Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults
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Gender nonconformity, that is, transgressing conventionally “masculine” vs. “feminine” characteristics, is often stigmatized. Stigmatization and discrimination are social stressors that raise risk of adverse mental and physical health outcomes and may drive health inequities. However, little is known about the relationship between such social stressors and health-related quality of life (HRQOL). This paper aimed to examine associations between perceived gender nonconformity and HRQOL in a cohort of U.S. adolescents and young adults.
Using data from 8408 participants (18–31 years) in the U.S. Growing Up Today Study (93% white, 88% middle-to-high income), we estimated risk ratios (RRs) for the association of gender nonconformity (three levels: highly gender conforming, moderately conforming, and gender nonconforming) and HRQOL using the EuroQol questionnaire (EQ-5D-5L). Models were adjusted for demographic characteristics, including sexual orientation identity.
Gender nonconformity was independently associated with increased risk of having problems with mobility [RR (95% confidence interval): 1.76 (1.16, 2.68)], usual activities [2.29 (1.67, 3.13)], pain or discomfort [1.59, (1.38, 1.83)], and anxiety or depression [1.72 (1.39, 2.13)], after adjusting for sexual orientation and demographic characteristics. Decrements in health utility by gender nonconformity were observed: compared to persons who were highly gender conforming, mean health utility was lower for the moderately gender conforming [beta (SE): −0.011 (.002)] and lowest for the most gender nonconforming [−0.034 (.005)].
In our study, HRQOL exhibited inequities by gender nonconformity. Future studies, including in more diverse populations, should measure the effect of gender-related harassment, discrimination, and violence victimization on health and HRQOL.
KeywordsMasculinity Femininity Stigma EQ5D Gender nonconformity Health-related quality of life
Data analyses and article preparation were supported by the Kate and Murray Seiden and Frank Denny Fund for Children Scholarship received by A. R. Gordon. A. R. Gordon is also supported by F32DA042506 from the National Institute of Drug Abuse. The Growing Up Today Study (R01HD057368 and R01HD066963) and B. M. Charlton (F32HD084000) are supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. S. B. Austin is supported by the Maternal and Child Health Bureau, Health Resources Services Administration, U.S. Department of Health & Human Services (T71-MC00009 and T76-MC00001) and C. A. Okechukwu is supported by T76-MC00001. The funders had no role in the study other than the funding. The authors would like to thank the members of the Sexual Orientation, Gender Identity & Expression (SOGIE) Working Group and the GUTS team of investigators for their contributions to this paper. The authors would also like to express their gratitude to the thousands of young people across the country participating in the Growing Up Today Study.
Compliance with ethical standards
Conflict of interest
The authors declare they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The Brigham and Women’s Hospital Institutional Review Board approved this study.
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