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Should alcohol consumption measures be adjusted for gender differences?

Because of biological differences between men and women, the same quantity of alcohol consumed over the same time period produces higher blood alcohol levels (BALs) in women than in men. Some alcohol researchers have proposed that quantity and volume measures of alcohol consumption (e.g. usual number of drinks per drinking day and overall amount of alcohol consumed) should be adjusted to reflect these biological differences. To date, no standard adjustment for biological gender differences has been adopted. In this paper, we review the literature on biological and behavioral differences related to alcohol consumption and effects and discuss the implications of these differences in terms of adjusting alcohol consumption measures. Our review suggests that adjusting measures of alcohol consumption to compensate for biological sex differences is most appropriate for research or policy applications involving the short and long-term physiological effects of alcohol in contexts where gender differences in how alcohol is consumed can be assumed to be minimal. In other circumstances, non-biological gender differences relating to alcohol use, such as pace of drinking, may moderate the relationship between alcohol consumption and biological gender differences, making an adjustment less defensible. We also identify areas where more knowledge is needed not only to address the issue of adjusting alcohol measures for gender differences but also to understand better the relationship between alcohol consumption and effects.

Alcohol Drinking↗

Gender differences in the brain: implications for the study of human alcoholism.

Gender differences in alcohol intake and response to alcohol may be influenced by basic variations in the organization and modulation of male and female brains. Although a number of genetic, social, environmental, and metabolic factors have been proposed to explain the gender differences observed in risk for alcoholism, alcohol intake, and medical consequences of excessive alcohol intake, very little attention has been given to the role of gender differences in the brain regarding alcohol use. Recent evidence documents the influence of neurosteroids on neurotransmitter activity in the brain and the impact of alcohol on neurosteroid levels. Neurosteroids are found in different levels in males and females during development and throughout life, depending on factors such as age, stage of development, estrous and menstrual cycles, and stress. This study discusses the hypothesis that many of the gender differences observed concerning alcohol use and misuse are determined by gender differences in the brain, which in turn differentially influence the behavioral and neurochemical responses of males and females to alcohol.

Alcoholism↗

Cross-national variation of gender differences in adolescent subjective health in Europe and North America.

The cross-national consistency and variation of gender differences in subjective health complaints was examined in a sample of 125732 11- to 15-year-olds from 29 European and North American countries, participating in the WHO collaborative study 'Health behaviour in school-aged children (HBSC) 1997/98'. Health complaints were measured with the Health Behaviour in School-aged Children Symptom Checklist. Gender differences in health complaints were analysed through multilevel logistic regression analysis. The results indicated a very robust pattern of increasing gender differences across age, with 15-year-old girls as a group at increased risk for health complaints across all countries. The magnitude of gender differences varied across countries, with some countries showing a consistently strong gender difference across age group and different health complaints, and other countries showing a consistently weak gender difference. The gender difference in health complaints was stronger in countries with a low gender development index score. The findings underscore the need to incorporate socio-contextual factors in the study of gender health inequalities during adolescence.

Adolescent↗

Gender differences in depression: implications for treatment.

The study of gender differences in psychiatric disorders has received increasing attention in recent years. Depression has emerged as an important area of focus, as epidemiologic data have consistently shown that depression is twice as common in women as in men. In addition to this difference in prevalence, there may be gender differences in presentation, course of illness, and treatment response to both medications and psychotherapy. This article reviews current knowledge of gender differences in depression and presents recommendations for gender-specific assessment and treatment of depression.

Antidepressive Agents↗

Gender differences in responses to traumatic events: a prospective study.

Gender differences in psychological responses to motor vehicle accidents were examined as part of a large-scale prospective study of PTSD. Participants were recruited from an emergency room (n = 275) and interviewed 1 week, 1 month, and 4 months later. No gender differences were seen in the prevalence or recovery from PTSD, or in symptom levels at 1- and 4 months. Women had a higher prevalence of lifetime- and postaccident generalized anxiety disorder. Gender differences were found regarding the type, but not the total number, of potentially traumatic events previously experienced. These results suggest that gender differences in responses to traumatic events are not explained by exposure as such, but rather may result from gender-specific attributes of the event.

Accidents, Traffic↗

Gender Differences in Patients Referred for Electrophysiology Procedures.

Gender differences are prevalent in cardiology and particularly in patients who have undergone coronary artery bypass surgery and percutaneous transluminal coronary angioplasty. The purpose of this study was to determine whether similar gender differences are present in electrophysiology. Eight-hundred seventy-three patients were identified from the ÒEP ManagerÓ database over approximately a two-year period at North Shore University Hospital. Overall, the majority of patients referred for invasiveive electrophysiology procedures were men (67 percent). A higher percentage of men had coronary disease despite the type of study/implant. There was a relatively equal distribution of men and women who underwent head-up tilt table testing (47 and 53 percent respectively). We conclude that gender differences are present in electrophysiology studies and that further studies are necessary to determine whether a bias exists in this field.

Journal Article↗

A meta-analytic review of gender differences in ADHD.

The present study examined gender differences in ADHD through a meta-analysis. Effect size estimates for the primary symptoms and correlates of ADHD were calculated in an attempt to replicate and extend a previous meta-analysis on gender differences in the disorder. Relatively lenient inclusion criteria were used in order to maximize the number of studies included in the effect sizes. The results indicated that in comparison to ADHD boys, ADHD girls had lower ratings on hyperactivity, inattention, impulsivity, and externalizing problems. In addition, ADHD girls had greater intellectual impairments and more internalizing problems than ADHD boys. Overall, the results of the current meta-analysis indicated general agreement with the previous meta-analysis. The clinical implications of these gender differences and future research considerations are discussed.

Attention Deficit Disorder with Hyperactivity↗

Gender differences in fat mass of 5-7-year old children.

OBJECTIVE: Studying gender differences in fat mass and distribution in a homogeneous group of children. DESIGN: Cross-sectional study. SUBJECTS: 610 children aged 5-7 y in Kiel, Germany. METHODS: Anthropometric measures, bioelectrical impedance analysis (BIA). RESULTS: Although boys had increased body weights (P<0.05), body mass indexes (BMI's) (P<0.001) and waist/hip ratios (WHRs) (P<0.001), the %fat mass as assessed by BIA (P<0.05) was increased in girls. Although the increased BMI in boys was independent of the percentile used, gender differences (that is, lower values for boys than for girls at the same age) in WHR, the sum of four skinfolds and %fat were seen up to the 90th percentile. By contrast, above the 90th percentile there were no differences in skinfold thickness and %fat between boys and girls. Studying 42 BMI-matched pairs (boys and girls) also showed that the %fat estimated by BIA (P<0.001) was increased in girls. Plotting the average of %fat as obtained from skinfold- and BAI-measurements against the difference between data obtained by the use of the two methods shows that BIA %fat overestimates skinfold %fat at low or normal percent fat mass (that is, up to 20%) in both genders. By contrast, at increased fat mass, BIA %fat seems to underestimate skinfold %fat in both genders. CONCLUSIONS: Gender differences in fat mass and fat distribution are obvious in children aged 5-7 y. These differences are independent of gender differences in body weight. However, the nutritional state has an influence and gender differences cannot be detected in overweight and obese children. Our data also suggest that a children-specific formula used to calculate %fat from skinfold measurements is inappropriate.

Anthropometry↗

Influence of cardiac functional capacity on gender differences in maximal oxygen uptake in children.

OBJECTIVE: To examine the role of gender differences in cardiac functional capacity in explaining higher mean values for maximal oxygen uptake (VO(2)max) in boys than in girls. DESIGN: Comparative group exercise testing. SETTING: Pediatric exercise testing laboratory. SUBJECTS: Twenty-five prepubertal boys (mean [+/- SD] age, 12 +/- 0.4 years) and 24 premenarcheal girls (mean age, 11.7 +/- 0.5 years). INTERVENTIONS: Maximal incremental upright cycle exercise. MEASUREMENTS AND RESULTS: Mean values for VO(2)max were the following: boys, 47.2 +/- 6.1 mL/kg/min; and girls, 40.4 +/- 5.8 mL/kg/min (16.8% difference; p < 0.05). The average maximal stroke index with Doppler echocardiography was 62 +/- 9 mL/m(2) for boys and 55 +/- 9 mL/m(2) for girls (12.7% difference; p < 0.05). No significant gender differences were seen in maximal heart rate or arterial venous oxygen difference. When VO(2)max and maximal stroke volume (SV) were expressed relative to lean body mass, gender differences declined but persisted, falling to 6.2% and 5.2%, respectively. CONCLUSIONS: These findings indicate that differences in SV as well as in body composition contribute to gender-related variations in VO(2)max during childhood. Whether this reflects small gender differences in relative heart size or dynamic factors influencing ventricular preload and contractility during exercise is unknown.

Body Composition↗

Are there gender differences in major depression and its response to antidepressants?

BACKGROUND: The prevalence of major depression for women is about twice that for men. This gender difference in prevalence rates has led to much research addressing gender differences in the presentation and features of major depression, and, to a lesser extent, research addressing gender differences in treatment response and personality. However, studies differ considerably in the population sampled, and findings vary significantly. In the current retrospective examination of data, we investigated all of these variables in one single sample of outpatients with major depression seen in a tertiary care centre. METHODS: A sample of 139 men and 246 women with major depression receiving antidepressant treatment (SSRIs, TCAs, SNRIs, MAOIs, or RIMAs) in an outpatient setting were contrasted with regard to symptoms and severity of depression, course of illness, treatment response, and personality. RESULTS: Women were found to experience more vegetative and atypical symptoms, anxiety, and anger than men, and to report higher severity of depression on self-report measures. Regarding personality, women scored higher on conscientiousness, the extraversion facet warmth, the openness facet feelings, and sociotropy. Effect sizes were small to moderate. No differences were found in the course of the illness and treatment response. LIMITATIONS: Findings are not generalizable to inpatient or community samples, and some of the gender differences may be accounted for by gender differences in treatment seeking behaviour. CONCLUSIONS: While men and women receiving antidepressant treatment show some gender differences in the psychopathology of major depression, these differences do not appear to translate into differences in response to antidepressants. Gender differences in personality appear less profound than in the average population, indicating the potential role of a certain personality type that predisposes individuals to develop clinical depression, independent of gender. CLINICAL RELEVANCE: The current examination underscores the role gender plays in the presentation and treatment of major depression.

Adolescent↗

Is the gender difference in mental rotation disappearing?

Several investigators have used meta-analysis to compare the results of studies of gender differences on various spatial tests and have concluded that the magnitude of the gender difference in spatial ability is decreasing over time. The present study used meta-analytic techniques to compare the effect size (d) of the gender difference in 14 studies published from 1975 to 1992 which administered the Mental Rotations test to adolescents and young adults. Males scored significantly higher than females in all the studies. Analyses of the d's computed for the studies revealed that the magnitude of the gender difference on the Mental Rotations test has remained stable over time. Neither the Pearson correlation relating the d's to the publication dates of the studies nor the Z test of the linear contrast relating the publication dates of the studies to the effect sizes showed a linear change in the size of the gender difference over time. The finding of a stable gender difference on the Mental Rotations test argues against the general conclusion that the gender difference in spatial ability is decreasing.

Adolescent↗

Selected contribution: Gender differences in the endothelin-B receptor contribution to basal cutaneous vascular tone in humans.

To test whether the contribution of endothelin-B (ET-B) receptors to resting vascular tone differs between genders, we administered the ET-B receptor antagonist BQ-788 into the forearm skin of 11 male and 11 female subjects by intradermal microdialysis. Skin blood flow was measured using laser-Doppler flowmetry at the microdialysis site. The probe was perfused with Ringer solution alone, followed by BQ-788 (150 nM) and finally sodium nitroprusside (28 mM) to effect maximal cutaneous vasodilation. Cutaneous vascular conductance (CVC) was calculated (laser-Doppler flowmetry/mean arterial pressure) and normalized to maximal levels (%max). In male subjects, baseline CVC was (mean +/- SE) 19 +/- 3%max and increased to 26 +/- 5%max with BQ-788 (P < 0.05 vs. baseline). In female subjects, baseline CVC was 13 +/- 1%max and decreased to 10 +/- 1%max in response to BQ-788. CVC responses to BQ-788 differed with gender (P < 0.05); thus the contribution of ET-B receptors to resting cutaneous vascular tone differs between men and women. In men, ET-B receptors mediate tonic vasoconstriction, whereas, in women, ET-B receptors mediate tonic vasodilation.

Adult↗

Gender differences in platelet GPIIb-IIIa activation.

Gender differences in the development of thrombotic diseases have been described in numerous clinical settings. Enhanced platelet reactivity in both sexes is associated with the development of vascular thromboses. Because activation of platelet GPIIb-IIIa receptors is a central event in thrombus formation, we examined GPIIb-IIIa function in normal male and female volunteers. Using flow cytometry, we quantitated gender differences in the number of binding sites for FITC-labeled fibrinogen (FITC-FGN) and FITC-labeled PAC-1 antibody (FITC-PAC-1). Washed platelets were incubated with either FITC-FGN or FITC-PAC-1 and activated with either ADP or thrombin receptor activating peptide (TRAP) prior to cytometric acquisition of data. The dissociation constant for FITC-FGN was the same in both sexes (approx. 1.6 x 10(-7)M), however, the number of GPIIb-IIIa receptors per platelet capable of binding fibrinogen was significantly greater in women than men in response to 2 microM ADP (16,319 +/- 1871 vs 9669 +/- 1994, p = 0.02), 20 microM ADP (39,951 +/- 4711 vs 25,948 +/- 4953, p = 0.05) and 50 microM TRAP (39,236 +/- 3965 vs 21,848 +/- 4159, p = 0.007). Similarly, the number of GPIIb-IIIa receptors capable of binding PAC-1 in response to ADP and TRAP was 50% to 80% greater in women than men. Binding experiments using specific anti-GPIIb-IIIa monoclonal antibodies (P2 and 10E5), as well as quantitative Western blotting experiments, showed no gender difference in the total number of GPIIb-IIIa molecules expressed. Analysis of data from female subgroups demonstrated an association of GPIIb-IIIa reactivity with menstrual phase. We conclude that GPIIb-IIIa receptors on platelets from premenopausal women are more "activatable" than those on platelets from young men. Variations in the serum concentrations of estrogens and/or progestins may modulate GPIIb-IIIa function.

Adult↗

Gender differences in sexuality: a meta-analysis.

This meta-analysis surveyed 177 usable sources that reported data on gender differences on 21 different measures of sexual attitudes and behaviors. The largest gender difference was in incidence of masturbation: Men had the greater incidence (d = .96). There was also a large gender difference in attitudes toward casual sex: Males had considerably more permissive attitudes (d = .81). There were no gender differences in attitudes toward homosexuality or in sexual satisfaction. Most other gender differences were in the small-to-moderate range. Gender differences narrowed from the 1960s to the 1980s for many variables. Chodorow's neoanalytic theory, sociobiology, social learning theory, social role theory, and script theory are discussed in relation to these findings.

Female↗

Gender differences in teenage smoking.

This study analyzes the patterns and correlates of gender differences in cigarette smoking in a national sample of white high school seniors in 1985. More females than males were smokers, because females had higher rates for the early stages of smoking adoption. Specifically, females were more likely to have tried smoking at least once and, among those who had tried smoking, females were more likely to have smoked more than once or twice. Gender differences in smoking varied, depending on the students' characteristics. For example, the female excess in the early stages of smoking adoption was small or absent among rural students or very religious students, apparently because traditional values inhibit smoking adoption more among females than among males. We estimated the contributions of gender differences in students' characteristics to gender differences in smoking adoption. For example, males were more involved in sports, and this appears to be one reason why males had lower rates of smoking adoption than females. On the other hand, males had more deviant behavior and attitudes, and this would be expected to contribute to greater smoking adoption by males. The findings of this study indicate important gender differences in the determinants of smoking adoption.

Adolescent↗

Influence of body composition, hemoglobin concentration, and cardiac size and function of gender differences in maximal oxygen uptake in prepubertal children.

OBJECTIVE: To determine the relative contribution of the gender difference in body composition, blood hemoglobin concentration, and cardiac dimension and function at rest and exercise of the gender difference in maximal oxygen uptake (O(2)max) in 10- to 12-year-old children. SUBJECTS: Thirty-five healthy children (17 girls and 18 boys; mean +/- SD age, 10.5 +/- 0.4 years). EXPERIMENTAL DESIGN: An anthropometric evaluation (body surface area, body fat content, and lean body mass [LBM]), assessment of hemoglobin concentration, echocardiographic evaluation at rest (left ventricular dimensions, and diastolic and systolic indexes at rest), and cardiovascular evaluation during a maximal cycle exercise (stroke volume [SV], total peripheral resistance). RESULTS: The boys exhibited a higher mass-relative O(2)max than the girls (47.9 mL/kg/min vs 40.9 mL/kg/min, respectively); but when normalized for LBM (allometric equation), the difference totally disappeared (19.0 mL/kg LBM(1.33)/min vs 18.9 mL/kg LBM(1.33)/min, respectively). No significant gender differences were seen in maximal heart rate and arteriovenous oxygen difference; however, maximal SV (SVmax) was significantly higher in boys than in girls, but when expressed relative to LBM, the difference was no longer significant. CONCLUSIONS: These findings demonstrate that contrary to adults, the sole limiting factor of O(2) that distinguished boys from girls was a lower SVmax in the latter; however, this gender difference totally disappeared when normalized for LBM. Consequently, the gender difference in heart size and cardiac function during exercise should be interpreted as only one aspect of the lower LBM in girls and not as reflective of a more basic functional gender difference.

Body Composition↗

Gender differences in volumetric bone density: a study of opposite-sex twins.

Gender difference in bone size is a potential confounder when comparing bone density between males and females. A comparison of volumetric BMD (vBMD) between men and women, which is a measure of bone mass relative to three-dimensional bone volume (g/cm(3)) as opposed to areal bone density (g/cm(2)), may be a more accurate reflection of gender differences in bone density. The aims of this study were to examine gender differences in bone mass (BMC), areal BMD (aBMD), volumetric BMD (vBMD) by comparing twins of opposite sex in whom the effects of age, genes and environment are partially controlled for. DEXA derived BMC, aBMD, vBMD at the third lumbar vertebra (L3), femoral neck (FN) and forearm (1/3 radius) were compared between 82 opposite sex pairs aged 18-80. BMC was significantly higher in males at all three sites (26-45.5%). For aBMD the gender differences remained significant at all sites except the spine. The average differences in aBMD were not as great as the differences in BMC (2.2-20.5%). The differences in vBMD, however, followed a different pattern. FN and L3 vBMD were significantly higher in females (4.8 and 0.6%, respectively), while radial BMD was not significantly different between the sexes. Comparing aBMD values between males and females, when females in general have a smaller skeleton than males may not be a true indication of gender differences in bone density. A comparison of vBMD between men and women shows only small differences in bone density between the sexes.

Adult↗

Gender differences in cardiovascular and catecholamine responses to cold-air exposure at rest.

Metabolic and cardiovascular responses were examined in 8 men and 9 women during 2 hrs of sitting at rest in 5 degrees C. The men and women had similar body fatness and both groups responded with similar changes relative to control in cardiac output, blood pressure, total peripheral resistance, VO2, respiratory exchange ratio, and rectal temperature. However, greater increases in stroke volume and decreases in heart rate and skin temperature were observed in men compared to women (p < 0.05). The contribution of CHO and fat to the total energy expended differed (p < 0.05) between genders; the CHO:fat ratio was 47:53 in men and 36:64 in women. No gender differences could be observed in plasma catecholamines. It is concluded that there are striking cardiovascular and metabolic gender differences in response to cold stress which cannot be accounted for by body fatness or catecholamine responses.

Adrenergic alpha-Agonists↗