A Meta-Analysis of the Association between Gender and Protective Behaviors in Response to Respiratory Epidemics and Pandemics - PubMed (original) (raw)

Meta-Analysis

A Meta-Analysis of the Association between Gender and Protective Behaviors in Response to Respiratory Epidemics and Pandemics

Kelly R Moran et al. PLoS One. 2016.

Abstract

Respiratory infectious disease epidemics and pandemics are recurring events that levy a high cost on individuals and society. The health-protective behavioral response of the public plays an important role in limiting respiratory infectious disease spread. Health-protective behaviors take several forms. Behaviors can be categorized as pharmaceutical (e.g., vaccination uptake, antiviral use) or non-pharmaceutical (e.g., hand washing, face mask use, avoidance of public transport). Due to the limitations of pharmaceutical interventions during respiratory epidemics and pandemics, public health campaigns aimed at limiting disease spread often emphasize both non-pharmaceutical and pharmaceutical behavioral interventions. Understanding the determinants of the public's behavioral response is crucial for devising public health campaigns, providing information to parametrize mathematical models, and ultimately limiting disease spread. While other reviews have qualitatively analyzed the body of work on demographic determinants of health-protective behavior, this meta-analysis quantitatively combines the results from 85 publications to determine the global relationship between gender and health-protective behavioral response. The results show that women in the general population are about 50% more likely than men to adopt/practice non-pharmaceutical behaviors. Conversely, men in the general population are marginally (about 12%) more likely than women to adopt/practice pharmaceutical behaviors. It is possible that factors other than pharmaceutical/non-pharmaceutical status not included in this analysis act as moderators of this relationship. These results suggest an inherent difference in how men and women respond to epidemic and pandemic respiratory infectious diseases. This information can be used to target specific groups when developing non-pharmaceutical public health campaigns and to parameterize epidemic models incorporating demographic information.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1

Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of search strategy.

A flow diagram providing the organization of the article search and selection process along with values for article retention numbers at each state.

Fig 2

Fig 2. Map of global study distribution.

A map visualizing the number of studies addressing populations from each country.

Fig 3

Fig 3. Density graph showing the sets of log odds ratios for pharmaceutical and non-pharmaceutical behaviors addressed for the 88 included study populations.

Males are used as the reference; positive log odds ratios correspond to females being more likely to adopt/practice a given behavior, and negative log odds ratios correspond to males being more likely to adopt/practice a given behavior. The set of non-pharmaceutical behaviors shown is trimmed such that the log odds ratio falling outside of three standard deviations from the mean is excluded.

Fig 4

Fig 4. Forest plot of the associations between gender and non-pharmaceutical behaviors.

The effect size and confidence interval of each study are indicated by a square and a horizontal line, respectively. The weight of each study in the model is indicated by the size of its square. A log odds ratio of 0, indicated by the dashed reference line, corresponds to no gender difference in behavioral response. Positive log odds ratios correspond to greater behavioral response by females, while negative log odds ratios correspond to greater behavioral response by males. The population mean effect size of the random-effects model incorporating these studies is given by the placement of the diamond, while the horizontal corners of the diamond illustrate the 95% CI of this mean effect size.

Fig 5

Fig 5. Forest plot of the associations between gender and pharmaceutical behaviors.

The effect size and confidence interval of each study are indicated by a square and a horizontal line, respectively. The weight of each study in the model is indicated by the size of its square. A log odds ratio of 0, indicated by the dashed reference line, corresponds to no gender difference in behavioral response. Positive log odds ratios correspond to greater behavioral response by females, while negative log odds ratios correspond to greater behavioral response by males. The population mean effect size of the random-effects model incorporating these studies is given by the placement of the diamond, while the horizontal corners of the diamond illustrate the 95% CI of this mean effect size. Publications with the same author(s) and year of publication are differentiated by the first word of their title. Publications including multiple studies are denoted by labeling the studies A, B, etc.

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