Boston, MA -- 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.'"

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HSPH's Lindsay Frazier, associate professor in the Department of Epidemiology, was a co-author on the study.

Funding for the study came from NIH grants HD066963 and HD057368, and from the Maternal and Child Health Bureau, Health Resources and Services Administration, training grants MC00001 and Leadership Education in Adolescent Health Project 6T71-MC00009.

"Masculine boys, feminine girls and cancer risk behaviors: An 11-year longitudinal study," Andrea L. Roberts, Margaret Rosario, Jerel P. Calzo, Heather L. Corliss, Lindsay Frazier, S. Bryn Austin, Journal of Adolescent Health, online April 16, 2014.

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives--not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.

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