluation is based on the reading of the whole article. The criteria of the evaluation focus on the consideration of the sex/gender-category in different stages of the research process reported in the publication. Based on the works of Eichler, Fuchs and Maschewsky-Schneider [1] and Doyal [2], [3], reference will be made to the conceptual clarity regarding the operationalisation of sex/gender, the methods of analysis and the interpretation/ conclusion.
The term "sex" refers to the biological characteristics commonly associated with being a men or a woman. Biological characteristics refer to the physiological and anatomic differences or rather similarities of men and women. Differences exist regarding hormones, primary and secondary sex characteristics as well as sex chromosomes. For example: Men generally have more massive bones than women; due to differences in metabolism and particular enzymes, the decomposition of alcohol is slower in women than in men, and women recover faster than men from anaesthesia.
The term "gender" refers to the different social, cultural and psychological dimensions of sex/gender as e.g. masculinity and femininity. This also includes social roles, rights and duties, living circumstances and life styles, the self-identification as male or female or characteristics that are attributed to men and women (sex stereotypes). Cultural and social constructions of being a woman, man, girl and boy are not static but changeable. For example: In many countries women earn significantly less money than men for similar work; in Vietnam more men than women smoke, as smoking is traditionally considered inappropriate for women; in most parts of the world, women do more housework than men.

Advices for completion:
The questionnaire can be completed electronically as a word document or on paper.

Assessment of the consideration of sex and gender aspects
The evaluation is carried out in three steps: Step one (3.1): screening question to generally assess whether "sex and/or gender aspects" were considered "anyhow" separately for five stages of the research process (Background/research question, Study design/planning, statistical modelling, statistical analyses/description of the results, Discussion/conclusion).
Step three (3.3): evaluation of the consideration of sex and gender aspects regarding four different stages of the research process.

Consideration of sex and/or gender aspects during the different stages of the research process, respectively in the sections of the publication
This question is supposed to get a general impression on whether there is anything to find about "sex and/or gender". The evaluation is carried out separately for five different stages, or rather sections. We included some diagnostic questions (derived mainly from [1,7]) for each of the five stages/ sections, which are supposed to guide you through the evaluation. The answer YES includes the explicit as well as the implicit consideration of sex and/or gender aspects. Here, explicit consideration means that sex/gender aspects are included with a clear explanation while implicit consideration means that the study includes sex/gender aspects with no specific explanation regarding sex/gender.

Overall evaluation:
How