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• Published: 28 April 2020

The impact a-gender: gendered orientations towards research Impact and its evaluation

• J. Chubb   ORCID: orcid.org/0000-0002-9716-820X 1 &
• G. E. Derrick   ORCID: orcid.org/0000-0001-5386-8653 2  

Palgrave Communications volume  6 , Article number:  72 ( 2020 ) Cite this article

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A Correction to this article was published on 19 May 2020

This article has been updated

Using an analysis of two independent, qualitative interview data sets: the first containing semi-structured interviews with mid-senior academics from across a range of disciplines at two research-intensive universities in Australia and the UK, collected between 2011 and 2013 ( n  = 51); and the second including pre- ( n  = 62), and post-evaluation ( n  = 57) interviews with UK REF2014 Main Panel A evaluators, this paper provides some of the first empirical work and the grounded uncovering of implicit (and in some cases explicit) gendered associations around impact generation and, by extension, its evaluation. In this paper, we explore the nature of gendered associations towards non-academic impact (Impact) generation and evaluation. The results suggest an underlying yet emergent gendered perception of Impact and its activities that is worthy of further research and exploration as the importance of valuing the ways in which research has an influence ‘beyond academia’ increases globally. In particular, it identifies how researchers perceive that there are some personality traits that are better orientated towards achieving Impact; how these may in fact be gendered. It also identifies how gender may play a role in the prioritisation of ‘hard’ Impacts (and research) that can be counted, in contrast to ‘soft’ Impacts (and research) that are far less quantifiable, reminiscent of deeper entrenched views about the value of different ‘modes’ of research. These orientations also translate to the evaluation of Impact, where panellists exhibit these tendencies prior to its evaluation and describe the organisation of panel work with respect to gender diversity.

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Introduction.

The management and measurement of the non-academic impact Footnote 1 (Impact) of research is a consistent theme within the higher education (HE) research environment in the UK, reflective of a drive from government for greater visibility of the benefits of research for the public, policy and commercial sectors (Chubb, 2017 ). This is this mirrored on a global scale, particularly in Australia, where, at the ‘vanguard’ (Upton et al., 2014 , p. 352) of these developments, methods were first devised (but were subsequently abandoned) to measure research impact (Chubb, 2017 ; Hazelkorn and Gibson, 2019 ). What is broadly known in both contexts as an ‘Impact Agenda’—the move to forecast and assess the ways in which investment in academic research delivers measurable socio-economic benefit—initially sparked broad debate and in some instances controversy, among the academic community (and beyond) upon its inception (Chubb, 2017 ). Since then, the debate has continued to evolve and the ways in which impact can be better conceptualised and implemented in the UK, including its role in evaluation (Stern, 2016 ), and more recently in grant applications (UKRI, 2020 ) is robustly debated. Notwithstanding attempts to better the culture of equality and diversity in research, (Stern, 2016 ; Nature, 2019 ) in the broader sense, and despite the implementation of the Impact agenda being studied extensively, there has been very little critical engagement with theories of gender and how this translates specifically to more downstream gendered inequities in HE such as through an impact agenda.

The emergence of Impact brought with it many connotations, many of which were largely negative; freedom was questioned, and autonomy was seen to be at threat because of an audit surveillance culture in HE (Lorenz, 2012 ). Resistance was largely characterised by problematising the agenda as symptomatic of the marketisation of knowledge threatening traditional academic norms and ideals (Merton, 1942 ; Williams, 2002 ) and has led to concern about how the Impact agenda is conceived, implemented and evaluated. This concern extends to perceptions of gendered assumptions about certain kinds of knowledge and related activities of which there is already a corpus of work, i.e., in the case of gender and forms of public engagement (Johnson et al., 2014 ; Crettaz Von Roten, 2011 ). This paper explores what it terms as ‘the Impact a-gender’ (Chubb, 2017 ) where gendered notions of non-academic, societal impact and how it is generated feed into its evaluation. It does not wed itself to any feminist tradition specifically, however, draws on Carey et al. ( 2018 ) to examine, acknowledge and therefore amend how the range of policies within HE and how implicit power dynamics in policymaking produce gender inequalities. Instead, an impact fluidity is encouraged and supported. For this paper, this means examining how the impact a-gender feeds into expectations and the reward of non-academic impact. If left unchecked, the propagation of the impact a-gender, it is argued, has the potential to guard against a greater proportion of women generating and influencing the use of research evidence in public policy decision-making.

Scholars continue to reflect on ‘science as a gendered endeavour’ (Amâncio, 2005 ). The extensive corpus of historical literature on gender in science and its originators (Merton, 1942 ; Keller et al., 1978 ; Kuhn, 1962 ), note the ‘pervasiveness’ of the ‘masculine’ and the ‘objective and the scientific’. Indeed, Amancio affirmed in more recent times that ‘modern science was born as an exclusively masculine activity’ ( 2005 ). The Impact agenda raises yet more obstacles indicative of this pervasiveness, which is documented by the ‘Matthew’/‘Matilda’ effect in Science (Merton, 1942 ; Rossiter, 1993 ). Perceptions of gender bias (which Kretschmer and Kretschmer, 2013 hypothesise as myths in evaluative cultures) persist with respect to how gender effects publishing, pay and reward and other evaluative issues in HE (Ward and Grant, 1996 ). Some have argued that scientists and institutions perpetuate such issues (Amâncio, 2005 ). Irrespective of their origin, perceptions of gendered Impact impede evaluative cultures within HE and, more broadly, the quest for equality in excellence in research impact beyond academia.

To borrow from Van Den Brink and Benschop ( 2012 ), gender is conceptualised as an integral part of organisational practices, situated within a social construction of feminism (Lorber, 2005 ; Poggio, 2006 ). This article uses the notion of gender differences and inequality to refer to the ‘ hierarchical distinction in which either women and femininity and men and masculinity are valued over the other ’ (p. 73), though this is not precluding of individual preferences. Indeed, there is an emerging body of work focused on gendered associations not only about ‘types’ of research and/or ‘areas and topics’ (Thelwall et al., 2019 ), but also about what is referred to as non-academic impact. This is with particular reference to audit cultures in HE such as the Research Excellence Framework (REF), which is the UK’s system of assessing the quality of research (Morley, 2003 ; Yarrow and Davies, 2018 ; Weinstein et al., 2019 ). While scholars have long attended to researching gender differences in relation to the marketisation of HE (Ahmed, 2006 ; Bank, 2011 ; Clegg, 2008 ; Gromkowska-Melosik, 2014 ; Leathwood et al., 2008 ), and the gendering of Impact activities such as outreach and public engagement (Ward and Grant, 1996 ), there is less understanding of how far academic perceptions of Impact are gendered. Further, how these gendered tensions influence panel culture in the evaluation of impact beyond academia is also not well understood. As a recent discussion in the Lancet read ‘ the causes of gender disparities are complex and include both distal and proximal factors ’. (Lundine et al., 2019 , p. 742).

This paper examines the ways in which researchers and research evaluators implicitly perceive gender as related to excellence in Impact both in its generation and in its evaluation. Using an analysis of two existing data sets; the pre-evaluation interviews of evaluators in the UK’s 2014 Research Excellence Framework and interviews with mid-senior career academics from across the range of disciplines with experience of building impact into funding applications and/ or its evaluation in two research-intensive universities in the UK and Australia between 2011 and 2013, this paper explores the implicitly gendered references expressed by our participants relating to the generation of non-academic, impact which emerged inductively through analysis. Both data sets comprise researcher perceptions of impact prior to being subjected to any formalised assessment of research Impact, thus allowing for the identification of unconscious gendered orientations that emerged from participant’s emotional and more abstract views about Impact. It notes how researchers use loaded terminology around ‘hard’, and ‘soft’ when conceptualising Impact that is reminiscent of long-standing associations between epistemological domains of research and notions of masculinity/femininity. It refers to ‘hard’ impact as those that are associated with meaning economic/ tangible and efficiently/ quantifiably evaluated, and ‘soft’ as denoting social, abstract, potentially qualitative or less easily and inefficiently evaluated. By extending this analysis to the gendered notions expressed by REF2014 panellists (expert reviewers whose responsibility it is to review the quality of the retrospective impact articulated in case studies for the purposes of research evaluation) towards the evaluation of Impact, this paper highlights how instead of challenging these tendencies, shared constructions of Impact and gendered productivity in academia act to amplify and embed these gendered notions within the evaluation outcomes and practice. It explores how vulnerable seemingly independent assessments of Impact are to these widespread gendered- associations between Impact, engagement and success. Specifically, perceptions of the excellence and judgements of feasibility relating to attribution, and causality within the narrative of the Impact case study become gendered.

The article is structured as follows. First, it reviews the gender-orientations towards notions of ‘hard’ and ‘soft’ excellence in forms of scholarly distinction and explores how this relates to the REF Impact evaluation criteria, and the under-representation of women in the academic workforce. Specifically, it hypothesises the role of how gendered notions of excellence that construct academic identities contribute to a system that side-lines women in academia. This is despite associating the generation of Impact as a feminised skill. We label this as the ‘Impact a-gender’. The article then outlines the methodology and how the two, independent databases were combined and convergent themes developed. The results are then presented from academics in the UK and Australia and then from REF2014 panellists. This describes how the Impact a-gender currently operates through academic cultural orientations around Impact generation, and in its evaluation through peer-review panels by members of this same academic culture. The article concludes with a recommendation that the Impact a-gender be explored more thoroughly as a necessary step towards guiding against gender- bias in the academic evaluation, and reward system.

Literature review

Notions of impact excellence as ‘hard’ or ‘soft’.

Scholars have long attempted to consider the commonalities and differences across certain kinds of knowledge (Becher, 1989 , 1994 ; Biglan, 1973a ) and attempts to categorise, divide and harmonise the disciplines have been made (Biglan, 1973a , 1973b ; Becher, 1994 ; Caplan, 1979 ; Schommer–Aikins et al., 2003 ). Much of this was advanced with a typology of the disciplines from (Trowler, 2001 ), which categorised the disciplines as ‘hard’ or ‘soft’. Both anecdotally and in the literature, ‘soft’ science is associated with working more with people and less with ‘things’ (Cassell, 2002 ; Thelwall et al., 2019 ). These dichotomies often lead to a hierarchy of types of Impact and oppose valuation of activities based on their gendered connotations.

Biglan’s system of classifying disciplines into groups based on similarities and differences denotes particular behaviours or characteristics, which then form part of clusters or groups—‘pure’, ‘applied’, ‘soft’, ‘hard’ etc. Simpson ( 2017 ) argues that Biglan’s classification persists as one of the most commonly referred to models of the disciplines despite the prominence of some others (Pantin, 1968 ; Kuhn, 1962 ; Smart et al., 2000 ). Biglan ( 1973b ) classified the disciplines across three dimensions; hard and soft, pure and applied, life and non-life (whether the research is concerned with living things/organisms) . This ‘taxonomy of the disciplines’ states that ‘pure-hard’ domains tend toward the life and earth sciences,’pure-soft’ the social sciences and humanities, and ‘applied hard’ focus on engineering and physical science with ‘soft-applied’ tending toward professional practice such as nursing, medicine and education. Biglan’s classification looked at levels of social connectedness and specifically found that applied scholars Footnote 2 were more socially connected, more interested and involved in service activities, and more likely to publish in the form of technical reports than their counterparts in the pure (hard) areas of study. This resonates with how Impact brings renewed currency and academic prominence to applied researchers (Chubb, 2017 ). Historically, scholars inhabiting the ‘hard’ disciplines had a greater preference for research; whereas, scholars representing soft disciplines had a greater preference for teaching (Biglan, 1973b ). Further, Biglan ( 1973b ) also found that hard science scholars sought out greater collaborative efforts among colleagues when teaching as opposed to their soft science counterparts.

There are also long-standing gendered associations and connotations with notions of ‘hard’ and ‘soft’ (Storer, 1967 ). Typically used to refer to skills, but also used heavily with respect to the disciplines and knowledge domains, gendered assumptions and the mere use of ‘hard’ or ‘soft’ to describe knowledge production carries with it assumptions, which are often noted in the literature; ‘ we think of physics as hard and of political science as soft ’, Storer explains, adding how ‘hard seems to imply tough, brittle, impenetrable and strong, while soft on the other hand calls to mind the qualities of weakness, gentleness and malleability’ (p. 76). As described, hard science is typically associated with the natural sciences and quantitative paradigms whereas normative perceptions of feminine ‘soft’ skills or ‘soft’ science are often equated with qualitative social science. Scholars continue to debate dichotomised paradigms or ‘types’ of research or knowledge (Gibbons, 1999 ), which is emblematic of an undercurrent of epistemological hierarchy of the value of different kinds of knowledge. Such debates date back to the heated back and forth between scholars Snow (Snow, 2012 ) and literary critic Leavis who argued for their own ‘cultures’ of knowledge. Notwithstanding, these binary distinctions do few favours when gender is then ascribed to either knowledge domain or related activity (Yarrow and Davies, 2018 ). This is particularly pertinent in light of the current drive for more interdisciplinary research in the science system where there is also a focus on fairness, equality and diversity in the science system.

Academic performance and the Impact a-gender

Audit culture in academia impacts unfairly on women (Morley, 2003 ), and is seen as contributory to the wide gender disparities in academia, including the under-representation of women as professors (Ellemers et al., 2004 ), in leadership positions (Carnes et al., 2015 ), in receiving research acknowledgements (Larivière et al., 2013 ; Sugimoto et al., 2015 ), or being disproportionately concentrated in non-research-intensive universities (Santos and Dang Van Phu, 2019 ). Whereas gender discrimination also manifests in other ways such as during peer review (Lee and Noh, 2013 ), promotion (Paulus et al., 2016 ), and teaching evaluations (Kogan et al., 2010 ), the proliferation of an audit culture links gender disparities in HE to processes that emphasise ‘quantitative’ analysis methods, statistics, measurement, the creation of ‘experts’, and the production of ‘hard evidence’. The assumption here is that academic performance and the metrics used to value, and evaluate it, are heavily gendered in a way that benefits men over women, reflecting current disparities within the HE workforce. Indeed, Morely (2003) suggests that the way in which teaching quality is female dominated and research quality is male dominated, leads to a morality of quality resulting in the larger proportion of women being responsible for student-focused services within HE. In addition, the notion of ‘excellence’ within these audit cultures implicitly reflect images of masculinity such as rationality, measurement, objectivity, control and competitiveness (Burkinshaw, 2015 ).

The association of feminine and masculine traits in academia (Holt and Ellis, 1998 ), and ‘gendering its forms of knowledge production’ (Clegg, 2008 ), is not new. In these typologies, women are largely expected to be soft-spoken, nurturing and understanding (Bellas, 1999 ) yet often invisible and supportive in their ‘institutional housekeeping’ roles (Bird et al., 2004 ). Men, on the other hand are often associated with being competitive, ambitious and independent (Baker, 2008 ). When an individual’s behaviour is perceived to transcend these gendered norms, then this has detrimental effects on how others evaluate their competence, although some traits displayed outside of these typologies go somewhat ‘under the radar’. Nonetheless, studies show that women who display leadership qualities (competitiveness, ambition and decisiveness) are characterised more negatively than men (Rausch, 1989 ; Heilman et al., 1995 ; Rossiter, 1993 ). Incongruity between perceptions of ‘likeability’ and ‘competence’ and its relationship to gender bias is present in evaluations in academia, where success is dependent on the perceptions of others and compounded within an audit culture (Yarrow and Davis, 2018). This has been seen in peer review, reports for men and women applicants, where women were disadvantaged by the same characteristics that were seen as a strength on proposals by men (Severin et al., 2019 ); as well as in teaching evaluations where women receive higher evaluations if they are perceived as ‘nurturing’ and ‘supportive’ (Kogan et al., 2010 ). This results in various potential forms of prejudice in academia: Where traits normally associated with masculinity are more highly valued than those associated with femininity (direct) or when behaviour that is generally perceived to be ‘masculine’ is enacted by a woman and then perceived less favourably (indirect/ unconscious). That is not to mention direct sexism, rather than ‘through’ traits; a direct prejudice.

Gendered associations of Impact are not only oversimplified but also incredibly problematic for an inclusive, meaningful Impact agenda and research culture. Currently, in the UK, the main funding body for research in the UK, UK Research and Innovation (UKRI) uses a broad Impact definition: ‘ the demonstrable contribution that excellent research makes to society and the economy ’ (UKRI website, 2019 ). The most recent REF, REF2014, Impact was defined as ‘ …an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia ’. In Australia, the Australian Research Council (ARC) proposed that researchers should ‘embed’ Impact into the research process from the outset. Both Australia and the UK have been engaged in policy borrowing around the evaluation of societal impact and share many similarities in approaches to generating and evaluating it. Indeed, Impact has been deliberately conceptualised by decision-makers, funders and governments as broad in order to increase the appearance of being inclusivity, to represent a broad range of disciplines, as well as to reflect the ‘diverse ways’ that potential beneficiaries of academic research can be reached ‘beyond academia’. The adoption of societal impact as a formalised criterion in the evaluation of research excellence was initially perceived to be potentially beneficial for women, due to its emphasis on concepts such as ‘public engagement’; ‘duty’ and non-academic ‘cooperation/collaboration’ (Yarrow and Davies, 2018 ). In addition, the adoption of narrative case studies to demonstrate Impact, rather than adopting a complete metrics-focused exercise, can also be seen as an opportunity for women to demonstrate excellence in the areas where they are over-represented, such as teaching, cultural enrichment, public engagement (Andrews et al., 2005 ), informing public policy and improving public services (Schatteman, 2014 ; Wheatle and BrckaLorenz, 2015). However, despite this, studies highlight how for the REF2014, only 25% of Impact Case Studies for business and management studies were from women (Davies et al., 2020 ).

With respect to Impact evaluation, previous research shows that there is a direct link between notions of academic culture, and how research (as a product of that culture) is valued and evaluated (Leathwood and Reid, 2008 ; p. 120). Geertz ( 1983 ) argues that academic membership is a ‘cultural frame that defines a great part of one’s life’ influences belief systems around how academic work is orientated. This also includes gendered associations implicit in the academic reward system, which in turn influences how academics believe success is to be evaluated, and in what form that success emerges. This has implications in how academic associations of the organisation of research work and the ongoing constructions of professional identity relative to gender, feeds into how these same academics operate as evaluators within a peer review system evaluation. In this case, instead of operating to challenge these tendencies, shared constructions of gendered academic work are amplified to the extent that they unconsciously influence perceptions of excellence and the judgements of feasibility as pertaining to the attribution and causality of the narrative argument. As such, in an evaluation of Impact with its ambiguous definition (Derrick, 2018 ), and the lack of external indicators to signal success independent of cultural constructions inherent in the panel membership, effects are assumed to be more acute. In this way, this paper argues that the Impact a-gender can act to further disadvantage women.

The research combines two existing research data sets in order to explore implicit notions of gender associated with the generation and evaluation of research Impact beyond academia. Below the two data sets and the steps involved in analysing and integrating findings are described along with our theoretical positioning within the feminist literature Where verbatim quotation is used, we have labelled the participants according to each study highlighting their role and gender. Further, the evaluator interviews specify the disciplinary panel and subpanel to which they belonged, as well as their evaluation responsibilities such as: ‘Outputs only’; ‘Outputs and Impact’; and ‘Impacts only’.

Analysis of qualitative data sets

This research involved the analysis and combination of two independently collected, qualitative interview databases. The characteristics and specifics of both databases are outlined below.

Interviews with mid-senior academics in the UK and Australia

Fifty-one semi-structured interviews were conducted between 2011 and 2013 with mid-senior academics at two research-intensive universities in Australia and the UK. The interviews were 30–60 min long and participants were sourced via the research offices at both sites. Participants were contacted via email and invited to participate in a study concerning resistance towards the Impact agenda in the UK and Australia and were specifically asked for their perceptions of its relationship with freedom, value and epistemic responsibility and variations across discipline, career stage and national context. Mostly focused on ex ante impact, some interviewees also described their experiences of Impact in the UK and Australia, in relation to its formal assessment as part of the Excellence Innovation Australia (EIA) for Australia and the Research Excellence Framework (REF) in the UK.

Participants comprised mid to senior career academics with experience of winning funding from across the range of disciplines broadly representative of the arts and humanities, social sciences, physical science, maths and engineering and the life and earth sciences. For the purposes of this paper, although participant demographic information was collected, the relationship between the gender of the participants, their roles, disciplines/career stage was not explicitly explored instead, such conditions were emergent in the subsequent inductive coding during thematic analysis. A reflexive log was collected in order to challenge and draw attention to assumptions and underlying biases, which may affect the author, inclusive of their own gender identity. Further information on this is provided in Chubb ( 2017 ).

Pre- and post-evaluation interviews with REF2014 evaluators

REF2014 in the UK represented the world’s first formalised evaluation of ex-post impact, comprising of 20% of the overall evaluation. This framework served as a unique experimental environment with which to explore baseline tendencies towards impact as a concept and evaluative object (Derrick, 2018 ).

Two sets of semi-structured interviews were conducted with willing participants: sixty-two panellists were interviewed from the UK’s REF2014 Main Panel A prior to the evaluation taking place; and a fifty-seven of these were re-interviewed post-evaluation. Main Panel A covers six Sub-panels: (1) Clinical Medicine; (2) Public Health, Health Services and Primary Care; (3) Allied Health Professions, Dentistry, Nursing and Pharmacy; (4) Psychology, Psychiatry and Neuroscience; (5) Biological Sciences; and (6) Agriculture, Veterinary and Food Sciences. Again, the relationship between the gender of the participants and their discipline is not the focus for the purposes of this paper.

Database combination and identification of common emergent themes

The inclusion of data sets using both Australian and UK researchers was pertinent to this study as both sites were at the cusp of implementing the evaluation of Impact formally. These researcher interviews, as well as the evaluator interviews were conducted prior to any formalised Impact evaluation took place, but when both contexts required ex ante impact in terms of certain funding allocation, meaning an analysis of these baseline perceptions between databases was possible. Further, the inclusion of the post-evaluation interviews with panellists in the UK allowed an exploration of how these gendered perceptions identified in the interviews with researchers and panellists prior to the evaluation, influenced panel behaviour during the evaluation of Impact.

Initially, both data sets were analysed using similar, inductive, grounded-theory-informed approaches inclusive of a discourse and thematic analysis of the language used by participants when describing impact, which allowed for the drawing out of metaphor (Zinken et al., 2008 ). This allowed data combination and analysis of the two databases to be conducted in line with the recommendations for data-synthesis as outlined in Weed ( 2005 ) as a form of interpretation. This approach guarded against the quantification of qualitative findings for the purposes of synthesis, and instead focused on an initial dialogic approach between the two authors (Chubb and Derrick), followed by a re-analysis of qualitative data sets (Heaton, 1998 ) in line with the outcomes of the initial author-dialogue as a method of circumventing many of the drawbacks associated with qualitative data-synthesis. Convergent themes from each, independently analysed data set were discussed between authors, before the construction of new themes that were an iterative analysis of the combined data set. Drawing on the feminist tradition the authors did not apply feminist standpoint theory, instead a fully inductive approach was used to unearth rich empirical data. An interpretative and inductive approach to coding the data using NVIVO software in both instances was used and a reflexive log maintained. The availability of both full, coded, qualitative data sets, as well as the large sample size of each, allowed this data-synthesis to happen.

Researcher’s perceptions of Impact as either ‘hard’ or ‘soft’

Both UK and Australian academic researchers (researchers) perceive a guideline of gendered productivity (Davies et al., 2017 ; Sax et al., 2002 ; Astin, 1978 ; Ward and Grant, 1996 ). This is where men or women are being dissuaded (by their inner narratives, their institutions or by colleagues) from engaging in Impact either in preference to other (more masculine) notions of academic productivity, or towards softer (for women) because they consider themselves and are considered by others to be ‘good at it’. Participants often gendered the language of Impact and introduced notions of ‘hard’ and ‘soft’. On the one hand, this rehearses and resurfaces long-standing views about the ‘Matthew Effect’ because often softer Impacts were seen as being of less value by participants, but also indicates that the word impact itself carries its own connotations, which are then weighed down further by more entrenched gender associations.

Our research shows that when describing Impact, it was not necessarily the masculinity or femininity of the researcher that was emphasised by participants, rather researchers made gendered presumptions around the type of Impact, or the activity used to generate it as either masculine or feminine. Some participants referred to their own research or others’ research as either ‘hard’ or as ‘soft and woolly’. Those who self-professed that their research was ‘soft’ or woolly’ felt that their research was less likely to qualify as having ‘hard’ impact in REF terms Footnote 3 ; instead, they claimed their research would impact socially, as opposed to economically; ‘ stuff that’s on a flaky edge — it’s very much about social engagement ’ (Languages, Australia, Professor, Male) . One researcher described Impact as ‘a nasty Treasury idea,’ comparing it to: a tsunami, crashing over everything which will knock out stuff that is precious ’ . (Theatre, Film and TV, UK, Professor, Male) . This imagery associates the concept of impact with force and weight (or hardness as mentioned earlier) particularly in disciplines where the effect of their research may be far more nuanced and subtle. One Australian research used force to depict the impact of teaching and claimed Impact was like a footprint, and teaching was ‘ a pretty heavy imprint ’ (Environment, UK, Professor, Male) . Participants characterised ‘force and weight’ as masculine, suggesting that some connotations of Impact and the associated activities may be gendered. The word ‘Impact’ was inherently perceived by many researchers as problematic, bound with linguistic connotations and those imposed by the official definitions, which in many cases are perceived as negative or maybe even gendered (Chubb, 2017 ): ‘ The etymology of a word like impact is interesting. I’ve always seen what I do as being a more subtle incremental engagement, relevance, a contribution ’. (Theatre, Film and TV, UK, Professor, Male) .

Researchers associated the word ‘impact’ with hard-ness, weight and force; ‘ anything that sorts of hits you ’ (Languages, UK, Senior Lecturer, Female) . One researcher suggested that Impact ‘ sounds kind of aggressive — the poor consumer! ’ (History, Australia, Professor, Female) . Talking about her own research in the performing arts, one Australian researcher commented: ‘ It’s such a pain in the arse because the Arts don’t fit the model. But in a way they do if you look at the impact as being something quite soft ’ (Music, Australia, Professor, Female) . Likewise, a similar comparison was seen by a female researcher from the mechanical engineering discipline: ‘ My impact case study wasn’t submitted mainly because I’m dealing with that slightly on the woolly side of things ’ (Mechanical Engineering, Australia, Professor, Female) . Largely, gender related comments hailed from the ‘hard’ science and from arts and humanities researchers. Social scientists commented less, and indeed, one levelled that Impact was perhaps less a matter of gender, and more a matter of ability (Chubb, 2017 ): ‘ It’s about being articulate! Both guys and women who are very articulate and communicate well are outward looking on all of these things ’ ( Engineering Education, Australia, Professor, Female).

Gendered notions of performativity were also very pronounced by evaluators who were assessing the outputs only, suggesting how these panel cultures are orientated around notions of gender and scientific outputs as ‘hard’ if represented by numbers. The focus on numbers was perceived by the following panellist as ‘ a real strong tendency particularly amongst the Alpha male types ’ within the panel that relate to findings about the association of certain traits—risk aversion, competitiveness, for example, with a masculinised market logic in HE;

And I like that a lot because I think that there is a real strong tendency particularly amongst the Alpha male types of always looking at the numbers, like the numbers and everything. And I just did feel that steer that we got from the panel chairs, both of them were men by the way, but they were very clear, the impact factors and citations and the rank order of a journal is this is information that can be useful, but it’s not your immediate first stop. (Panel 1, Outputs and Impact, Female)

However, a metric-dominant approach was not the result of a male-dominated panel environment and instead, to the panels credit, evaluators were encouraged not to use one-metric as the only deciding factor between star-rating of quality. However, this is not to suggest that metrics did not play a dominant role. In fact, in order to resolve arguments, evaluators were encouraged to ‘ reflect on these other metrics ’ (Panel 3, Outputs only, Male) in order to rectify arguments where the assessment of quality was in conflict. This use of ‘other metrics’ was preferential to a resolution of differences that are based on more ‘soft’ arguments that are based on understanding where differences in opinion might lie in the interpretation of the manuscript’s quality. Instead, the deciding factor in resolving arguments would be the responsibility, primarily, of a ‘hard’ concept of quality as dictated by a numerical value;

Read the paper, judge the quality, judge the originality, the rigour, the impact — if you have to because you’re in dispute with another assessor, then reflect on these other metrics. So I don’t think metrics are that helpful actually if and until you’ve got a real issue to be able to make a decision. But I worry very much that metrics are just such a simple way of making the process much easier, and I’m worried about that because I think there’s a bit of game playing going on with impact factors and that kind of thing. (Panel 3, Outputs Only, Male)

Table 1 outlines the emergent themes, which, through inductive coding participants broadly categorised domains of research, their qualities and associations, types of activities and the gendered assumption generally made by participants when describing that activity. The table is intended only to provide an indicative overview of the overall tendencies of participants toward certain narratives as is not exhaustive, as well as a guide to interpret the perceptions of Impact illustrated in the below results.

Table one describes the dichotomous views that seemed to emerge from the research but it’s important to note that researchers associated Impact as related to gender in subtle, and in some cases overt ways. The data suggests that some male participants felt that female academics might be better at Impact, suggesting that female academics might find it liberating, linked it to a sense of duty or public service, implying that it was second nature. In addition, some male participants associated types of Impact domains as female-orientated activity and the reverse was the case with female and male-orientated ‘types’ of Impact. For example, at one extreme, a few male researchers seemed to perceive public engagement as something, which females would be particularly good at, generalising that they are not competitive ‘ women are better at this! They are less competitive! ’ (Environment, UK, Professor, Male) . Indeed, one male researcher suggested that competitiveness actually helps academics have an impact and does not impede it:

I get a huge buzz from trying to communicate those to a wider audience and winning arguments and seeing them used. It’s not the use that motivates me it’s the process of winning, I’m competitive! (Economics, UK, Professor, Male)

Analysis also revealed evidence that some researchers has gendered perceptions of Impact activities just as evaluators did. Here, women were more likely to promote the importance of engaging in Impact activities, whereas men were focused on producing indicators with hard, quantitative indicators of success. Some researchers implied that public engagement was not something entirely associated with the kinds of Impact needed to advance one’s career and for a few male researchers, this was accordingly associated with female academics. Certain female researchers in the sciences and the arts suggested similarly that there was a strong commitment among women to carry out public engagement, but that this was not necessarily shared by their male counterparts who, they perceived, undervalued this kind of work:

I think the few of us women in the faculty will grapple with that a lot about the relevance of what we’re doing and the usefulness, but for the vast majority of people it’s not there… [She implies that]…I think there is a huge gender thing there that every woman that you talk to on campus would consider that the role of the university is along the latter statement (*to communicate to the public). The vast majority of men would not consider that’s a role of the university. There’s a strong gender thing. (Chemical Engineering, Australia, Professor, Female)

Notwithstanding, it is important to distinguish between engagement and Impact. This research shows that participants perceive Impact activities to be gendered. There was a sense from one arts female researcher that women might be more interested in getting out there and communicating their work but that crucially, it is not the be-all and end- all of doing research: ‘ Women feel that there’s something more liberating, I can empathise with that, but that couldn’t be the whole job ’. Music, Australia, Professor, Female Footnote 4 . When this researcher, who was very much orientated towards Impact, asked if there were enough interviewees, she added ‘ mind you, you’ve probably spoken to enough men in lab coats ’. This could imply that inward-facing roles are associated with male-orientated activity and outward facing roles as perceived as more female orientated. Such sentiments perhaps relate to a binary delineation of women as more caring, subjective, applied and of men as harder, scientific and theoretical/ rational. This links to a broader characterisation of HE as marketised and potentially, more ‘male’ or at least masculinised—where increasing competitiveness, marketisation and performativity can be seen as linked to an increasingly macho way of doing business (Blackmore, 2002 ; Deem, 1998 ; Grummell et al., 2009 ; Reay, n.d. ). The data is also suggestive of the attitude that communication is a ‘soft’ skill and the interpersonal is seen as a less masculine trait. ‘ This is a huge generalisation but I still say that the profession is so dominated by men, undergraduates are so dominated by men and most of those boys will come into engineering because they’re much more comfortable dealing with a computer than with people ’ (Chemical Engineering, Australia, Professor, Female) . Again, this suggests women are more likely to pursue those scientific subjects, which will make a difference or contribute to society (such as nursing or environmental research, certainly those subjects that would be perceived as less ‘hard’ science domains).

There was also a sense that Impact activity, namely in this case public engagement and community work, was associated with women more than men by some participants (Amâncio, 2005 ). However, public engagement and certain social impact domains appeared to have a lower status and intellectual worth in the eyes of some participants. Some inferred that social and ‘soft’ impacts are seen as associated. With discipline. For instance, research concerning STEM (Science, Technology, Engineering and Medicine) subjects with females. They in turn may be held in low esteem. Some of the accounts suggest that soft impacts are perceived by women as not ‘counting’ as Impact:

‘ At least two out of the four of us who are female are doing community service and that doesn’t count, we get zero credit, actually I would say it gets negative credit because it takes time away from everything else ’. (Education Engineering, Australia, Professor, Female)

This was intimated again by another female UK computer scientist who claimed that since her work was on the ‘woolly side’ of things, and her impacts were predominantly in the social and public domain, she would not be taken seriously enough to qualify as a REF Impact case study, despite having won an award for her work:

‘ I don’t think it helps that if I were a male professor doing the same work I might be taken more seriously. It’s interesting, why recently? Because I’ve never felt that I’ve not been taken seriously because I’m a woman, but something happened recently and I thought, oh, you’re not taking me seriously because I’m a woman. So I think it’s a part ’. (Computer Science, UK, Professor, Female)

Researchers also connect the ‘hard’ and ‘soft’ associations with Impact described earlier to male and female traits. The relationship between Impact and gender is not well understood and it is not clear how much these issues are directly relatable to Impact or more symptomatic of the broader picture in HE. In order to get a broader picture, it is important to examine how these gendered notions of Impact translate into its evaluation. Some participants suggested that gender is a factor in the securing of grant money—certainly this comment reveals a local speculation that ‘the big boys’ get the grants, in Australia, at least: ‘ ARC grants? I’ve had a few but nothing like the big boys that get one after the other ,’ (Chemical Engineering, Australia, Professor, Female) . This is not dissimilar to the ‘alpha male’ comments from the evaluators described below who note a tendency for male evaluators to rely on ‘hard’ numbers whose views are further examined in the following section.

Gendered excellence in Impact evaluation

In the pre-evaluation interviews, panellists were asked about what they perceived to be ‘excellent’ research and ‘excellent’ Impact. Within this context, are mirrored conceptualisations of impacts as either ‘soft’ or ‘hard’ as was seen with the interviews with researchers described above. These conceptualisations were captured prior to the evaluation began. They can therefore be interpreted as the raw, baseline assumptions of Impact that are free from the effects of the panel group, showed that there were differences in how evaluators perceived Impact, and that these perceptions were gendered.

Although all researchers conceptualised Impact as a linear process for the purposes of the REF2014 exercise (Derrick, 2018 ), there was a tendency for female evaluators to be open to considering the complexity of Impact, even in a best-case scenario. This included a consideration that Impact as dictated within the narrative might have different indicators of value to different evaluators; ‘ I just think that that whole framing means that there is a form of normative standard of perfect impact ’ (Main Panel, Outputs and Impacts, Female) . This evaluator, in particular, went further to state how that their impression of Impact would be constructed from the comparators available during the evaluation;

‘ Given that I’m presenting impact as a good story, it would be like you saying to me; ‘Can you describe to me a perfect Shakespearean play?’…. well now of course, I can’t. You can give me lots of plays but they all have different kinds of interesting features. Different people would say that their favourite play was different. To me, if you’re taking interpretivist view, constructivist view, there is no perfect normative standard. It’s just not possible ’. (Panel 1, Outputs and Impacts, Female)

Female evaluators were also more sensitive to other complex factors influencing the evaluation of Impact, including time lag; ‘ …So it takes a long time for things like that to be accepted…it took hundreds of studies before it was generally accepted as real ’ (Panel 1, Outputs and Impacts, Female ); as well as the indirect way that research influences policy as a form of Impact;

‘ I don’t think that anything would get four stars without even blinking. I think that is impossible to answer because you have to look at the whole evidence in this has gone on, and how that does link to the impact that is being claimed, and then you would then have to look at how that impact, exactly how that research has impacted on the ways of the world, in terms of change or in terms of society or whatever. I don’t think you can see this would easily get four stars because of the overall process is being looked at, as well as the actual outcome ’ . (Panel 3, Outputs and Impact, Female)

Although these typologies were not absolute, there was a lack of complexity in the nuances around Impact. There was also heavily gendered language around Impacts as measurable, or not, that mirrored the association of Impact as being either ‘hard’, and therefore measurable, or ‘soft, and therefore more nuanced in value. In this way, male evaluators expressed Impact as a causal, linear event that occurred ‘ in a very short time ’ (P2, Outputs and Impact, Male) and involved a single ‘ star ’ (P3, Impacts only, Male) or ‘ impact champion ’ (Main Panel, Outputs and Impacts, Male) that drove it from start (research), to finish (Impact). These associations about Impact being ‘soft’ and ‘hard’ made by evaluators, mirror the responses from researchers in the above sections. In the example below, the evaluator used words such as ‘ strong ’ and ‘ big way ’ to describe Impact success, as well as emphasises causality in the argument;

‘ …if it has affected a lot of people or affected policy in a strong way or created change in a big way, and it can be clearly linked back to the research, and it’s made a difference ’. (Panel 2, Outputs and Impact, Male)

These perhaps show disciplinary differences as much as gendered differences. Further, there was a stronger tendency for male evaluators to strive towards conceptualisations of excellence in Impact as measurable or ‘ it’s something that is decisive and actionable ’ (Panel 6, Impacts, Male) . One male evaluator explained his conceptualised version of Impact excellence as ‘ straightforward ’ and therefore ‘ obviously four-star ’ due to the presence of metrics with which to measure Impact. This was a perception more commonly associated with male evaluators;

‘ …if somebody has been able to devise a — let’s say pancreatic cancer — which is a molecular cancer, which hasn’t made any progress in the last 40 years, and where the mortality is close to 100% after diagnosis, if someone devised a treatment where now suddenly, after diagnosis of pancreatic cancer, 90 percent of the people are now still alive 5 years later, where the mortality rate is almost 0%, who are alive after 5 years. That, of course, would be a dramatic, transformative impact ’. (Panel 1, Outputs and Impact, Male)

In addition, his tendency to seek various numeric indicators for measuring, and therefore assessing Impact (predominantly economic impact), as well as compressing its realisation to a small period of time ( ‘ suddenly ’ ) in a causal fashion, was more commonly expressed in male evaluators. This tendency automatically indicates the association of impacts as either ‘soft’ or ‘hard’ and divided along gendered norms, but also expresses Impact in monetary terms;

‘ Something that went into a patient or the company has pronounced with…has spun out and been taken up by a commercial entity or a clinical entity ’ (Panel 3, Outputs and Impacts, Male) , as well as impacts that are marketised; ‘ A new antimicrobial drug to market ’. (Panel 6, Outputs and Impact, Male) .

There was also the perception that female academics would be better at engagement (Johnson et al., 2014 ; Crettaz Von Roten, 2011 ) due to its link with notions of ‘ duty ’ (as a mother), ‘ engagement ’ and ‘ public service ’ are reflected in how female evaluators were also more open to the idea that excellent Impact is achieved through productive, ongoing partnerships with non-academic stakeholders. Here, the reflections of ‘duty’ from the evaluators was also mirrored by in interviews with researchers. Indeed, the researchers merged perceptions of parenthood, an academic career and societal impact generation. One female researcher drew on her role as a mother as supportive of her ability to participate in Impact generation, ‘ I have kids that age so… ’ (Biology, UK, Senior Lecturer, Female) . Indeed, parenthood emerged from researchers of both genders in relation to the Impact agenda. Two male participants spoke positively about the need to transfer knowledge of all kinds to society referencing their role as parents: ‘ I’m all for that. I want my kids to have a rich culture when they go to school ’ (Engineering, Australia, Professor, Male, E2) , and ‘ My children are the extension of my biological life and my students are an extension of my thoughts ’ (Engineering, Australia, Professor, Male, E1) . One UK female biologist commented that she indeed enjoys delivering public engagement and outreach and implies a reference to having a family as enabling her ability to do so: ‘ It’s partly being involved with the really well-established outreach work ,’ (Biology, UK, Senior Lecturer, Female) .

For the evaluators, the idea that ‘public service’ as second nature for female academics, was reflected in how female evaluators perceived the long, arduous and serendipitous nature of Impact generation, as well as their commitment to assessing the value of Impact as a ‘pathway’ rather than in line with impact as a ‘product’. Indeed, this was highlighted by one male evaluator who suggested that the measurement and assessment of Impact ‘ …needs to be done by economists ’ and that

‘ you [need] to put in some quantification one everything…[that] puts a negative value on being sick and a positive large value on living longer. So, yeah, the greatest impact would be something that saves us money and generates income for the country but something broad and improves quality of life ’. (Panel 2, Impacts, Male)

Since evaluators tend to exercise cognitive bias in evaluative situations (Langfeldt, 2006 ), these preconceived ideas about Impact, its generation and the types of people responsible for its success are also likely to permeate the evaluative deliberations around Impact during the peer review process. What is uncertain is the extent that these messages are dominant within the panel discourse, and therefore the extent that they influence the formation of a consensus within the group, and the ‘dominant definition’ of Impact (Derrick, 2018 ) that emerges as a result.

Notions of gender from the evaluators post-evaluation

Similar notions of gender-roles in academia pertaining to notions of scientific productivity were echoed by academics who were charged with its evaluation as part of the UK’s 2014 Research Excellence Framework. Interviews with evaluators revealed not only that the panel working-methods and characteristics about what constituted a ‘good’ evaluator were implicitly along gendered norms, but also that the assumed credit assumptions of performativity were also based on gender.

In assessments of the Impact criterion, an assessment that is not as amenable to quantitative representation requiring panels to conceptualise a very complex process, with unstandardised measures of significance and reach, there was still a gendered perception of Impact being ‘women’s work’ in academia. This perception was based on the tendency towards conceptualising Impact as ‘slightly grubby’ and ‘not very pure’, which echoes previously reported pre-REF2014 tensions that Impact is a task that an academic does when they cannot do real research (de Jong et al., 2015 );

But I would say that something like research impact is — it seems something slightly grubby. It’s not seen as not — by the academics, as not very pure. To some of them, it seems women’s work. Talking to the public, do you see what I mean? (Main Panel, Outputs and Impact, Female)

In addition, gendered roles also relate to how the panel worked with the assessment of Impact. Previous research has outlined how the equality and diversity assessment of panels for REF2014 were not conducted until after panellists were appointed (Derrick, 2018 ), leading to a lack of equal-representation of women on most panels. Some of the female panellists reflected that this resulted not only in a hyper-awareness of one’s own identity and value as a woman on the panel, but also implicitly associating the role that a female panellist would play in generating the evaluation. One panellist below, reflected that she was the only female in a male-dominated panel, and that the only other females in the room were the panel secretariat. The panellist goes further to explain how this resulted in a gendered-division of labour surrounding the assessment of Impact;

I mean, there’s a gender thing as well which isn’t directing what you’re talking about what you’re researching, but I was the only woman on the original appointed panel. The only other women were the secretariat. In some ways I do — there was initially a very gendered division of perspective where the women were all the ones aggregate the quantitative research, or typing it all up or talking about impact whereas the men were the ones who represented the big agenda, big trials. (Main Panel, Outputs and Impact, Female)

In addition, evaluators expressed opinions about what constituted a good and a bad panel member. From this, the evaluation showed that traits such as the ability to work as a ‘team’ and to build on definitions and methods of assessment for Impact through deliberation and ‘feedback’ were perceived along gendered lines. In this regard, women perceived themselves as valuable if they were ‘happy to listen to discussions’, and not ‘too dogmatic about their opinion’. Here, women were valued if they played a supportive, supplementary role in line with Bellas ( 1999 ), which was in clear distinction to men who contributed as creative thinkers and forgers of new ideas. As one panellist described;

A good panel member is an Irish female. A good panel member was someone who was happy to — someone who is happy to listen to discussions; to not be too dogmatic about their opinion, but can listen and learn, because impact is something we are all learning from scratch. Somebody who wasn’t too outspoken, was a team player. (Panel 3, Outputs and Impact, Female)

Likewise, another female evaluator reflected on the reasons for her inclusion as a panel member was due to her ‘generalist perspective’ as opposed to a perspective that is over prescribed. This was suggestive of how an overly specialist perspective would run counter to the reasons that she was included as a panellist which was, in her opinion, due to her value as an ethnic and gender ‘token’ to the panel;

‘ I think it’s also being able to provide some perspective, some general perspective. I’m quite a generalist actually, I’m not a specialist……So I’m very generalist. And I think they’re also well aware of the ethnic and gender composition of that and lots of reasons why I’m asked on panels. (Panel 1, Outputs and Impact, Female)

Women perceived their value on the panel as supportive, as someone who is prepared to work on the team, and listen to other views towards as a generalist, and constructionist, rather than as an enforced of dogmatic views and raw, hard notions of Impact that were represented through quantitative indicators only. As such, how the panel operated reflects general studies of how work can be organised along gender lines, as well as specific to workload and power in the academy. The similarity between the gendered associations towards conceptualising Impact from the researchers and evaluators, combined with how the panel organises its work along gendered lines, suggests how panel culture echoes the implicit tendencies within the wider research community. The implications of this tendency in relation to the evaluation of non-academic Impact is discussed below.

Discussion: an Impact a-gender?

This study shows how researchers and evaluators in two, independent data sets echoed a gendered orientation towards Impact, and how this implies an Impact a-gender. That gendered notions of Impact emerged as a significant theme from two independent data sets speaks to the importance of the issue. It also illustrates the need for policymakers and funding organisations to acknowledge its potential effects as part of their efforts towards embedding a more inclusive research culture around the generation and evaluation of research impact beyond academia.

Specifically, this paper has identified gendered language around the generation of, and evaluation of Impact by researchers in Australia and the UK, as well as by evaluators by the UK’s most recent Research Excellence Framework in 2014. For the UK and Australia, the prominence of Impact, as well as the policy borrowing between each country (Chubb, 2017 ) means that a reliable comparison of pre-evaluation perceptions of researchers and evaluators can be made. In both data sets presumptions of Impact as either ‘soft’ or ‘hard’ by both researchers and evaluators were found to be gendered. Whereas it is not surprising that panel culture reflects the dominant trends within the wider academic culture, this paper raises the question of how the implicit operation of gender bias surrounding notions of scientific productivity and its measurement, invade and therefore unduly influence the evaluation of those notions during peer-review processes. This negates the motivation behind a broad Impact definition and evaluation as inclusive since unconscious bias towards women can still operate if left unchecked and unmanaged.

Gendered notions of excellence were also related to the ability to be ‘competitive’, and that once Impact became a formalised, countable and therefore competitive criterion, it also become masculine where previously it existed as a feminised concept related to female academic-ness. As a feminised concept, Impact once referred to notions of excellence requiring communication such as public engagement, or stakeholder coordination—the ‘softer’ impacts. However, this association only remains ‘soft’ insofar as Impact remains unmeasurable, or more nuanced in definition. This is especially pertinent for the evaluation of societal impact where already conceived ideas of engagement and ‘ women’s work ’ influence how evaluators assess the feasibility of impact narratives for the purposes of its assessment. This paper also raises the question that notions of gender in relation to Impact persist irrespective of the identities assumed for the purposes of its evaluation (i.e., as a peer reviewer). This is not to say that academic culture in the UK and Australia, where Impact is increasingly being formalised into rewards systems, is not changing. More that there is a tendency in some evaluations for the burden of evidence to be applied differently to genders due to tensions surrounding what women are ‘good’ at doing: engagement, versus what ‘men’ are good at doing regarding Impact. In this scenario, quantitative indicators of big, high-level impacts are to be attributable to male traits, rather than female. This has already been noted in student evaluations of teaching (Kogan et al., 2010 ) and of academic leadership performance where the focus on the evaluation is on how others interpret performance based on already held gendered views about competence based on behaviours (Williams et al., 2014 ; Holt and Ellis, 1998 ). As such, when researchers transcend these gendered identities that are specific to societal impact, there is a danger of an Impact-a-gender bias arising in the assessment and forecasting of Impact. This paper extends this understanding and outlines how this may also be the case for assessments of societal impact.

By examining perceptions, as well as using an inductive analysis, this study was able to unearth unconsciously employed gendered notions that would not have been prominent or possible to pick up if we asked the interviewees about gender directly. This was particularly the case for the re-analysis of the post-evaluation interviews. However, future studies might consider incorporating a disciplinary-specific perspective as although the evaluators were from the medical/biomedical disciplines, researchers were from a range of disciplines. This would identify any discipline-specific risk towards an Impact a-gender. Nonetheless, further work that characterises the impact a-gender, as well as explores its wider implications for gender inequities within HE is currently underway.

How research evidence is labelled as excellent and therefore trustworthy, is heavily dictated by an evaluation process that is perceived as impartial and fair. However, if evaluations are compounded by gender bias, this confounds assessments of excellence with gendered expectation of non-academic impact. Consequently, gendered expectations of excellence for non-academic impact has the potential to: unconsciously dissuade women from pursuing more masculinised types of impact; act as a barrier to how female researchers mobilise their research evidence; as well as limit the recognition female researchers gain as excellent and therefore trustworthy sources of evidence.

The aim of this paper was not to criticise the panellists and researchers for expressing gendered perspectives, nor to present evidence about how researchers are unduly influenced by gender bias. The results shown do not support either of these views. However, the aim of this paper was to acknowledge how gender bias in research Impact generation can lead to a panel culture dominated by academics that translate the implicit and explicit biases within academia that influence its evaluation. This paper raises an important question regarding what we term the ‘Impact a-gender’, which outlines a mechanism in which gender bias feeds into the generation and evaluation of a research criterion, which is not traditionally associated with a hard, metrics-masculinised output from research. Along with other techniques used to combat unconscious bias in research evaluation, simply by identifying, and naming the issue, this paper intends to combat its ill effects through a community-wide discussions as a mechanism for developing tools to mitigate its wider effect if left unchecked or merely accepted as ‘acceptable’. In addition, it is suggested that government and funding organisations explicitly refer to the impact a-gender as part of their wider EDI (Equity, Diversity and Inclusion) agendas towards minimising the influence of unconscious bias in research impact and evaluation.

Data availability

Data is available upon request subject to ethical considerations such as consent so as not to compromise the individual privacy of our participants.

Change history

19 may 2020.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

For the purposes of this paper, when the text refers to non-academic, societal impact, or the term ‘Impact’ we are referring to the change and effect as defined by REF2014/2021 and the larger conceptualisation of impact that is generated through knowledge exchange and engagement. In this way, the paper refers to a broad conceptualisation of research impact that occurs beyond academia. This allows a distinction between Impact as central to this article’s contribution, as opposed to academic impact, and general word ‘impact’.

Impact scholars or those who are ‘good at impact’ are often equated with applied researchers.

One might interpret this as meaning ‘economic impact’.

This is described in the next section as ‘women’s work’ by one evaluator.

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This research was funded by the UK Economic and Social Research Council (ESRC) Future Research Leaders Programme (ES/K008897/2). We would also like to acknowledge their peers for offering their views on the paper in advance of publication and in doing so thank Dr. Richard Watermeyer, University of Bath, Professor Paul Wakeling, University of York and Dr. Gabrielle Samuel, Kings College London.

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Outcomes of research evaluation are arguably playing an ongoing and increasingly important role in academic careers and success, but there are several factors that hold the potential to militate against fairness, gender equality and equality of opportunity ( Yarrow, 2016 ). This article discusses my recent PhD research into women’s lived experiences of research evaluation in a UK Russell Group university and explores some of the factors that may affect submissions to the Research Excellence Framework (REF). The last run of the REF occurred in 2014 with results being published in December 2015; 154 UK institutions submitted to the exercise. Currently there is a national requirement at the institutional level for a combination of research outputs (65%), the impact of research (20%), and the institutional research environment (15%), though at the individual level, each university currently decides which academics’ work will be included or excluded. However, the inclusion criteria are under review for the 2020 REF after the publication of the Stern Review ( Stern, 2016 ).

The Stern Review is also significant in that currently recommendations for the next REF are being made, as well as the Stern Review strategically informing not only how the REF should be adapted, but also implemented at the national and institutional level in the future. However, I argue that the recommendations made in terms of equality and diversity issues, are not clear or tangible and that there is a clear need for further investigation into the equality and diversity issues surrounding research evaluation. Conversely, it is noteworthy to consider the potentially very significant game-changer which is proposed ( Stern, 2016 ), to include all research-active staff in future exercises and allocate them to a UOA (unit of assessment). Although this may appear to remedy career issues associated with non-inclusion, it is currently not clear whether this recommendation will be recognised and subsequently implemented, and so there is an ongoing need to better understand the current method of selective inclusion.

It is important to demonstrate that whilst the exercise is designed to evaluate research outputs and not individual academics per se, based on my findings I argue that the two are inextricably linked. It is further of note that I found high levels of anxiety surrounding individual submissions that have ramifications not only for individual academics’ identities, but also stress and academic well-being ( Yarrow, 2016 ).

My study focused on female academics’ lived experiences and career aspirations in the context of the 2014 REF, as well as the views of research directors and heads of school in the study entitled National Research Evaluation and its effects on female academics’ careers in the UK – A Case Study ( Yarrow, 2016 ). The sample in the case study drew on 80 semi-structured, life-history inspired interviews with academics across humanities and social sciences in an anonymous UK university, made up of 65 female academics and 15 key respondents. The sample covered a broad age range, as well as a range of female academics spanning ECRs (early career researchers) to professors, as well as career academics and individuals who had been in practice prior to pursuing an academic career. It is important to make clear that my research was not conducted at the University of Edinburgh, but another Russell Group University, though a number of the findings may be generalised across UK higher education institutions that submit to the REF.

This article will cast light on why women are not only less likely to be submitted to research evaluation exercises in the UK, but also the role that informal networks and unconscious bias may play in some academic careers.

Why are women still less likely to be submitted to the REF?

It is clear that there is a stark disconnect between women’s ongoing under-representation in leadership positions, for example, and the increasing representation of female students ( Grove, 2012 ). Women in the UK continue to be under-represented not only in leadership positions in industry and academia, but in the upper echelons of academia ( HESA, 2015 ; Fletcher, 2007 ), particularly in the professoriate, where only around 23% of professors are female ( HESA, 2015 ). Conversely, women are over-represented in temporary, or part-time academic positions ( ECU, 2015 ).

In Education, 62 per cent of the eligible staff were female and the average percentage of staff selected was 21 per cent; whereas in Electrical and Electronic Engineering, Metallurgy and Materials, where only 12 per cent of the eligible staff were female, the average proportion of staff selected was 65 per cent. ( HEFCE, 2015 , p. 9, point 51)

This therefore demonstrated that there are indeed differences between disciplines, but that these tend to be in areas where women are proportionately well represented, however that overall women are still less likely to be submitted to the REF.

More male scholars are included in programmes of national research evaluation than their female counterparts in the UK, but for what reasons?

It is clear that women who reach full professorship are in the minority compared to their male counterparts; it is argued here that outcomes of research evaluation play an increasingly important role in this. Contemporary female careers in the academy are argued by Van den Brink & Benschop to be still to an extent marred and constrained by practices of inequality that have no relation to merit ( 2011 , p. 518), it is clear from the study that there are gendered perceptions of merit which appear to affect women’s lived experiences not only of research evaluation, but of academic careers more broadly ( Yarrow, 2016 ).

Findings from my research suggest that outcomes of research evaluation, and whether an individual is included in the REF or not, may play a role in continuing vertical gender segregation in humanities and social sciences, because of the increasing importance of REF inclusion, also often referred to colloquially as ‘REF-ability’ and the associated career leverage gains in an increasingly ‘marketised’ academy, characterised by ever-increasing competition and corporatisation ( Rogers et al., 2014 ; Deem, 1998 ; Willmott, 1995 ; 2003 ).

The long-term impact of maternity leave and time taken out on academic careers, particularly during an REF cycle, is an ongoing issue. This appears to be a factor that is damaging to women’s career development, primarily because the REF is a time-oriented mechanism ( Yarrow, 2016 ). Whilst periods of maternity leave are accounted for in terms of a reduction of one paper per period of maternity leave, the longer-term caring responsibilities still hold the potential to detract from women’s longer-term career development, which becomes further problematic and typified when it is also considered that women are still engaged disproportionately in domestic labour in the home. Furthermore, women in academia take shorter periods of maternity leave than many other professions, which may be indicative of an awareness of the potential implications of taking maternity leave, and the associated anxiety ( Bawden, 2014 ).

The importance of informal networks

Informal networks play an integral, yet somewhat indirect, role in submissions to, and management of the REF. The importance of informal networks was clear throughout the study, often expressed in terms of learning ‘the rules of the game’ as well as finding out about opportunities for promotion or development and having access to decision-makers, and having them ‘on-side’ which also plays a role in women’s submissions to the REF, particularly as it is often the head of school or research director who make the final decisions on inclusion or exclusion ( Yarrow, 2016 ). It is also noteworthy that the head of school role is often disproportionately occupied by male academics, and this was so in the anonymous university in my case study.

Informal networks have also been found to play an integral role in the recruitment and selection of REF panel members who evaluated submissions, a finding that echoes earlier findings in the REF analysis of panel membership ( REF, 2011 ). It is of note that the 2014 REF panels were disproportionately male, and that this in itself may import issues of gender bias, particularly when the reliance on informal networks for the recruitment and selection of panel members is considered. Informality is the invisible hand that holds the potential to affect equality and diversity, and particularly women’s experiences of research evaluation in the UK today, yet it is a factor largely ignored by the recent Stern Review ( Stern, 2016 ).

The pervasive role of unconscious bias

A growing body of literature surrounds the notion of unconscious bias specifically in higher education. Unconscious bias may be defined as “the associations that we hold which, despite being outside our conscious awareness, can have a significant influence on our attitudes and behaviour” ( ECU, 2013 , p. 1). Implicit bias may be defined as “when we have attitudes towards people or associate stereotypes with them without our conscious knowledge. A fairly commonplace example of this is seen in studies that show that white people will frequently associate criminality with black people without even realising they’re doing it” ( Perception Institute, 2016 ).

The tensions between unconscious and implicit bias are being increasingly questioned in academia, though this is still an area which requires further awareness and training in order to better understand its potential implications. The main differences and tensions between unconscious bias and implicit bias, though the terms are often used interchangeably in the current discourse, centre on the notion that individuals are unaware of their biases (unconscious), but that increasingly, bodies such as the Equality Challenge Unit argue that the notion of implicit bias must be questioned as to how unconscious it may actually be, as individuals are being made more actively aware of biases and stereotypes for example through equality and diversity training and that: “Once we know that biases are not always explicit, we are responsible for them” ( ECU, 2013 , p. 1).

The importance of the potential role of unconscious bias in higher education has been made clear by the Equality Challenge Unit in that they acknowledge that “bias is likely to be relevant to many areas of an institution’s work, for example appraisals and grievances, Research Excellence Framework submissions, student admissions and course evaluations” ( ECU, 2013 , p. 4), thereby demonstrating the wide range of aspects of academic life that unconscious bias may affect.

Moreover, it is important to note that there appears to be a disparity between institutional promises and policies surrounding equality and diversity in general, with the ECU highlighting that institutional strategies and promises are simply not equal to an institution actively practising its commitment to equality and diversity ( ECU, 2013 , p. 4). It is argued that in the gaps between organisational practice, the equality and diversity discourse and some universities’ policies, opportunities for inequalities persist through the presence of unconscious bias, as well as informal subversion of policy and practice. It is these grey areas or lacunae, which appear to actively contribute to gender inequality in academia. The policies and processes are indeed in place, partly due to compliance with legislation such as the Equality Act, 2010, but in some instances these serve to be merely tick-box exercises, and in reality decisions are made quickly and informally, but may still be portrayed to be in line with organisational protocol.

The notion of unconscious or implicit bias is currently being increasingly explored theoretically, and the recent research of Milkman et al. whilst focusing on doctoral students applying to universities in the US, demonstrates that multiple decisions are made before formal entry into organisations ( Milkman et al., 2015 ). This also contributes to the notion that unconscious bias is notoriously difficult to identify, measure, and correct.

However, unconscious bias is an issue which appears to be encompassed in several aspects of the processes, contributing to REF submissions, peer review processes in journals and the readers of materials for REF submissions in some institutions. This becomes increasingly problematic when the issue of the lack of clarity surrounding the recruitment and selection of REF panel members is deliberated, and that journal editorial boards are still dominated by (often well-networked) men ( Özbilgin, 2009 ). Additionally, the recruitment and selection of panel members, as well as a lack of female and BME (black and minority ethnic) panel members, has again been identified. Although there is an acknowledgement from REF that there are issues with REF panels ( REF, 2011 ), there is little indication as to what the concrete actions may be to remedy this in order to improve the current situation.

Academic excellence cannot be treated as an objective and measurable attribute, but that it is a social construction that is always embedded within a social context and is thus subject to multiple cultural and political influences. ( Van den Brink & Benschop, 2011 , p. 50)

With specific regard to unconscious bias in higher education, the main research focuses on its role in recruitment and selection, and decision-making. However, Roos (2008) argues that workplace interactions are permeated with gendered and institutionalised status beliefs, as well as organisational policies and decision-making processes that are also marred by institutional gender stereotypes ( 2008 , p. 186), thus demonstrating the linkages between institutional policies, decision-making and how this may interact with gender inequality.

Not only do these lenses shape how people perceive, conceive, and discuss social reality, but because they are embedded in social institutions, they also shape the more material things – like unequal pay and inadequate day care – that constitute social reality itself. ( Easterly & Ricard, 2011 , p. 62)

This demonstrates again the role that not only unconscious bias, but gender assumptions can play in the construction of social reality for women in higher education organisations. Whilst the effects are evident through the under-representation of women in the upper echelons of the academy, but how change can be sought and implemented, and unconscious bias tackled, remain to an extent theoretical. However, the following section outlines some of the recommendations from participants in the study, which may be helpful or insightful for others, as well as providing some insight into what may be anecdotal, but constructive advice to departments to avoid potential unfairness.

An integral aspect where the role of unconscious bias was pertinent was with regard to the recruitment and selection of REF panel members, internal university readers of outputs for submission, and peer review. There is a body of literature which suggests that unconscious gendered bias plays a role in the conceptualisation of excellence and suitability for certain types of work. See, for example, Leslie et al. (2015) .

Whilst focusing on the gender biases of faculty favouring male students in the sciences in the US, Moss-Racusin et al. (2012) found that female students were less likely to be hired because they were perceived (notably by both male and female faculty members) to be less competent, and that ultimately this may well undermine academic meritocracy. Budden et al. (2008) , found that even in processes of double-blind peer review, this is often not adhered to in practice; when double-blind review is used, where neither the author’s nor the reviewer’s identity is known, the number of women who are subsequently published increases. This has linkages to my PhD research upon which this article draws, in that it may be argued that where panels are disproportionately male with an under-representation of female academics, the scope for the impact of unconscious as well as implicit bias may potentially be increased ( Yarrow, 2016 ). This holds the potential to further contribute to gender bias in research evaluation processes, thereby being further potentially damaging to the careers of female academics. Although these linkages may appear tenuous on the surface, my empirical findings suggest the contrary – women’s lived experiences in the academy still appear to be shaped, in some instances, by the permeation of unconscious bias into university practices, such as recruitment and selection, and inclusion in research evaluation, both of which play an important role in academic careers.

Helpful pointers from participants

The following section outlines some of the pointers from the PhD study findings that participants gave as to what has helped them in their careers, and might be useful for others:

Building up a positive relationship with the head of school.

Learning to say ‘no’.

Building up your own network and alliances within your university and further afield.

Not letting others take credit for your work such as by being first author on a paper.

Having a senior mentor who is also willing to introduce you to their contacts.

Department-level advice to help avoid unfairness

My findings indicated that departmental culture and leadership within a department plays an important role in women’s experiences of REF. The following points are some of the strategies that some key respondents in my study outlined as being useful to help avoid unfairness:

Have open meetings to discuss the workload model if there is one in place, and hold the meeting in hours when people with children and caring responsibilities can attend.

Actively engage with and know about research from the Equality Challenge Unit and the University and College Union; there may be issues at play that you’re simply not aware of.

Reassure academics who are not included that this will not affect their internal promotions.

Discuss the myths around REF and REF submissions that may be present in the department and actively involve everyone in better understanding and then dispelling them.

Ongoing emotional support, reassurance and kindness.

Women are still significantly under-represented in the upper echelons of the academy nationally and research evaluation evidently plays a role in this. The REF may hold the potential to provide positive opportunity for change, as well as equality of opportunity through a more transparent framework that makes use of gender-balanced panels, for example, though currently it appears that women are still at a disadvantage, particularly in the context of increasing individualisation of academic work and in an academy where gentlemen’s agreements still hold weight and networks play an extremely important role in many aspects of academic life.

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Minority scholars less likely to be submitted to research excellence framework.

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British academics with black or Asian ethnicity were less likely to be selected for inclusion in last year’s research excellence framework (REF) than their white colleagues, even when other factors were controlled for, a study has revealed.

According to the research by the Higher Education Funding Council for England, black scholars were much less likely to be selected, a discrepancy that remained even when factoring in other variables such as whether they held a PhD, their contract status, previous location and grade.

In terms of raw percentages, Asian academics were as likely to be included as white colleagues. But they were found to be underrepresented when other factors were controlled for.

Men were far more likely to be selected than women, although this could be explained by control variables, concluded the report Selection of Staff for Inclusion in the REF 2014 , which was released last week.

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Research Excellence at CIHR

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• Message from Rhonda Kropp, Associate Vice-President, Learning Health Systems

Research Excellence: Current Context

Research excellence: understanding the issue, guiding principles, key components, related links, message from rhonda kropp associate vice-president, learning health systems.

I am pleased to announce the release of CIHR's Research Excellence Framework, a major step in advancing our strategic plan commitment to research excellence in all its diversity.

This Framework positions CIHR on a clear path towards achieving our vision where Canadian health research is recognized as inclusive, collaborative, transparent, culturally safe, and focused on real-world impact. We are looking to ensure agency-funded research is scientifically excellent and ultimately leads to impacts that benefit all people in Canada, including those historically underrepresented in the health research system.

We recognize that moving this Research Excellence Framework into practice will require meaningful changes to our policies and programs, and that it will benefit from a holistic, collaborative, and transparent approach. As such, we are also releasing an associated implementation plan that details the suite of early actions we will be taking towards inclusive research excellence.

We are grateful for the many collaborations that informed this work, and we welcome the opportunity to continue learning from others — as we collectively look for ways to improve health and maximize the impact of health research in Canada.

There is significant and growing interest in Canada and internationally in what is meant by research excellence , and how it impacts the research ecosystem. Footnote 1 , Footnote 2 This has been made clear through calls for more responsible research assessment Footnote 3 , Footnote 4 , Footnote 5 , a re-imagining of what is considered excellent Footnote 6 , Footnote 7 , acknowledgement that research culture can be problematic Footnote 8 , Footnote 9 , and that current incentive structures are biased. Footnote 10

CIHR is legislated through the CIHR Act to "excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system". Footnote 11 While CIHR's expectations for agency-funded research have evolved over time – as exemplified through its actions related to sex and gender in research , equity, diversity and inclusion , Indigenous Health Research , official languages , patient-oriented research , knowledge mobilization , open access , research data management , and training and mentorship – the agency has never explicitly described how it views research excellence. However, CIHR's 2021–2031 Strategic Plan includes a commitment to advance research excellence in all its diversity , in part through championing a more inclusive concept of research excellence, and so a formal definition is needed.

To inform its conceptualization of research excellence, CIHR undertook several evidence-gathering activities: a comprehensive literature review; an international environmental scan; and an initial series of discussions with the health research community. These activities informed CIHR's understanding of how problematic behaviours, barriers and biases are limiting what is currently conceptualized as excellent research and who are considered excellent researchers (Figure 1).

Figure 1: Biases, behaviours and perpetuation of systemic barriers associated with a narrow concept of research excellence

In Figure 1, a flowchart illustrates biases, behaviours and perpetuation of systemic barriers associated with a narrow concept of research excellence. The left side of the figure, labeled 'CIHR's ecosystem realities,' highlights factors such as limited public funding, many qualified researchers, legislative imperative to fund "excellence." An arrow extends to the right indicating the need to identify and report on "excellence." On the right, a section labeled 'research ecosystem realities' includes incentive structures to identify and evaluate "excellence," leading to the consequences of hypercompetition, biases introduced within the research ecosystem, metrics-based assessment, and problematic behaviours and a lack of desired behaviours in some actors. Collectively, these elements contribute to a narrow concept of "excellence." Below the headings "CIHR's system realities and Research ecosystem realities," with two arrows pointing up, is the text "systemic barriers have influence over the entire ecosystem."

Evidence demonstrates that existing incentive structures designed to identify excellence have resulted in a hypercompetitive environment and reliance on metrics-based assessment of outputs (such as journal impact factors). Many biases (e.g., racial Footnote 12 , Footnote 13 , gender Footnote 14 , Footnote 15 , language Footnote 16 , Footnote 17 , program design Footnote 18 , and assessment practice biases Footnote 19 , Footnote 20 ) and behaviours (e.g., contributions to a toxic research environment Footnote 21 , Footnote 22 , Footnote 23 , limited knowledge mobilization Footnote 24 , Footnote 25 , and inadequate mentoring and training Footnote 26 , Footnote 27 ) perpetuate a narrow concept of excellence Footnote 28 — one that does not inherently recognize and value diversity among researchers, research or the full range of research contributions that can address scientific and societal problems. Furthermore, systemic barriers (e.g., physical, geographical, or social) have had a negative impact over the entire research ecosystem and consequently in how research excellence has been defined, pursued, and assessed. Footnote 29 , Footnote 30 , Footnote 31 , Footnote 32

Collectively, these biases, behaviours and barriers reduce the diversity of perspectives, methods and contributions that are rewarded within the research ecosystem, resulting in research waste Footnote * and minimizing the potential impact of already scarce research funds. Therefore, it is imperative that CIHR broaden its concept of excellence, to ensure agency-funded research has impacts that benefit all people in Canada, including those historically underrepresented in the health research funding system.

CIHR Research Excellence Framework

CIHR's strategic plan envisions that, by 2031, Canadian health research will be internationally recognized as inclusive, collaborative, transparent, culturally safe, and focused on real world impact. To align CIHR's activities and investments towards this vision, CIHR has crafted a definition of research excellence, based on three guiding principles and comprising eight key components.

CIHR recognizes that many other research funders and organizations are exploring the concept of research excellence and ways to reward a broader range of contributions and outputs. As such, CIHR's approach to research excellence will continue to be evidence-informed and will evolve as part of ongoing dialogue with national and international partners as well as the Canadian health research community.

CIHR believes that excellent research is rigorous, inclusive and conducted in ways that meaningfully integrate a diversity of perspectives, disciplines, and methods in order to maximize impact and benefit to society.

Excellent research recognizes that biological, socio-economic, cultural and experiential differences impact health and should be considered for research and related activities to be of benefit. An inclusive concept of research excellence positively influences who sets research priorities; who conducts, participates in and benefits from research; how research is conducted; and how it is assessed.

The following foundational principles will guide CIHR's work in integrating a more inclusive approach to research excellence across its programs, policies and practices:

• Holistic : Research excellence is broad and spans how research is conceptualized, prioritized, taught, carried out, assessed, funded and used.
• Adaptable: Research excellence is not one-size-fits-all, but rather context- and content-specific. Flexible, catered approaches are required to recognize and incent the breadth of research within CIHR's mandate.
• Evergreen: Research excellence is a concept designed to be adjusted as new evidence emerges, and as science and society evolve.

The following key components should be considered and addressed within all CIHR-funded research whenever relevant and appropriate:

• Ethics: Excellent research must meet international standards of ethics.
• Equity, Diversity, and Inclusion (EDI): Research is excellent when it is inclusive, equitable, diverse, anti-racist, anti-ableist, and anti-colonial in approach and impact. Excellent research reflects the diversity of scientific talent in Canada, empowers participation of communities historically marginalized and disadvantaged in health research (including but not limited to women, Francophone researchers, Indigenous Peoples and organizations, persons with disabilities, and Black and other communities marginalized by race), and supports inclusion across the lifespan for research involving humans. Within this component, it should be especially noted that the right to conduct research in the official language of one's choice, which is protected through the Official Languages Act , is a key pillar of inclusion.
• Indigenous Knowledge: Guided by a spirit of reconciliation and co-existence, research must prioritize requirements of First Nations, Inuit and Métis communities and respect the self-determination of Indigenous Peoples. This involves building trust, respect and relationships with communities; recognizing Indigenous knowledge systems; learning and understanding culture; co-producing research to ensure questions and approaches are shaped by community priorities and remain in the community; presenting findings using accessible and community-centric approaches; and respecting Indigenous data sovereignty.
• Patient-Oriented Research: Excellent research includes meaningful engagement of patients, people with lived and living experience, and other knowledge users as partners throughout the entire research process. This approach helps to ensure questions and results are relevant and enhance the integration of findings into the health care system and clinical practice, with the goal of improving patient experiences and outcomes.
• Knowledge Mobilization: Excellent research employs tailored approaches for optimizing the impact of agency-funded research. Excellent research involves co-designing research priorities and questions with knowledge users, and/or mobilizing findings via a broad range of accessible and equitable formats to inform health-related decisions by policy makers, practitioners, patients and communities.
• Open Science: Excellent research incorporates open science practices that enable timely access and sharing of research findings, data and other outputs, in order to maximize the use and impact of agency-funded research.
• Scientific Rigour : Excellent research must use robust research designs that minimize bias across methodologies, analysis, interpretation and transparent reporting of results. Footnote 33
• Training, Mentorship and Sponsorship: CIHR recognizes the importance of training, mentorship and sponsorship in creating and supporting the diversity of talent needed to conduct excellent research. This includes valuing efforts to address gaps in training and support across all career stages, transitions, and paths, and to build capacity amongst groups currently underrepresented in the health research ecosystem.

CIHR links:

• Equity, diversity and inclusion in the research system
• Health research training at CIHR
• Indigenous health research
• Knowledge mobilization
• Learning for peer reviewers
• San Francisco Declaration on Research Assessment (DORA)

Tri-agency links:

• Open science
• Responsible conduct of research
• Tri-agency EDI action plan
• Tri-agency research data management policy

• Schools & departments

Research Excellence Framework (REF)

The 2021 Research Excellence Framework (REF) confirm the outstanding quality and impact of our research in the Arts, Humanities and Social Sciences.

The 2021 Research Excellence Framework (REF) confirmed the outstanding quality and impact of our research in the Arts, Humanities and Social Sciences, and our collegial, supportive and inclusive research culture.

Overall, the University came fourth in the UK for the breadth and quality of our research (based on the Research Professional ranking). Within the submission, our College returned 1,130 staff across 20 Units of Assessment. 86% of our submission was assessed as being world-leading or internationally excellent. Of the 20 Units we led or joint led, two came first in the UK for breadth and quality (Sociology, and Anthropology & Development Studies). Thirteen were ranked in the top five.

We achieved a remarkable 100% for our research environment score for 3 and 4 star research. This part of the assessment measures the ‘vitality and sustainability’ of the Schools and research centres in which research and impact is supported.  

Our impact case studies spanned an extraordinary spectrum of the benefits our research makes to society in Scotland and internationally, helping tackle pressing challenges such as climate change and healthy ageing as well as enriching and preserving cultural heritage.

By working with partners and contributing expertise to public, private and third sector organisations, we have helped improve policy and practice in key areas such as criminal justice, education, and health; developed leadership, skills and capability in a range of businesses including in the creative industries; and fostered critical reflection and informed debate on our history, politics and identity.  

Within CAHSS we celebrate the contribution all of our staff made to the REF –researchers; technical and professional services staff; our postgraduate and early career researchers, and our students - all contribute to our flourishing environment.

Edinburgh Impact

About the Research Excellence Framework (REF)

The Research Excellence Framework (REF) is the UK’s system for assessing the quality of research in UK higher education institutions, evaluating the quality of our research publications and outputs, our research environment, and the societal and economic impact of our research.

https://www.ref.ac.uk/ 

How Research England supports research excellence

Research excellence framework.

The Research Excellence Framework (REF) is the UK’s system for assessing the excellence of research in UK higher education providers (HEPs).

The REF outcomes are used to inform the allocation of around £2 billion per year of public funding for universities’ research.

The REF was first carried out in 2014, replacing the previous Research Assessment Exercise. Research England manages the REF on behalf of all the four UK higher education funding bodies:

• Research England
• Scottish Funding Council
• Higher Education Funding Council for Wales
• Department for the Economy, Northern Ireland.

The funding bodies’ shared policy aim for research assessment is to secure the continuation of a world-class, dynamic and responsive research base across the full academic spectrum within UK higher education.

REF objectives

The REF objectives are to:

• provide accountability for public investment in research and produce evidence of the benefits of this investment
• provide benchmarking information and establish reputational yardsticks, for use in the higher education sector and for public information
• inform the selective allocation of funding for research.

Find out more on the REF website.

REF progress update: November 2023

REF progress update: December 2023

Last updated: 8 April 2024

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Volume 44 Issue 1 September 5, 2024

Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework

Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland

PURPOSE: Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field.

SEARCH METHODS: A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature.

SEARCH RESULTS: The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles).

DISCUSSION AND CONCLUSIONS: Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.

Introduction

Sexual minority (e.g., lesbian, gay, bisexual, queer, asexual) and gender minority (e.g., transgender, nonbinary, other gender-diverse) people are at heightened risk for alcohol use, hazardous drinking, [*] and alcohol use disorder (AUD) compared to their heterosexual and cisgender counterparts. 2-6 (For definitions of various sexual and gender minority [SGM] populations, see, for example, the National Institutes of Health Office of Diversity, Equity, and Inclusion website. 7 ) Alcohol disparities are concerning, given their co-occurrence with and bidirectional impact on myriad mental health outcomes (e.g., mood and anxiety disorders) and physical health outcomes (e.g., cardiovascular disease, sexually transmitted infections) and related disparities. 8-12 Health disparities based on sexual orientation and gender identity are considered health inequities because they are rooted in historical and societal systems of oppression (e.g., heterosexism, anti-bisexual prejudice, cissexism), 13,14 and are avoidable health outcomes that reflect socially unjust conditions.

Sexual orientation inequities in alcohol outcomes have been documented across the alcohol use and addiction continuum. Epidemiological work indicates that sexual minority youth initiate alcohol use at younger ages than their heterosexual peers, 15-18 and alcohol use persists (and sometimes accelerates) into adulthood. 16,18-23 Sexual minority people—girls and women in particular—are more likely than heterosexual individuals to engage in hazardous drinking, such as binge or heavy episodic drinking (HED; defined, unless otherwise indicated, as four or more drinks within a 2-hour period for females or five or more drinks within 2 hours for males 24 ) and high-intensity HED (i.e., drinking twice or more times the threshold for HED 24 ), 25-28 to experience negative alcohol-related consequences and harms, 29,30 and to engage in polysubstance use. 31 Sexual minority individuals also have a higher prevalence of AUD than do heterosexual people. 32-35 While there has been a decline in alcohol use among young people in the United States, sexual orientation inequities remain stable and have widened for sexual minority girls and women. 28,36-38 Representing the heterogeneity that exists within the sexual minority community, mounting evidence from representative samples consistently demonstrates that sexual minority girls and women as well as plurisexual (e.g., bisexual, pansexual, queer) individuals are at greatest risk for alcohol use, hazardous drinking, and AUD, whereas these inequities are evident but sometimes less consistent for sexual minority boys and men. 5,17,25-27,39-44

Gender identity inequities in alcohol consumption have been documented across multiple alcohol outcomes. In alcohol and other substance use initiation, gender identity inequities are evident as early as 12 years of age, and these disparities widen over adolescence. 18 Representative and nonprobability studies indicate that gender minority people are more likely to report alcohol and other substance use, HED, and polysubstance use than are their non-transgender or cisgender peers. 3,31 Compared with cisgender adults, transgender adults have more negative consequences related to alcohol use, 45 including alcohol-related sexual assault and suicide ideation. 46-48 While some population-level studies do not document alcohol inequities, 49-52 some of these studies were limited in their sample characteristics (e.g., clinical samples of treatment-seeking participants) 49,50 and measurement of alcohol use (e.g., poor scale reliability). 51 Additionally, results from multiple large-scale studies indicate that transgender adults are more likely than cisgender adults to have a diagnosis of AUD and other substance use disorders. 50,53-55 Gender minority adults are more likely than cisgender adults to report that they wanted help to reduce their use of alcohol and other substances. 56

Transgender and other gender minority people, including binary (e.g., transgender women and men) and nonbinary (e.g., genderqueer, agender) individuals, 57 have differing alcohol use patterns. Transfeminine people have higher prevalence of AUD and other substance use disorders compared to transmasculine people. 53 Transgender people who identify as a sexual minority 58,59 and who are assigned female at birth may be at heightened risk for alcohol use outcomes. 48,60 Nonbinary people may be at greater risk for alcohol use, hazardous drinking, AUD, and substance use disorders compared to other transgender people 51,61-63 and cisgender women. 63,64 However, some studies show less alcohol use for nonbinary individuals compared to cisgender women, 47,65,66 and one study found no differences in alcohol use between nonbinary and binary transgender youth. 67 As such, more research is needed to understand the unique drinking patterns of nonbinary and other gender-diverse individuals and how they compare to cisgender and other gender minority groups.

[*] Unless otherwise noted, hazardous drinking is defined here as alcohol use, including but not limited to frequent or high-volume drinking, that confers risk for negative alcohol-related consequences—such as mental, physical, academic, work, legal, or social harms. 1

Alcohol Inequities at the Intersection of Race/Ethnicity

An emerging literature base shows that alcohol inequities based on sexual orientation and gender identity vary at the intersection of race and ethnicity. The somewhat consistent pattern in the extant literature is that such inequities exist between Black, Indigenous, and People of Color (BIPOC) SGM individuals and their heterosexual peers of the same race/ethnicity. Other work has examined racial differences in alcohol use outcomes within SGM groups, and patterns of findings are less clear and vary by age group. These disparate findings may partially be explained by limitations of study designs. Some studies aggregated racial and ethnic groups into one BIPOC group, which ignores known racial and ethnic differences in drinking patterns as well as differences in the long-term effects of drinking (e.g., racial differences in AUD or alcohol-related consequences but not quantity or frequency of alcohol use). Additionally, other studies aggregated across adulthood without considering developmental changes in drinking across the lifespan.

Findings from nationally representative probability studies (i.e., studies that involve a randomly selected sample representing the population) and nonprobability studies (i.e., studies that use nonrandom samples, such as convenience or community samples) show that SGM BIPOC youth report greater alcohol and polysubstance use compared to their heterosexual and cisgender peers of the same race/ethnicity; 68-72 these inequities are especially elevated between Hispanic/Latine and Black American transgender students and their same-race peers. 72 In contrast, racial/ethnic differences in alcohol use among SGM youth show less consistent patterns. A large study of bisexual youth found that Black bisexual girls were less likely to engage in HED compared to White bisexual girls, whereas Black and White bisexual boys and Hispanic and White bisexual youth had comparable levels of HED. 73 A longitudinal study found that Black SGM youth reported less alcohol use than all other racial groups of SGM youth in the sample. 74 Other work indicates that Black young sexual minority men had lower increases in alcohol use from adolescence to adulthood compared to their White counterparts, whereas Hispanic/Latine young sexual minority men had higher increases in their alcohol use trajectories from adolescence to adulthood compared to their White counterparts. 75 A recent study found that Latine and Black gender minority youth had the highest prevalence of recent alcohol use, HED, and cannabis use compared to most other SGM youth; Asian/Pacific Islander SGM youth had some of the lowest prevalence rates of alcohol use compared to other SGM groups. 76

The patterns of findings for racial/ethnic differences in sexual orientation inequities in alcohol use among adult samples are gendered. Findings from probability samples show that Black and Hispanic/Latine sexual minority women are at greater risk for multiple alcohol use outcomes (e.g., alcohol quantity and frequency, HED) and other substance use compared to same-race peers and, to some extent, to White heterosexual and sexual minority women. 44,77-81 With the exception of two studies, 82,83 these findings are also present in nonprobability samples of sexual minority women. 84,85 Conversely, several probability and nonprobability samples have found no differences between BIPOC sexual minority men and BIPOC heterosexual men in HED, 39,44,80,86 heavy drinking (e.g., frequent and high-volume daily, weekly, or episodic drinking), 39,81,86 alcohol-related consequences, 39 and substance use problems, 84 whereas other probability studies indicated lower heavy weekly drinking (defined as more than 14 drinks per week) and HED for Black sexual minority men compared to Black and White heterosexual men. 86 In contrast, other work found that Black, Hispanic/Latine, and White sexual minority men were more likely than same-race heterosexual men to be current drinkers. 81

Research examining racial/ethnic differences in gender identity disparities in alcohol use is scant and has inconsistent patterns. 3 A large-scale study indicated that Hispanic/Latine transgender adults had a greater likelihood of current alcohol use and engagement in HED compared to non-Hispanic/Latine White transgender adults. 66 This study also found that Black and "other" BIPOC transgender adults had a lower likelihood of current alcohol use and frequency of HED compared to White transgender adults, and no differences were found between Biracial/Multiracial and White participants. 66 Two community studies found no racial/ethnic differences in past-year alcohol dependence (as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) among transgender women 87 and in drinking five or more alcoholic drinks on one occasion in the past year among Canadian transgender people. 88 A study of college students found that BIPOC transgender college students were at greater risk than White transgender college students for alcohol-related blackouts. 45

Oppression as a Unifying Framework

Building on prior established oppression theories and models, this paper focuses on oppression as an organizing framework that centers on multiple and intersecting types of oppression and the harms that they inflict on marginalized people. Oppression involves an unjust system of power, privilege, and domination, wherein some social groups have more power and privilege than other groups, and they intentionally and unintentionally use this power and privilege to maintain domination over oppressed groups. 13,14,89-91 Oppression is perpetrated explicitly and implicitly at multiple levels, including structural (i.e., systemic, cultural, and institutional) and individual (i.e., interpersonal and intrapersonal) levels. 13,14,89-92 It inflicts stress (i.e., oppression-based stress) at these levels and results in deleterious consequences and harms for oppressed social groups (e.g., SGM people). Oppression threatens the social safety of marginalized individuals and creates processes that reinforce an absence of safety. 93 Oppression is also a shaming process that further silences and isolates oppressed individuals to enable oppressors to maintain power. 94 Moreover, oppression is both a process (i.e., historical or ongoing process of oppression of marginalized groups through restriction, dehumanization, and deprivation) and a state (i.e., state of inequality). 89 Similarly, marginalized individuals are both subjected to the traumatic process of oppression (i.e., oppression-based stressors) across multiple levels and experience oppression-based stress as a state that results from direct or vicarious exposure to oppression-based stressors. Due to its sociohistorical roots, oppression-based stress and related trauma can be transmitted across generations. 90

Utilizing an oppression framework is inclusive of and integrates multiple well-established but often disparate theoretical models that focus on discrimination or stigma to explain health inequities among varying marginalized groups (e.g., minority stress and sexual stigma models for SGM people, racism-based stress for BIPOC, sexism models for women). 13,14,90,92,95-100 A major limitation of some of these theoretical models is their focus on only one axis of oppression (e.g., heterosexism, cissexism, racism, sexism) and their over-focus on individual-level processes (e.g., discrimination). For example, the primary guiding theoretical model for understanding health inequities among SGM people is the minority stress model, which initially focused on heterosexism-based stress at the interpersonal and intrapersonal levels (i.e., minority stress) among sexual minority people and later adapted to consider cissexism-based stress and its negative impact on gender minority people. 96,97,101

Intersectionality theory, which was developed by Black feminist scholars, posits that social groups concurrently experience multiple oppression-based stressors (e.g., racism, sexism, classism, heterosexism, anti-bisexual prejudice, cissexism, ableism, ageism, xenophobia, colonialism, antisemitism, Islamophobia, weight-based oppression) related to their intersecting and marginalized social positions and identities (e.g., race, ethnicity, gender, class, sexual orientation, religion). These multiple forms of oppression-based stressors are perpetuated and concurrently reinforced by interconnected structural systems of oppression. 102-105 Moreover, identity is not an additive sum or multiplicative of several social positions or oppressions (i.e., experiences of SGM BIPOC individuals are not simply the sum of all of their oppressions); in fact, social identities are concurrently influencing each other and are shaped by a matrix of power, privilege, and oppression. 104,106 This notion is consistent with the mixed findings in alcohol inequities at the intersection of sexual orientation, gender, race, and ethnicity, wherein some marginalized groups do not have higher risk for alcohol use compared to privileged groups. 84

An oppression framework reflects prior oppression and intersectional approaches that underscore that each individual is within a context of interlocking systems that create and perpetuate health inequities; this framework helps shifts the lens from the individual to the systems and structures of oppression. 91,102,103,106-108 This is important as the over-focus on the individual and their coping and resilience capabilities can be pathologizing and disempowering and can further perpetuate the status quo of oppression. 91,102,103,106-108 Moreover, centering the focus on oppression allows for an intersectional understanding of the common processes that exist across all and intersecting forms of oppression (e.g., power, privilege, domination, subordination) and their negative impacts on oppressed groups. 91,103 In doing so, disrupting and dismantling systems of oppression are an integral part of promoting and achieving health equity.

Oppression-Based Stress Among SGM People

SGM individuals experience multiple systems of oppression, including heterosexism (i.e., oppression of sexual minority people), anti-bisexual oppression (i.e., oppression of bisexual and other plurisexual people), and cissexism (i.e., oppression of transgender and nonbinary people) at multiple levels that are linked to and shape each other. For example, structural oppression can perpetuate interpersonal oppression (e.g., higher rates of hate crimes and harassment of SGM people) and intrapersonal oppression (e.g., internalized heterosexism or cissexism).

Structural Oppression

Structural oppression, also known as structural, institutional, or cultural stigma, includes heterosexist and cissexist policies or laws and cultural norms or attitudes that create or reinforce inequities among SGM groups to maintain power and privilege among heterosexual and cisgender groups. 13,14,92,109,110 Despite increased visibility and positive changes for SGM individuals in the United States over the past two decades, structural oppression (e.g., cissexist, heterosexist, racist, and sexist legislation) and violence toward SGM people have increased significantly. 111

Structural heterosexism and cissexism create structural-level barriers and stressors and exacerbate other social determinants of health. For instance, SGM people are more likely than heterosexual and cisgender individuals to encounter structural barriers, such as lack of access to care and health insurance, 112,113 and to experience other inequities in social determinants of health, such as housing insecurity and instability, food insecurity, and economic hardship (e.g., unemployment). 52,112-115

Furthermore, structural oppression operates overtly and covertly by shaping cultural and social norms, which are well-known factors that impact alcohol use. 116 Among SGM communities, oppression shapes drinking and other substance-related social norms through exploitative economic and capitalistic factors. Due to historic and systemic heterosexism and cissexism, there is a lack of safe and affirming spaces for SGM people to be in community with each other. 2,117 SGM bars, which often were one of the few spaces for SGM people to connect and resist multiple forms of oppression, 2,117 frequently involved alcohol and other substance use. Moreover, economic forces have targeted and exploited SGM communities and organizations. Alcohol companies use marketing strategies (e.g., sponsorship of events, advertising) to target specific communities, which ultimately influences their drinking norms and their culture more broadly. 116,118 Scholars have indicated that alcohol and tobacco companies have engaged in targeted marketing of SGM communities. 119-122 As such, SGM culture has become intertwined with alcohol and other substance use; in fact, sexual minority individuals perceive drinking as a normed component of queer identity and culture. 123 This has influences on SGM people's social networks, 124,125 permissive drinking norms, 126 misperceptions of others' drinking, 127,128 and lower perceived risks associated with drinking. 129

Interpersonal and Intrapersonal Oppression

Oppression-based stressors at the interpersonal level, commonly known as distal minority stressors in the minority stress model, 96,97,101 include heterosexist, anti-bisexual, or cissexist violence, discrimination, harassment, microaggressions, non-affirmation (e.g., being misgendered), body- or gender-policing, and transitioning-identity stress. 96,130,131 These stressors can be directly or vicariously experienced in every domain of SGM people's lives, 130,132,133 are quite pervasive, inflict shame and trauma, impact experiences of social safety, and may be experienced from within the SGM community (e.g., bisexual prejudice, cissexism, racism, sexism, and/or ableism from within the SGM community; competition or social exclusion for not fitting rigid expectations related to success, sex, status, or body image). 93,96,134-136 Furthermore, SGM individuals who are in romantic relationships can experience couple-level oppression-based stressors, 137 and their own and their partner's oppression-based stressors can have crossover effects in the relationship. 138,139 Moreover, SGM individuals, especially sexual minority women, plurisexual women, and gender minority individuals, are disproportionally more likely to experience general life and traumatic stressors (e.g., verbal, physical, and sexual victimization) over their lifespan than are heterosexual and cisgender individuals. 140-143

At the intrapersonal or internalized level, oppression-based stressors reflect processes related to the internalization of oppression, which are considered proximal minority stressors and self-stigma in the minority stress model and sexual stigma theory, respectively. Examples include internalized oppression (e.g., internalized heterosexism, anti-bisexual prejudice, and/or cissexism, which reflect internalized shame); felt or awareness of oppression; anticipation, vigilance, or expectation of oppression-based stressors; sexual and/or gender identity concealment; 92,96,97,101 and gender dysphoria. 144 It is important to note that intrapersonal oppression-based stressors manifest in both interpersonal and intrapersonal domains and are not solely an intrapersonal process; they often manifest in an interaction between individuals and their oppressive environment. Additionally, oppression at the structural and interpersonal levels instills, shapes, and reinforces intrapersonal oppression-based processes.

In addition to oppression-based stressors that impact SGM people more broadly, SGM BIPOC experience unique and intersectional forms of oppression-based stressors at the intrapersonal and interpersonal levels. Documented forms of intersectional oppression-based stressors that SGM BIPOC uniquely experience are racism and invisibility in SGM communities, heterosexism, cissexism, anti-plurisexual oppression in their own racial and ethnic communities, and racism in dating and close relationships. 105,145 They also experience internalized racism as well as other forms of racism-based stressors that BIPOC are regularly exposed to over their lifetimes. 13,14,90,98-100

Oppression and Drinking Motivations Among SGM People

Several reviews of the SGM alcohol literature highlight that oppression-based stressors are a risk factor for alcohol use and hazardous drinking among SGM individuals. 2,4,5,40,146-151 For example, a meta-analysis of alcohol and substance use among sexual minority youth found that oppression-based stressors were some of the strongest risk factors for substance use. 151 Oppression-based stressors lead to poor health outcomes, including hazardous drinking, in part due to their disruptive and deleterious impacts on cognitive, affective, behavioral, physiological, and interpersonal and relational processes. 94,152-154 Addiction models can help further explain how oppression-based stressors lead to drinking behaviors and other alcohol use outcomes among SGM people. Congruent with negative reinforcement models, 155 the self-medication hypothesis, 156 and motivational models of substance use, 157,158 SGM people may use alcohol to cope with, regulate, or self-medicate negative emotions (e.g., distress, shame, hopelessness, anger) that are instigated by oppression-based stressors.

Motivational models of addiction indicate that individuals have varying motivations for alcohol consumption and these motives impact their drinking behaviors. 157,158 Consistent with oppression-based stress and negative reinforcement models, SGM people may drink to cope with distress instigated by general and oppression-based stressors or to enhance their mood or affective states that may be dampened by stress. In fact, meta-analytic work indicates that coping motives are one of the strongest predictors of drinking problems among the broader literature. 159 Qualitative work has found that sexual minority women and Black and Latine sexual minority adults use alcohol to cope with heterosexism-based stressors 123,160-162 and intersectional oppression-based stressors. 123 Similarly, researchers found that about one-fourth of transgender adults used alcohol or drugs to cope with cissexist discrimination, 163 and transgender college students were more likely than their cisgender peers to endorse coping and mood enhancement drinking motives. 45 Coping motives partially mediate the associations between heterosexism- and cissexism-based stressors and alcohol use and consequences among SGM adults. 164-169

Other drinking motives that influence SGM's alcohol use also may be influenced by oppression. In alignment with social learning theory, 170 social and conformity motives are relevant as SGM people may be motivated to drink due to peer modeling of substance use and permissive drinking social norms that are shaped by alcohol companies targeting SGM communities. Moreover, sexual enhancement drinking motives may be important as SGM individuals may drink to initiate or enhance their sexual experiences, 117,161,162,171 which have been systematically stigmatized. Lastly, SGM individuals may be motivated to drink to challenge the rigid binary gender socialization, engage freely in gender expression, and affirm their gender identities, 117,172 which have been policed by oppression.

Purpose of Present Narrative Review

As described above, alcohol inequities that SGM people experience have been widely explained by theoretical models of oppression, stigma, and stress. The purpose of this paper is to review and summarize recent developments and advancements in the literature that examine the impact of oppression-based stressors on alcohol use outcomes in SGM populations across multiple levels (e.g., intrapersonal, interpersonal, and structural). A common finding of prior SGM alcohol reviews has been that the field has largely used cross-sectional designs and has focused primarily on heterosexism-based stressors among sexual minority people. 2,4,5,40,146-151 Thus, this paper focuses only on methodologies that move beyond cross-sectional designs (i.e., experimental, longitudinal, and experience sampling) to understand the associations between heterosexism-based and anti-bisexual oppression-based stressors among SGM people. Previous SGM alcohol reviews have primarily focused on sexual minority people and have not considered other forms of oppression (e.g., cissexism, intersectional oppression), limiting our understanding of the literature on cissexism- and intersectional oppression-based stressors and alcohol use outcomes among SGM people and especially SGM BIPOC. Therefore, a second aim of this review is to summarize the existing literature on cissexism-based stressors and alcohol use outcomes among gender minority people as well as the literature on intersectional oppression among SGM BIPOC. Given that oppression manifests at the structural level and the limited attention of prior work on this type of oppression, the third aim of this paper is to review the literature on structural heterosexism and cissexism and alcohol use outcomes among SGM people. All study designs, including cross-sectional studies, were considered for the second and third aims.

Search Methods Employed

A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science). Search terms focused on alcohol consumption (e.g., alcohol, drink*); sexual minorities (e.g., LGBT, lesbian, gay, bisexual); gender minorities (e.g., transgender, nonbinary, gender diverse); and other relevant areas, such as intersectionality, oppression, minority stress, racism, and BIPOC individuals (e.g., intersectionality, minority stress, discrimination, stress, structural stigma, heterosexism, cissexism, racism, people of color, racial minorities). These searches captured 3,205 articles. Duplicates were removed. Each article's title and abstract were reviewed, and full-text articles that were of relevance to this paper were retrieved and reviewed in detail. Cross-sectional studies that focused on heterosexism and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature.

Results of the Literature Search

As a result of the search, this review included 50 articles that focused on the following four areas of the literature examining the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism and anti-bisexual oppression-based stress (22 articles); (2) any studies of cissexism-based stress (12 articles); (3) any studies of intersectional oppression among SGM BIPOC (seven articles, which included one article that overlapped with and is also included in the first category and one article that overlapped with and is also included in the fourth category); and (4) any studies of structural oppression (11 articles).

Results of the Reviewed Studies

Heterosexism and anti-bisexual oppression-based stress.

One development in the literature base is the use of experimental research. Despite the utility of experimental methodologies, to date only one study has examined the impact of heterosexism-based stress on alcohol outcomes among sexual minority individuals in a controlled laboratory setting. Researchers developed a novel experimental paradigm to assess heterosexism-based stress, which included mood induction using picture stimuli to manipulate heterosexism-based stress. This study provided the first experimental evidence to date that vicarious exposure to heterosexism elicited negative affect and alcohol craving as well as enhanced alcohol cue reactivity effects among sexual minority young adults who engaged in hazardous drinking. 133 This study also found that, compared with a neutral condition, elevated heterosexism-based psychophysiological stress reactivity, as assessed by the startle response, was correlated with more recent alcohol use. 173

Another major advancement and emerging literature base leverages longitudinal and intensive longitudinal/experience sampling (e.g., ecological momentary assessments, daily diary studies) designs to understand the concurrent and prospective within-person associations between oppression-based stressors and alcohol outcomes over time and in the natural environment. Among longitudinal studies with extended assessments periods (e.g., months), heterosexism-based stress was associated with concurrent and prospective alcohol use outcomes; however, findings were inconsistent. Four longitudinal studies ranging from three to seven waves of assessments over nine months to 2.5 years among SGM young adults found concurrent but not prospective positive associations between heterosexism-based stressors (e.g., microaggressions, victimization, internalized heterosexism) and several drinking outcomes. 74,165,174,175 One of these studies, however, found neither concurrent nor prospective associations between internalized heterosexism and alcohol use. 175 In contrast, five other longitudinal studies documented prospective associations between heterosexism-based stressors and alcohol use outcomes (e.g., HED, alcohol-related consequences) for sexual minority adolescents, 124 girls, 176 and college students, 167 as well as young sexual minority women. 177,178

Daily diary studies using 14- to 28-day monitoring periods with one survey per day among sexual minority women demonstrated some mixed findings regarding the within-person associations between heterosexism-based stress and same-day and next-day drinking outcomes. Studies provided support for the daily associations between interpersonal heterosexism-based stressors (e.g., discrimination, microaggressions) and same-day alcohol use, 138,179 same-day negative alcohol-related consequences, 180,181 and next-day quantity of drinks and HED 179 among young sexual minority women. 138,179-181 A dyadic analysis of the same dataset of sexual minority women 179 found that heterosexism-based stressors of a sexual minority woman's romantic partner were associated with her own same-day HED. 138 These studies also found nonsignificant associations between oppression-based stressors and the assessed alcohol outcomes for same- and next-day alcohol use. Only one study assessed intrapersonal heterosexism-based stress (i.e., sexual identity concealment) and found that it was not associated with any of the assessed alcohol outcomes. 179 Some of the mixed findings might be explained by the measures of oppression-based stressors used, as some only used one item to assess this construct, 181 and by mediating mechanisms, such as the ones found in one study to explain their associations (e.g., coping efficacy, social anxiety). 181

Daily diary studies of stress and drinking among sexual minority cisgender men provide less consistent patterns but highlight potential moderating variables (e.g., race and structural oppression). In one daily diary study, stressful daily events were associated with same-day drinking among heavy-drinking (defined as an average weekly consumption of at least 24 standard drinks over the past 90 days) sexual minority cisgender men who were treatment seeking; however, this study did not explicitly assess oppression-based stressors. 182 In contrast, another study found that heterosexism-based stressors were not associated with same-day or week-level drinking quantity or heavy drinking (defined as drinking five or more drinks in one sitting) in sexual minority cisgender men. 183 However, this study found that heterosexism stressors were associated with less same-day drinking for BIPOC participants, but were not associated with drinking frequency for White participants. 183 Another daily diary study of sexual minority men found that gay-related rejection sensitivity was not significantly associated with same-day alcohol use; however, it was associated with greater alcohol use among sexual minority men living in states with greater structural heterosexism (i.e., assessed presence of state-level heterosexist policies and social attitudes) than in states with less structural heterosexism. 184

Three ecological momentary assessment studies provided more nuanced findings for the within-day associations between heterosexism-based stressors and alcohol outcomes. One study indicated that momentary heterosexism/cissexism-based stressors (e.g., discrimination) were associated with concurrent and later substance use on the same day among SGM young adults. 185 However, this study did not discern these effects for alcohol use specifically. Another study found that parental heterosexism (e.g., rejection) assessed at baseline was associated with greater momentary alcohol and cannabis craving and negative affect among sexual minority youth who used nicotine; 186 the same study also found momentary associations between heterosexism stressors and nicotine craving. 187 The third study found that within-day associations between heterosexism stressors and alcohol use were moderated by baseline alcohol use frequency and scores on the Alcohol Use Disorders Identification Test (AUDIT), wherein heterosexism stressors were associated with alcohol use only among SGM young women who reported more frequent alcohol use and those who had higher AUDIT scores at baseline compared to participants with less frequent alcohol use or lower AUDIT scores. 188

Cissexism Stress and Alcohol Use Among Gender Minorities

Several studies have documented that multiple forms of cissexism-based stressors at the interpersonal level are associated with alcohol use, hazardous drinking, other substance use, and substance use disorder among gender minority individuals; 3,66,147,189-192 however, the results have been inconsistent, and studies relied primarily on cross-sectional designs.

Two cross-sectional studies found that victimization (i.e., bullying and harassment) was associated with greater alcohol and other substance use 191 and HED 193 among gender minority youth; moreover, victimization mediated alcohol inequities between gender minority and cisgender youth. 191,193 Two other studies of gender minority adults found that cissexism-based discrimination, especially in specific contexts (i.e., public spaces, housing), was associated with more alcohol use, engagement and frequency of recent HED, and alcohol-related problems. 66,190 In contrast, other cross-sectional studies showed that cissexism stressors were not associated with consuming five or more drinks on one occasion in the past year 88 or with consuming four or more drinks in a single day within the past three months 194 in gender minority adults. In a 3-year longitudinal study, cissexism-based verbal and physical abuse was associated with drinking five or more drinks in one sitting and other substance use in transgender women; these effects were also mediated by depressive symptoms. 195

Limited studies have assessed the effects of cissexism-based stress at the intrapersonal level. In one cross-sectional study, several cissexism-based stressors (i.e., internalized stigma, gender identity concealment, gender dysphoria, and anticipated stigma) were individually and together associated with problematic alcohol use in an online sample of transgender and nonbinary adults, and these associations were mediated through drinking-to-cope motives. 169 Similarly, other work found that gender dysphoria was associated with greater heavy drinking. 194 Another study found that expectations of oppression were positively correlated with hazardous drinking among a sample of gender minority people; however, this association was not significant in multivariate models. 196

Intersectional Oppression and Alcohol Use Among SGM BIPOC

A small but burgeoning body of research has focused on multiple forms of oppression and drinking behaviors among SGM BIPOC. In a longitudinal study of young Black and Latine sexual minority men, researchers identified several groups based on their experiences of oppression-based stressors, including individuals who experienced minimal oppression (i.e., infrequent heterosexism and racism stressors), individuals who primarily experienced multiple forms of the same single-axis of oppression (i.e., heterosexism or racism), and a group who experienced compound oppressions (i.e., frequent heterosexism as well as racism stressors). 197 Compared to the minimal oppression group, the other groups had a higher likelihood of drinking, with the compound oppression group being at the highest risk. 197 In sum, heterogenous experiences at multiple axes of oppression (i.e., heterosexism and racism) were associated with hazardous drinking. 197 Similarly, in a longitudinal study of Black, Latine, and Multiracial sexual minority men, racism-based discrimination and gay rejection sensitivity were indirectly associated with heavy drinking (i.e., five or more drinks) over 12 months; this association was mediated through emotion dysregulation, such as depressive and anxiety symptoms. 198 Other researchers found that racism and racist sexual objectification were associated with screening positive for AUD among Black and Latine/Latin American Canadian sexual minority men. 199

Four studies examined the associations between intersectional oppression-based stress unique to SGM BIPOC (e.g., racism and invisibility in SGM communities, heterosexist and cissexist oppression in one's own racial and ethnic communities, racism in dating experiences, racist sexual objectification) and alcohol use outcomes. These studies found that intersectional oppression-based stress at the interpersonal level was associated with recent and heavy alcohol use (i.e., five or more drinks in one sitting), hazardous drinking, alcohol-related consequences, and AUD in SGM BIPOC youth, 200 Black and Latine sexual minority women and sexual minority men, 199,201 and Latine sexual minority men. 202

Only one study examined intersectional structural oppression by examining the intersection of structural heterosexism and racism; results indicated that the associations between structural racism and hazardous drinking were amplified for Black sexual minority men living in states with high structural heterosexism but not for their White counterparts. 203

Structural Oppression and Alcohol Use

A total of 11 studies focused on various domains of structural oppression and alcohol use. These studies assessed structural oppression in multiple ways, from measuring only one indicator (e.g., same-sex marriage laws) to indices of multiple indicators of structural oppression (e.g., laws that ban same-sex marriage or adoption, employment nondiscrimination laws, social attitudes toward sexual minority people). One study found that among sexual minority adults, living in states with high levels of structural heterosexism (e.g., banning same-sex marriage, negative attitudes towards sexual minority individuals) was associated with greater risk for AUD compared with living in states with lower levels of structural heterosexism. 204 Other work found that the interaction of heterosexism at the structural and intrapersonal levels (i.e., gay-related rejection sensitivity) was associated with greater daily alcohol use among sexual minority men. 184 In a study mentioned earlier, structural heterosexism and racism were independently associated with hazardous drinking among Black sexual minority men, but not White sexual minority men, and their interaction exacerbated this association. 203 Moreover, structural heterosexism was related to the accessibility of SGM-inclusive and tailored programming at substance use treatment facilities. 205

Some studies have examined the impact of SGM-protective laws and policies on drinking behaviors of SGM individuals. One study found that state-level transgender-inclusive and transgender-protective policies (i.e., an index of 35 different types of laws, such as laws related to nondiscrimination, parenting rights, health, safety, ability to correct listed gender on documents) were associated with less alcohol use, fewer poor mental health days, and more regular health care checks in transgender adults living in those states. 206 Protective state-level sexual orientation policies also were associated with a lower likelihood of engaging in high-intensity drinking among sexual minority men, and, to some extent sexual minority women, 207 and with less negative alcohol-related consequences for sexual minority women. 208 Some of these protective polices were most beneficial in terms of drinking outcomes for Black and Latine sexual minority women, as well as sexual minority women with a high school education or less. 208 Another study detected no disparities in HED between lesbian and heterosexual women in states with state-level protections, and disparities between bisexual and heterosexual women were lower in states with protections compared to states without these protections. 209 Additionally, alcohol control-related policies significantly reduced HED for all women, but only in states that also had nondiscrimination laws and not in states without nondiscrimination laws. 209 However, these findings were not documented for sexual minority men. 209 In contrast to these findings, another study found that SGM equity laws (e.g., nondiscrimination laws) were associated with less cigarette use but more alcohol use and HED among SGM youth. 210 Lastly, research on school-based protective structural factors—such as SGM-affirming organizations (e.g., Gender and Sexuality Alliances; GSAs) and anti-heterosexist bullying policies—found that the presence of such factors was associated with less alcohol use, HED, and other substance use for SGM youth compared to SGM youth who attended schools or lived in jurisdictions without such protective factors. 211-213

Results of this narrative review indicate mounting evidence that implicates oppression-based stressors in inequities in alcohol use, hazardous drinking, and AUD in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. 13 Among the reviewed literature on heterosexism and anti-bisexual oppression, several studies have provided support for longitudinal and daily concurrent and prospective associations between oppression-based stressors and drinking outcomes; however, there are several mixed and inconsistent findings. With respect to cissexism, several studies have documented that multiple forms of cissexism-based stress at the interpersonal and intrapersonal levels are associated with alcohol use and hazardous drinking among gender minority individuals. Again, some of these findings have been inconsistent, and most studies relied primarily on cross-sectional designs. Among the intersectional oppression literature focused on the intersection of racism and heterosexism/cissexism, recent work showed that heterosexism and racism-based stressors at the interpersonal and structural levels were independently associated with alcohol use outcomes, and their intersection at the structural level exacerbated their independent structural effects on drinking; however, these associations to date have only been tested among BIPOC sexual minority men. Additionally, there is support for the associations between unique and intersectional oppression-based stressors and greater alcohol use outcomes among SGM BIPOC. Lastly, the structural oppression alcohol literature has yielded emerging and somewhat consistent evidence among SGM youth and adults that structural oppression is associated with greater alcohol use outcomes and that structural measures that protect SGM people are associated with less alcohol use. There is some potential evidence for gender differences in these associations. Given some inconsistent and mixed patterns of findings across the reviewed literature bases, future research needs greater specificity, robust and well-validated measures, and more attention to intersectional and addiction frameworks.

Limitations and Gaps: Future Research Directions

Several weaknesses and much heterogeneity in the reviewed studies' drinking inclusion criteria and assessment of different types of oppression-based stressors in the SGM populations may contribute to inconsistent patterns of results. First, the majority of cross-sectional and longitudinal studies, as well as some of the experience sampling studies, did not have alcohol use as an inclusion criterion. As such, study samples included SGM individuals who had never initiated or had abstained from alcohol use as well as individuals who used alcohol and had a wide range of drinking patterns (i.e., experimental, infrequent, occasional, frequent, and heavy use). This obscures understanding of the associations between oppression-based stressors and alcohol outcomes. Second, different types of oppression-based stress have received different levels of attention. Overall, there is a large focus on oppression-based stress at the interpersonal and intrapersonal levels and limited investigation of oppression at the structural level, despite the significant increase of anti-SGM legislation in the United States. Applying an oppression framework and examining the intersection of different forms of oppression at multiple levels can refine understanding of oppression-based stress and alcohol use and further clarify mixed and inconsistent findings. Additionally, more studies have focused on oppression-based stressors at the interpersonal level than at the intrapersonal level. There are mixed findings regarding the associations between internalized oppression, concealment, and alcohol use; as such, continued examination of internalized stigma and multiple other oppression-based stressors at the intrapersonal level (e.g., anticipation of oppression, gender dysphoria) is needed in advancing the field. Third, except for two measures developed to assess oppression-based stressors, 132,214 experience sampling studies lacked well-validated measures of oppression-based stressors at the interpersonal and intrapersonal levels. Using validated measures can improve research rigor and allow for comparisons across studies. Given the diverse and unique ways oppression-based stressors can be experienced as well as the recent identification of additional and different types of heterosexism- and cissexism-based stress (e.g., non-affirmation, body or gender policing, couple-based stress, anti-bisexual prejudice) for specific SGM subgroups (e.g., gender minority people, SGM BIPOC), further research using validated measures to examine the impact of multiple types of oppression-based stressors on alcohol outcomes is needed. Future research should also consider varying contexts in which oppression is inflicted, such as online versus in-person oppression, vicarious versus direct oppression, oppression occurring outside versus within the SGM community, the type of perpetrator(s), or whether oppression is experienced individually or within a romantic couple or group. Finally, although there has been an increase in longitudinal and experience sampling studies of oppression-based stressors and alcohol use among sexual minority populations, the literature examining the associations between cissexism and alcohol use among gender minority people and intersectional oppression-based stressors and alcohol use among SGM BIPOC is lagging far behind.

One strength, but also a limitation of this review, is that the intersectional lens applied throughout primarily covered only the intersections of gender identity, sexual orientation, and race/ethnicity and their related oppressions. Research is needed on other intersections of identities and oppression (e.g., sexism, classism, ableism, ageism). Qualitative methods provide a rich and in-depth understanding of the tenets of intersectionality theory; nonetheless, researchers can review several suggestions regarding the use of quantitative methods in intersectional research. 215-217

Additional research is needed to identify moderating and mediating mechanisms that help refine our understanding of the link between oppression-based stressors and alcohol use. Given that most of this literature has been cross-sectional, 4,5,40,147 researchers need to examine these mechanisms using more sophisticated methodologies and analytic strategies 147 as well as identify novel culturally and developmentally relevant mechanisms across the lifespan. Beyond individual-level factors, mechanisms at the structural level have been entirely understudied and need further investigation. In addition to the continued inquiry into oppression-based stress, motivational and positive reinforcement models (e.g., drinking to celebrate, be sexual, connect with others) should be examined to provide a comprehensive understanding of mechanisms driving drinking among SGM people. Similarly, well-known factors that impact drinking and AUD among the broader population (e.g., stressors and traumatic experiences unrelated to oppression; genetic factors such as family history of AUD), should be also considered. Research to understand how oppression shapes and interacts with sociocultural and psychophysiological mechanisms (e.g., social norms, allostatic load) to influence drinking may also help shed light on inconsistent results in the literature.

Increased rigor in the application of research methods and addiction theories that are commonly used in the wider alcohol literature is needed in the SGM alcohol literature. First, as most of the literature base has focused on primary alcohol outcomes (i.e., quantity and frequency of alcohol use), additional alcohol outcomes should be considered (e.g., blackouts, craving, alcohol cues, withdrawal, intoxication, AUD severity) using established measures and paradigms (e.g., cue reactivity, alcohol demand tasks). Second, craving is a hallmark feature of AUD, yet limited work has examined the impact of oppression-based stressors on craving in the SGM literature. 133,186,187 Heterosexism-based stress may elicit alcohol craving, and alcohol cues may maintain or potentiate craving 133 and lead to alcohol consumption. Therefore, future work should incorporate the context of drinking and related cues. Third, with the exception of three studies, 180,182,188 there is a lack of addiction theory-driven investigation of how the progression along the addiction continuum 155,218 may impact the link between etiological factors (e.g., oppression-based stress) and alcohol use outcomes. Future research needs to consider addiction severity, which could help better explain mixed or inconsistent findings in the literature related to stress and drinking among SGM. Relatedly, research is needed to examine the impact of oppression-based stressors on the initiation and progression of alcohol use and the development of AUD over time. Fourth, studies have conflated sex and gender when focusing on alcohol outcomes as well as used inconsistent definitions of hazardous drinking. 3 As such, researchers can improve the rigor of alcohol research among gender minority populations by following recommendations for the use of the AUDIT with gender minority populations 219 and making alcohol measures more gender inclusive. 220

Implications for Resilience Factors and Interventions

Oppression-based stressors exist in every domain in SGM people's lives and can impact their alcohol use; thus, protective, resilience, and resistance factors and interventions also must be identified and applied in every domain. At the structural level, affirming laws and policies that protect and bolster the civil rights and humanity of SGM people and eliminate oppression are paramount for addressing alcohol inequities. 207-209 Affirming institutional factors that reduce stigma, create safety and community, raise critical consciousness, and celebrate and empower SGM people are urgently needed. 211-213 The evidence shows that these structural interventions are especially helpful for SGM BIPOC 208 and can potentially increase the efficacy of alcohol control-related public health policies. 209 Furthermore, SGM-serving organizations and events must carefully consider the role of sponsorship and promotional efforts by alcohol companies and should engage in health-promoting and hazardous drinking prevention strategies. 119 Additionally, SGM people are more likely than heterosexual and cisgender individuals to seek treatment for AUD, but they experience more barriers to care and inadequate culturally-sensitive care. 221-224 Thus, more work is needed to intervene with structural treatment barriers, integrate SGM-affirmative and intersectional approaches, and improve cultural humility in care. These interventions must address AUD-specific stigma 225 and how it impacts the recovery process. Interventions are also needed to disrupt structural barriers that impact social determinants of health (e.g., economic, social).

Strengths-based models acknowledge individual and collective strengths that exist within SGM populations. 226-228 These models underscore strength and resilience factors such as the role of social support and community in promoting wellbeing in SGM populations; 226-228 thus, interventions that promote social connection and community should be prioritized. While promoting community connection and support is vital, it is important to note that prior work has yielded mixed findings, with community connection being both a protective and a risk factor for alcohol use. 2,146 This may be in part due to the aforementioned cultural and permissive drinking norms and exploitation of SGM communities by the alcohol industry. SGM individuals may also drink to connect, celebrate, and be in community with other SGM people. Additionally, the SGM community is not a monolith, and different subgroups can experience unique types of oppression-based stress within the SGM community (e.g., anti-bisexual prejudice, cissexism, racism, sexism, xenophobia, classism, ageism, ableism, religion-based oppression); thus, community interventions must consider these nuances and intersectional experiences.

Individual-level interventions and treatments that affirm SGM individuals and promote their coping skills and resistance to oppression and its related deleterious affective, cognitive, and interpersonal effects are needed to address hazardous drinking and AUD. Existing interventions for SGM populations have primarily focused on sexual minority men, 229,230 and there is a significant lack of interventions for sexual minority women and gender minority people. 4,229-231 Therapies that affirm sexual orientation, such as an affirming transdiagnostic cognitive-behavioral therapy and affirming counseling, show some efficacy in reducing alcohol use among young sexual minority men 232 and sexual minority women. 4,229-231 Gender-affirming interventions are needed, including ensuring access to gender-affirming care (e.g., affirming medical interventions, such as gender-affirming hormones and surgeries), because these interventions are protective against HED and AUD in gender minority people. 233,234 Given that oppression-based stress is a traumatizing process and that SGM groups experience a high prevalence of violence, future interventions should also be trauma-informed and sensitive to the multiple contexts in which victimization may be experienced (e.g., intimate relationships). 235 While social norms interventions (e.g., personalized normative feedback) have been efficacious in reducing alcohol use more generally, there is a paucity of intervention research that has tested their efficacy with SGM populations. Existing studies have yielded promising results in reducing alcohol use among sexual minority women 236 and sexual minority men. 237 There is also a need to adapt existing empirically supported alcohol interventions to consider the unique cultural factors and needs of SGM populations. 229-231

Future interventions also must integrate intersectional and social justice approaches to reduce and ultimately eliminate alcohol inequities among SGM people. For example, the radical healing framework was developed to promote the well-being and liberation of BIPOC communities and focuses on the promotion of critical consciousness, hope, resistance, authenticity, and community. 238 Moreover, strengths-based models underscore the role of identity pride and esteem, emotional awareness, and a future orientation that incorporates hope and optimism. 226,227 Although these models are significantly underutilized in the SGM alcohol field, they are excellent future directions for SGM populations.

Acknowledgments

This study was supported by grant R01 AA029989 from the National Institute on Alcohol Abuse and Alcoholism.

Correspondence

Address correspondence concerning this article to Ethan H. Mereish, Ph.D., Lavender Lab, Department of Psychology, University of Maryland, 1121 Biology-Psychology Building, 4094 Campus Drive, College Park, MD 20742. Telephone: 301–405–5874; Email: [email protected]

Disclosures

The author declares no competing financial or nonfinancial interests.

Publisher's note

Opinions expressed in contributed articles do not necessarily reflect the views of the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. The U.S. government does not endorse or favor any specific commercial product or commodity. Any trade or proprietary names appearing in Alcohol Research: Current Reviews are used only because they are considered essential in the context of the studies reported herein.

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