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Large racial and gender wage gaps in the U. Among full- and part-time workers in the U. Looking at gender, race and ethnicity combined, all groups, with the exception of Asian men, lag behind white men in terms of median hourly earningsaccording to a new Pew Research Center analysis of Bureau of Labor Statistics data. Among women across all races and ethnicities, hourly earnings lag behind those of white men and men in their own racial or ethnic group. While the hourly earnings of white men continue to outpace those of women, all groups of women have made progress in narrowing this wage gap sincereflecting at least in part a ificant increase in the education levels and workforce experience of women over time. White and Asian women have narrowed the wage gap with white men to a much greater degree than black and Hispanic women.
NCBI Bookshelf. In the search for a better understanding of genetic and environmental interactions as determinants of health, certain fundamental aspects of human identity pose both a challenge and an opportunity for clarification. With base pair comparisons possible across the individuals sequenced, the estimate that any two humans are Paradoxically, the evidence of vast s of DNA base pairs at which humans differ also became known at this time. It is estimated currently that any two people will differ at approximately 3 million positions along their genomes.
chapters have discussed the contributions of the social environment, behavior, psychological factors, physiological mechanisms, and genetic variation to health. These complex traits are multifaceted, and the goal is to tease apart the facets at different levels of organization in order to identify which of them directly modulate health. Failing to distinguish these different facets, both in the aggregate and within each level of analysis, will compromise the ability to obtain a more fine-grained understanding of how the different aspects of these fundamental individual traits interact to influence health.
Although the terms sex and gender are often used interchangeably, they, in fact, have distinct meanings.
Sex is a classification based on biological differences—for example, differences between males and females rooted in their anatomy or physiology. By contrast, gender is a classification based on the social construction and maintenance of cultural distinctions between males and females. Differences in the health of males and females female reflect the simultaneous influence of both sex and gender. Not only can gender relations influence the expression of biological traits, but also sex-associated any characteristics can contribute to amplify gender differentials in health Krieger, The relative contributions of gender relations and sex-linked biology to health differences between males and females depend on the specific Any outcome under consideration.
In other instances, gender relations substantially for observed gender differentials for a given health outcome—for example the higher prevalence of needle-stick injuries among female compared to male health care workers, which is in turn attributed to the gender segregation of the health care workforce. The prevalence of HIV infection through needle-stick injury is higher among female health care workers because the majority of doctors are men, the majority of nurses and phlebotomists are women, and drawing blood is relegated to nurses and phlebotomists who are mostly women Ippolito et al.
In yet other instances, gender relations can act synergistically with sex-linked biology to produce a health outcome. For example, the risk of hypospadias is higher among male infants born to races exposed to potential endocrine-disrupting agents at work.
Facts are more important than ever
In this example, maternal exposure to the endocrine-disrupting agent e. Once exposure occurs, the risk of the outcome is predicated on sex-linked biology and is different for women and men, as well as for female and male fetuses, because only women can be pregnant, and exposure can lead to the outcome hypospadias only among male fetuses all examples cited in Krieger, Finally, in some instances, sex-linked biology can be obscured by the influence of gender relations in producing health differentials between women and men. Arber and Any demonstrated the presence of such bias in a randomized experimental study involving video-vignettes of a scripted consultation in which patients presented race standardized symptoms of CHD.
Women were asked fewer questions and received fewer diagnostic tests compared to men. Besides the behavior of health any providers, a of other social processes are recognized as contributing to gender inequalities in health. At the macro or societal level, these include the gender segregation of the labor force alluded to above and gender discrimination.
Gender segregation of the workforce and gender discrimination together contribute to the persistence of the gender wage gap—that is the fact that women earn less than men in paid employment Reskin and Padavic, The gender wage gap in turn contributes to the feminization of poverty.
Women— particularly female he of households—are over-represented among poor households in virtually every society. The adverse health effects of poverty see Chapter 2 of this report therefore fall disproportionately on women and their children.
Within households, gender relations also are characterized by the unequal division of labor e. The stresses associated with care giving, particularly providing care for ill spouses, have been linked to adverse health outcomes, such as cardiovascular disease Lee et al. Men and women differ biologically because their primary reproductive hormones are different.
Less well recognized are the sex differences in certain aspects of immune function that stem from the fact that women and men face different immune challenges. Moreover, as is the case for many other mammalian species, other aspects of male and female biology also may differ because they have different roles in caring for offspring or function in different ecological niches, thus reducing parental competition.
For example, a brief stressor mimicking a burrow collapse in a more pronounced long-term innate inflammatory response in female rats than in male rats exposed to the same stressor Hermes et al. Given that females become aggressive during lactation and may likely suffer from wounding, selection would favor those who can mount an inflammatory response that is effective enough to enable them to survive at least long enough to wean their nursing pups. Given that males do not behave paternally in this species, a selection pressure at this juncture of the reproductive lifespan would not be as strong.
The central point is that sex differences in health and risk for disease are not simply minor correlates of differences in reproductive hormones. They also result from deeply embedded highly coordinated physiological systems that have evolved to serve sex-specific functions.
For example, women must have sufficient energy reserves to sustain the huge metabolic demands of pregnancy and lactation. Thus, it is not surprising to see sex differences in energy metabolism. Sex hormones have both genomic and nongenomic effects on the accumulation, distribution, and metabolism of adipose tissue, including the regulation of leptin Mayes and Watson, Leptin has long-term effects on the regulation of body weight, mediated through appetite, energy expenditure and body temperature.
Marked sex differences can be seen in levels of leptin, which in men but not women are associated with hypertension Sheu et al. Moreover, leptin stimulates cellular components of innate immunity, stimulating T-cells, macrophages, and neutrophils, as well as preventing the programmed cell death of neutrophils apoptosis Bruno et al. Indeed, leptin is increased during infections.
Thus, fat metabolism and immune functions are differentially controlled in men and women, and the implications for disease risk and treatment are only now beginning to be explored. In recent years, there has been an increased focus on understanding the differences and similarities between females and males at the societal level i.
There is, of course, huge variation in the degree of overlap in the physical traits of men and women. Sexual dimorphism is typically reserved for traits for which the difference is relatively large, such as height population overlap of one standard deviation—10 percent of men are smaller than the average womanwhile smaller differences are typically termed as sexually differentiated, such as hand shape Williams et al.
A ificant of studies have documented the differences between sexes across the lifespan. This may be the result of differences in exposure to the risk factors, the routes of exposure and processing of a foreign agent, and cellular responses to the body. Differences cannot simply be attributed to hormones. Sex affects behavior, perception, and health in multiple complex ways. Differences in the sex chromosomes are but one factor, although a ificant one for a small of diseases influenced by gene dosage i.
Rather, it is a multifaceted variable, biologically, psychologically and socially, with each facet having different effects on health and risk for disease. However, there can be variance, if not sex reversals, along a given dimen sion without comparable variation in the others. This disassociation clearly demonstrates their independence.
Thus, future research on the impact of interactions among social, behavioral, and genetic factors on health must determine which of these facets and dimensions contribute directly to sex differences in health and which are merely correlates. An example helps to illustrate human variation.
Genes, behavior, and the social environment: moving beyond the nature/nurture debate.
There are XY individuals with a genetic variant of the androgen receptor who are unambiguously heterosexual women and who are engaged in feminine social roles ranging from actresses to Olympic athletes. They have testes and hormone levels higher than those of pubertal boys. But, because their androgen receptors do not bind androgen, their genitalia, secondary sex characteristics, and musculature are fully differentiated as women.
Until the Olympic committee changed its definition of sex from genetic to hormonal sex, such women had to compete as men. These women share the health risk of gonadal cancer, and typically their testes—their source of estrogens—are removed.
However, their social roles—as actresses or Olympic athletes, for example— are better predictors of cardiovascular health and risk for muscle injury. The constructs of race and ethnicity, female have similar limitations and complexity as sex and gender, are explored in the following section.
According to Shields and colleagues. Both race and ethnicity can be potent predictors for disease risk; however, it is important to emphasize the distinction between correlation and causation and to explore interactions among factors, while rejecting a unidirectional model that moves from genotype to phenotype. With the increased attention being given to racial disparities in health, the definition of race has come any increased scientific scrutiny. Race continues to be one of the most politically charged subjects in American life, because its associated sociocultural component often has led to categorizations that have been misleading and inappropriately used Kittles and Weiss, Definitions of race involve descriptions that are embedded in cultural as well as biological factors, and a careful distinction must be made between race as a statistical risk factor and as causal genetic variables Kittles and Weiss, Thus, genetics cannot provide a single all-purpose human race scheme that Any be adequate for addressing all of the multifaceted dimensions of health differentials.
It may be found that some alleles associated with destructive or protective factors related to disease and health are created, modified, or triggered by cultural and contextual factors. Race also is notoriously difficult to define and is inconsistently reported in the literature and in self-reports.
Self-report has been the classic measure for race and is still reliable in some cases given certain caveats. The usefulness of the data derived from self-reports of race in health research, however, has been the subject of much debate Risch et al.
InBurchard and colleagues wrote the following:. Excessive focus on racial or ethnic differences runs the risk of undervaluing the great diversity that exists among persons within groups. However, this risk needs to be weighed against the fact that in epidemiologic and clinical research, racial and ethnic are useful for generating and exploring hypotheses about environmental and genetic risk factors, as well as interactions between risk factors, for important medical outcomes.
Erecting barriers to the collection of information such as race and ethnic background may provide protection against the aforementioned risks; however, it will simultaneously retard progress in biomedical research and limit the effectiveness of clinical decision-making. Although there are requirements for reporting race in specific in federally sponsored research, the Office of Management and Budget directive that set out this requirement notes that these are not scientific .