Feminine girls, masculine boys more likely to engage in behaviors that pose cancer risks

Young people who conform most strongly to norms of masculinity and femininity-the most "feminine" girls and the most "masculine" boys-are significantly more likely than their peers to engage in behaviors that pose cancer risks, according to a new study led by Harvard School of Public Health (HSPH) researchers. The most feminine teenage girls use tanning beds more frequently and are more likely to be physically inactive, while the most masculine teenage boys are more likely to use chewing tobacco and to smoke cigars, compared with their gender-nonconforming peers.

The study, the first to look at cancer risk behaviors in teens based on their gender expression, appears online April 16, 2014 in Journal of Adolescent Health.

"Our findings indicate that socially constructed ideas of masculinity and femininity heavily influence teens' behaviors and put them at increased risk for cancer. Though there is nothing inherently masculine about chewing tobacco, or inherently feminine about using a tanning booth, these industries have convinced some teens that these behaviors are a way to express their masculinity or femininity," said lead author Andrea Roberts, research associate in the Department of Social and Behavioral Sciences at HSPH.

Tobacco use, indoor tanning, and physical inactivity-all risk factors for cancer-are highly prevalent among young people in America. It's known that risk behavior differs according to gender: Boys are more likely to chew tobacco and smoke cigars, while girls are more likely to use tanning beds and be physically inactive.

The researchers analyzed data from 9,435 adolescents (6,010 females and 3,425 males) participating in the ongoing Growing Up Today Study (GUTS), which began enrolling participants from ages 9 to 14 in 1996. Participants who responded to questions about gender expression-how much girls described themselves as "feminine" or boys as "masculine"-and cancer risk behaviors were included in the study.

The results showed that boys who described themselves as very masculine, in terms of their self-image and play preferences in childhood, were almost 80% more likely to use chewing tobacco and 55% more likely to smoke cigars than boys who described themselves as the least masculine. The most feminine girls were 32% more likely to use tanning beds and 16% more likely to be physically inactive than the least feminine girls.

In contrast, the least masculine boys and least feminine girls were more likely to smoke cigarettes. The researchers speculate that these young people may be smoking in response to social stressors, perhaps due to social exclusion or harassment related to their gender nonconformity or perceived sexual orientation.

The study also found that activities such as reading magazines or watching television and movies played a role in promoting certain cancer risk behaviors. For instance, among girls, media engagement accounted for one-third to one-half of the higher likelihood of using tanning beds.

"Engaging in risk behaviors in adolescence likely increases the risk of engaging in similar behaviors in adulthood," said senior author S. Bryn Austin, associate professor in the Department of Social and Behavioral Sciences at HSPH. "So it is important to focus on prevention during the teen years, challenging notions such as 'tanning makes one beautiful' or 'cigar smoking and chewing tobacco is rugged or manly.'"