Diversity of Research Participant Gender, Race, and Ethnicity in Communication Sciences and Disorders: A Systematic Review and Quantitative Synthesis of American Speech-Language-Hearing Association Publications in 2020.

Purpose: One manifestation of systemic inequities in communication sciences and disorders (CSD) is the chronic underreporting and underrepresentation of sex, gender, race, and ethnicity in research. The present study characterized recent demographic reporting practices and representation of participants across CSD research. Methods: We systematically reviewed and extracted key reporting and participant data from empirical studies conducted in the United States (US) with human participants published in the year 2020 in journals by the American Speech-Language-Hearing Association (ASHA; k = 407 articles comprising a total n = 80,058 research participants, search completed November 2021). Sex, gender, race, and ethnicity were operationalized per National Institutes of Health guidelines (National Institutes of Health, 2015a, 2015b). Results: Sex or gender was reported in 85.5% of included studies; race was reported in 33.7%; and ethnicity was reported in 13.8%. Sex and gender were clearly differentiated in 3.4% of relevant studies. Where reported, median proportions for race and ethnicity were significantly different from the US population, with underrepresentation noted for all non-White racial groups and Hispanic participants. Moreover, 64.7% of studies that reported sex or gender and 67.2% of studies that reported race or ethnicity did not consider these respective variables in analyses or discussion. Conclusion: At present, research published in ASHA journals frequently fails to report key demographic data summarizing the characteristics of participants. Moreover, apparent gaps in representation of minoritized racial and ethnic groups threaten the external validity of CSD research and broader health care equity endeavors in the US. Although our study is limited to a single year and publisher, our results point to several steps for readers that may bring greater accountability, consistency, and diversity to the discipline.

Auditory free classification of gender diverse speakersa).

Auditory attribution of speaker gender has historically been assumed to operate within a binary framework. The prevalence of gender diversity and its associated sociophonetic variability motivates an examination of how listeners perceptually represent these diverse voices. Utterances from 30 transgender (1 agender individual, 15 non-binary individuals, 7 transgender men, and 7 transgender women) and 30 cisgender (15 men and 15 women) speakers were used in an auditory free classification paradigm, in which cisgender listeners classified the speakers on perceived general similarity and gender identity. Multidimensional scaling of listeners' classifications revealed two-dimensional solutions as the best fit for general similarity classifications. The first dimension was interpreted as masculinity/femininity, where listeners organized speakers from high to low fundamental frequency and first formant frequency. The second was interpreted as gender prototypicality, where listeners separated speakers with fundamental frequency and first formant frequency at upper and lower extreme values from more intermediate values. Listeners' classifications for gender identity collapsed into a one-dimensional space interpreted as masculinity/femininity. Results suggest that listeners engage in fine-grained analysis of speaker gender that cannot be adequately captured by a gender dichotomy. Further, varying terminology used in instructions may bias listeners' gender judgements.

Speech beyond the binary: Some acoustic-phonetic and auditory-perceptual characteristics of non-binary speakers.

Speech acoustics research typically assumes speakers are men or women with speech characteristics associated with these two gender categories. Less work has assessed acoustic-phonetic characteristics of non-binary speakers. This study examined acoustic-phonetic features across adult cisgender (15 men and 15 women) and subgroups of transgender (15 non-binary, 7 transgender men, and 7 transgender women) speakers and relations among these features and perceptual ratings of gender identity and masculinity/femininity. Differing acoustic-phonetic features were predictive of confidence in speaker gender and masculinity/femininity across cisgender and transgender speakers. Non-binary speakers were perceptually rated within an intermediate range of cisgender women and all other groups.

Revisiting the acoustics of speaker gender perception: A gender expansive perspective.

Examinations of speaker gender perception have primarily focused on the roles of fundamental frequency (fo) and formant frequencies from structured speech tasks using cisgender speakers. Yet, there is evidence to suggest that fo and formants do not fully account for listeners' perceptual judgements of gender, particularly from connected speech. This study investigated the perceptual importance of fo, formant frequencies, articulation, and intonation in listeners' judgements of gender identity and masculinity/femininity from spontaneous speech from cisgender male and female speakers as well as transfeminine and transmasculine speakers. Stimuli were spontaneous speech samples from 12 speakers who are cisgender (6 female and 6 male) and 12 speakers who are transgender (6 transfeminine and 6 transmasculine). Listeners performed a two-alternative forced choice (2AFC) gender identification task and masculinity/femininity rating task in two experiments that manipulated which acoustic cues were available. Experiment 1 confirmed that fo and formant frequency manipulations were insufficient to alter listener judgements across all speakers. Experiment 2 demonstrated that articulatory cues had greater weighting than intonation cues on the listeners' judgements when the fo and formant frequencies were in a gender ambiguous range. These findings counter the assumptions that fo and formant manipulations are sufficient to effectively alter perceived speaker gender.

Perceptual Evaluation of Speech Naturalness in Speakers of Varying Gender Identities.

Purpose The purpose of this study was to investigate how speech naturalness relates to masculinity-femininity and gender identification (accuracy and reaction time) for cisgender male and female speakers as well as transmasculine and transfeminine speakers. Method Stimuli included spontaneous speech samples from 20 speakers who are transgender (10 transmasculine and 10 transfeminine) and 20 speakers who are cisgender (10 male and 10 female). Fifty-two listeners completed three tasks: a two-alternative forced-choice gender identification task, a speech naturalness rating task, and a masculinity/femininity rating task. Results Transfeminine and transmasculine speakers were rated as significantly less natural sounding than cisgender speakers. Speakers rated as less natural took longer to identify and were identified less accurately in the gender identification task; furthermore, they were rated as less prototypically masculine/feminine. Conclusions Perceptual speech naturalness for both transfeminine and transmasculine speakers is strongly associated with gender cues in spontaneous speech. Training to align a speaker's voice with their gender identity may concurrently improve perceptual speech naturalness. Supplemental Material https://doi.org/10.23641/asha.12543158.

Antibiotic Prescriptions for Upper Respiratory Infections in a Pediatric Office Versus an Urgent Care Center.

It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physicians in these settings. This retrospective chart review evaluated pediatricians' antibiotic prescribing practices for patients with symptoms of an upper respiratory tract infection in the office setting and an urgent care setting. There was no difference in the total antibiotic prescribing rate by pediatricians in their primary care office versus an urgent care setting. Pediatricians who were high antibiotic prescribers in the office setting were also high prescribers in the urgent care. The highest prescribing physicians prescribed the appropriate recommended antibiotics for a particular diagnosis the lowest percentage of the time. Efforts to promote antimicrobial stewardship should be directed toward the individual physician and not toward the location where the patients are being evaluated.