Masculine Boys, Feminine Girls, and Cancer Risk Behaviors: An 11-Year Longitudinal Study

Abstract

Objective Cancer risk behaviors often begin in adolescence and persist through adulthood. Tobacco use, indoor tanning, and physical inactivity are highly prevalent, socially patterned cancer risk behaviors, and their prevalence differs strongly by sex. It is therefore possible that these behaviors also differ by gender expression within the sexes due to social patterning. Methods We examined whether 5 cancer risk behaviors differed by childhood gender expression within the sexes and whether patterns of media engagement (e.g., magazine readership and trying to look like media personalities) explained possible differences, in a US population-based cohort (N=9,435). Results The most feminine girls had higher prevalence of indoor tanning (prevalence risk ratio (pRR)=1.32, 95% CI=1.23, 1.42) and physical inactivity (pRR=1.16, 95% CI=1.01, 1.34) and lower prevalence of worse smoking trajectory (prevalence odds ratio (pOR)=0.75, 95% CI=0.65, 0.88) and smoking cigars (pRR=0.61, 95% CI=0.47, 0.79) compared with least-feminine girls. Media engagement accounted for part of the higher prevalence of indoor tanning. The most masculine boys were more likely to chew tobacco (pRR=1.78, 95% CI=1.14, 2.79) and smoke cigars (pRR=1.55, 95% CI=1.17, 2.06), but less likely to follow a worse smoking trajectory (pOR=0.69, 95% CI=0.55, 0.87) and be physically inactive (pRR=0.54, 95% CI=0.43, 0.69) compared with least-masculine boys. Conclusions We found some strong differences in patterns of cancer risk behaviors by gender expression within the sexes. Prevention efforts that challenge the “masculinity” of smoking cigarettes and cigars and chewing tobacco and challenge the “femininity” of indoor tanning to reduce their appeal to adolescents should be explored.

181. Gender Expression Associated With BMI in a Prospective Cohort Study of U.S. Adolescents

“…Evidence is accumulating that these messages carry with them health risks in myriad domains. [9][10][11][12]32 With the present study, it is clear that conformity to masculinity ideals confers risk of elevated BMI in both sexes and, for males in particular, more rapid BMI gains in adolescence. While our study examined a wide range of known predictors of BMI in youth, our results indicated that these exposures accounted for a relatively small proportion of the pronounced gender-expression group differences in BMI.…”

“…21 Furthermore, recent evidence implicates societal pressures on young people to conform to socially accepted expressions of masculinity and femininity in a range of health damaging behaviors, 9-11 including weightrelated behaviors. 11,12,32 Nevertheless, to our knowledge, this is the first prospective cohort study examining the relationship between gender expression and BMI in adolescence. Our findings indicate that socially assigned gender expression is a powerful predictor of BMI.…”

“…7,8 Previous research in other health domains has found differences by gender expression --that is, the degree to which one presents oneself in a way consistent with culturally defined expressions of masculine or feminine --in problem drinking 9 and violence perpetration. 10 Gender expression also patterns cancer risk behaviors, 11 including cigar smoking and U.V. tanning bed use, such that more masculine males are more likely than other males to smoke cigars and more feminine females are more likely than other females to engage in U.V.…”

“…For instance, in the Growing Up Today Study (GUTS), a national cohort of U.S. youth, researchers found that gender conforming girls were more likely to endorse trying to look like people in the media than gender nonconforming girls, and gender conforming boys were found to be more sports involved than gender nonconforming boys. 11,12 Because thinness is not consistent with dominant cultural standards of masculinity, youth who conform to masculinity norms may be more likely than other youth to engage in obesogenic behaviors, such as fast food consumption, 13 overeating, 14 and sedentary behaviors (e.g., TV viewing/sedentary screen time). 15 While gender expression and sexual orientation are distinct constructs, it is important to note that the association between gender expression and sexual orientation is well documented, 16 including in the GUTS cohort.…”

Gender Conformity and Use of Laxatives and Muscle-Building Products in Adolescents and Young Adults

“…18,19 Health behaviors, especially those related to appearance, may be a way of embodying or establishing adherence to gender norms. 17,20,21 Because appearance ideals for girls and women center on thinness, whereas appearance ideals for boys and men focus on muscularity, the likelihood of using products to modify weight, shape, or appearance may be associated with overall gender differences in conformity to femininity and masculinity norms. [22][23][24] Laxative use to maintain or lose weight, particularly among girls and women, may be connected to greater conformity to appearance norms associated with femininity, and muscle-building product use, particularly among boys and men, may be connected to greater conformity to appearance norms associated with masculinity.…”