142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Socially assigned gender expression and health-related quality of life in a cohort of young adults

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 4:30 PM - 4:50 PM

Allegra R. Gordon, MPH , Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
Mihail Samnaliev, PhD, MS , Children's Hospital Boston, Boston, MA
Brittany Charlton, ScD , Department of Epidemiology, Harvard School of Public Health, Boston, MA
Najat Ziyadeh , Children's Hospital Boston, Boston, MA
S. Bryn Austin, ScD , Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Background: Violating societal norms for masculine and feminine appearance and behavior puts one at heightened risk of harassment and discrimination, but the impact of these adverse experiences on health-related quality of life (HRQL) is unknown.

Purpose: To examine the relationship between gender expression and HRQL in a U.S. cohort.

Methods: Using data from the Growing Up Today Study (n=4,769), a prospective cohort of young adults, we assessed socially assigned gender expression with a self-report measure on how others perceive one’s appearance and mannerisms, from very feminine to very masculine.  A gender-specific continuous summary score was created (range: 1 [most conforming] to 7 [most nonconforming]). To assess HRQL, we used the EQ-5D, a population standardized instrument recommended in health economics (range: 0 [low] to 1 [high]). We used multivariable linear models, adjusted for age, race/ethnicity, and sexual orientation, to model the relationship between socially assigned gender expression and HRQL.

Results: Among women, mean HRQL ranged from 0.881 (SD=0.097) for those reporting greatest gender nonconformity to 0.927 (SD=0.090) for those reporting greatest conformity. Disparities were similar among men. In adjusted models, greater gender nonconformity was associated with a statistically significant decrement in HRQL for both women and men (women: β=-0.016, SE=0.002, p<0.001; men: β=-0.014, SE=0.004, p<0.001).

Discussion: This is the first study to document decrements in HRQL associated with socially assigned gender nonconformity and use a measure suitable for cost-effectiveness analysis. Our findings will inform future research on the degree to which these disparities may be explained by gender-related stigma and discrimination.

Learning Areas:

Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
Differentiate between gender identity and gender expression and discuss why they might have distinct implications for understanding and promoting women’s health. Describe one or more pathways by which gender nonconformity might contribute to lower health-related quality of life in young adulthood.

Keyword(s): Gender, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved in the field of public health for the past 13 years and in public health research for the past 10. I am currently a 4th year doctoral student studying social epidemiology, with a focus on the health effects of stigma and discrimination in relation to sexuality and gender.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.