Dentistry has traditionally been male-dominated in North America, although “primary care” dentistry disciplines, including dental public health (DPH), have greater gender equity than other areas. However, gender gaps are likely to persist, specifically in academia. As an example of the measurement of inclusion, we sought to identify gender equity in authorship in publications in DPH and epidemiology over six years. We found that while women occupied first and second authorship positions, men dominated the senior author position. Evaluating gender in authorship provides valuable information on inclusion and the movement toward achieving gender equity in dental public health.
Key points
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While dentistry in North America has historically been dominated by men, gender representation in the profession is changing, with more than half of dental students being women since 2018.
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Dental Public Health is one dental specialty area that has rapidly and recently changed to comprise more women than men.
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Inclusion represents feeling welcome and participating in the environmental contexts of Diversity, Equity, and Inclusion.
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Other professions and disciplines regularly assess gender representation in publication authorship to measure gender equity and inclusion; however, fewer such assessments have been made in dentistry, especially in the United States.
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First and second authorship is predominantly held by women in the field of dental public health/oral epidemiology, however, senior authorship continues to be dominated by men, with little improvement in equity over time.
Introduction
In the United States and Canada, dentistry, such as medicine, has traditionally been male-dominated. In the United States, the proportion of women dentists has increased to a point where currently they comprise 56% of first-year dental school students. Some slow progress toward gender equity among dental faculty has been made, with an overall 16% increase seen in women as faculty members between 2011–2012 and 2018–2019, with women accounting for 37% of the full or part-time dental faculty workforce in 2018-19. Clearly, gender gaps persist across dentistry, as seen both in academia and in the general workforce. Nonsurgical specialties of dentistry and those considered “primary care,” including dental public health (DPH), tend to have a higher percentage of women than men entering the field. ,
This article illustrates how measuring authorship by gender distribution can provide valuable data on inclusivity in dentistry. Considering inclusion as the feeling of being welcome in an environment, it provides the potential for an objective measurement of having access and being present, engaged, and involved. As such, we sought to measure gender in authorship in oral epidemiology and DPH publications over a six-year period and evaluate the impact of the COVID-19 pandemic on authorship gender equity.
Measuring Inclusion
One essential component of academic dentistry is “scholarly activity” as measured by research grant funding, presentations at international and national clinical and scientific meetings, and the quantity and quality of peer-reviewed publications. Indeed, publishing in scientific, clinical, or other academic journals is not only expected but necessary for academic advancement. Some investigators have measured gender equity in academic publishing and have identified gaps in disciplines with gender imbalance such as in medicine and dentistry, but also in areas with greater gender balance, including public health and its scientific foundation, epidemiology. ,
As often seen in dentistry as well as general academia, women in dental academia face barriers that hinder their success, including unequal access to resources, gender bias, lack of women as role models, and sexual harassment that men in dental academia are unlikely or less likely to encounter. An examination of whether women in dental academia are underrepresented might include a comparison of men to women proportions in various measures of academic success including academic position attainment, grant funding, and publishing.
To illustrate how one may measure inclusion or equity, we focus on gender equity. Gender, as compared with other constructs such as race, ethnicity, or sexual orientation, is a relatively straightforward construct to measure as gender is comparably easily identifiable through various methods. We focus on the dental specialty of dental public health (DPH) and its underlying science, oral epidemiology, as this specialty has a higher proportion of women compared to other specialties. We hypothesized that the higher proportion of women in the field of DPH would translate to gender equity in publications in journals that publish articles related to dental public health and oral epidemiology. We were also interested in whether an increasing trend over time for more women is seen for key (ie, first, second or senior) authorship positions, and whether factors including the gender of the journal editor-in-chief might be related to gender equity.
Data Source
We used PubMed to identify all journal articles published from January 2017 to December 2022 in the four primary English-language academic dental journals known to publish studies of oral epidemiology and DPH. These journals are Community Dentistry and Oral Epidemiology , Journal of Public Health Dentistry , JDR Clinical and Translational Research , and Community Dental Health .
Gender Measurement
We examined each article abstract (and/or the entire retrieved publication, if necessary), and manually extracted the first and last names of the first, second, and last (senior) author. Two investigators (SR and BS or SR and DS) independently identified the gender of each first, second, and last (senior) author (man vs woman vs unable to determine) using 3 methods: (1) as the DPH/oral epidemiology field is relatively small, and we often had first-hand knowledge of a person’s gender because of personal or professional interactions or associations; (2) using academic, professional and other websites, and (3) by using the AI-online program “genderize” ( genderize.io ), to identify gender based on the author first name. We then compared data on author gender between the two reviewers, and, in cases where there was discordance, we performed additional in-depth internet searches to reach a consensus. When no data were available on which we could make a definite judgment regarding the author’s gender, we classified the gender as “unable to determine.”
Analyses
Aside from author gender identification, for each publication, we assessed the following: (1) article title; (2) journal; (3) total number of authors; and (4) date of publication. We classified the type of each publication as either (1) original public health or oral epidemiologic research; (2) a systematic review of published epidemiologic or public health research; (3) another review of published epidemiologic or public health research; (4) editorial/opinion; (5) letter to the editor or author’s response; (6) conference proceedings; (7) Erratum/Corrigendum; or (8) basic science/animal study/other (not epidemiologic or public health) research. We evaluated whether article type was related to women’s authorship and subsequently excluded all articles other than original dental public health/oral epidemiology research articles from further analyses. We categorized the geographic location of the senior author as (1) North America; (2) Central/South America/Caribbean; (3) UK/Ireland; (4) Scandinavia/Nordic; (5) Europe; (6) Africa; (7) Middle East; (8) South Asia; (9) Southeast/East Asia; and (10) Australia/New Zealand.
We calculated the proportion of women as first, second, and last authors overall in the four journals more than the six years, and then by journal and year of publication using publication date (if the publication date was missing, we used the Epub date). We examined whether the proportion of women as first, second, and last authors changed over the six-years period and evaluated whether the articles published pre-vs. during/post-COVID-19 show differences. To do this, we excluded 2020 (since the COVID-19 pandemic officially began in March 2020) and defined 2017 to 2019 as the pre-pandemic era and 2021 to 2022 as the pandemic era. For bivariate analyses, we used chi-square tests, t-tests, and ANOVA. We used ANOVA to test trends over time. We used SPSS to conduct all statistical tests.
Evaluation
We identified 1483 publications from the four journals published between January 2017 and December 2022. The number of authors per publication ranged from 1 to 33 with a mean number of 4.87 authors (sd ±2.70) and a median of 5 authors. We identified the gender of all but 0.7% (n = 11) of the first authors, 1.2% (n = 18) of the second, and 0.2% (n = 3) of the last authors. We treated these data as missing. We found that review articles were more likely to have women as authors for both the second and last author positions, relative to all original research articles and editorials ( P <.1 for second authors and P <.01 for last authors) but found no statistically significant difference in the proportion of women authors in the first author position across article types. Follow Fig. 1 to see which types of publications we excluded that led to the final dataset of 1147 original public health or oral epidemiologic research publications.
Proportion of women vs. men as authors
Overall, for the four selected journals over the six years period, we found that 59.6% of the first authors, 54.1% of the second authors, and 45.4% of the last authors were women. The proportion of women as authors by journal and year are presented in Tables 1 and 2 .
| Journal | Proportion of Women as Authors | ||
|---|---|---|---|
| First Author | Second Author | Last Author | |
| Community Dentistry and Oral Epidemiology | 60.4 | 53.5 | 44.4 |
| Journal of Public Health Dentistry | 61.0 | 56.6 | 45.9 |
| JDR Clinical Translational Research | 59.5 | 48.5 | 44.4 |
| Community Dental Health | 56.8 | 58.6 | 48.5 |
| Total | 59.6 | 54.1 | 45.4 |
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