Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults.
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.
Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA. argordon@mail.harvard.edu.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA. argordon@mail.harvard.edu.
Allegra R
0000-0002-5731-7215
AR
Gordon
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Nancy
N
Krieger
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Cassandra A
CA
Okechukwu
Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Sebastien
S
Haneuse
Department of Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.|Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, USA.
Mihail
M
Samnaliev
Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Brittany M
BM
Charlton
Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA.|Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.|Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
S Bryn
SB
Austin
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D012725:Sexual Behavior / Q000523:psychology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
EQ5D; Femininity; Gender nonconformity; Health-related quality of life; Masculinity; Stigma