For the first time, a study - published in the Journal of Adolescent Health - has linked cancer risk in teenagers to gendered behaviors.
More precisely, the researchers behind the new study - from Harvard School of Public Health (HSPH) in Boston, MA - found that the most "feminine" girls and the most "masculine" boys were much more likely to take part in activities that are associated with cancer risk.
The research team drew their data from the ongoing Growing Up Today Study, which began recruiting participants aged between 9 and 14 in 1996.
The study looked at answers from 6,010 girls and 3,425 boys who responded to questions about gender expression. That is, how much the respondents considered themselves to be "feminine" or "masculine." The data on cancer risk behaviors was also included in the study.
Boys who described themselves as being very masculine in terms of self-image were almost 80% more likely to chew tobacco and 55% more likely to smoke cigars than the boys who described themselves as the least masculine.
Girls who described themselves as being very feminine were 32% more likely to use tanning beds and 16% more likely to be physically inactive than the girls who classed themselves as the least feminine.
Media was also shown to have a big influence on teens' behavior. About one third to one half of the girls who used tanning beds reported being influenced by magazines, TV or movies to use tanning beds.
Those four behaviors - chewing tobacco, smoking cigars, using tanning beds and being physically inactive - are all associated with cancer risk.
'Least' gender-conforming teens are 'most likely to smoke cigarettes'
This might suggest that teenagers who conform most strongly to gender norms are the most likely to engage in risky behaviors. However, the least masculine and the least feminine boys and girls in the study were also the most likely to smoke cigarettes.
Medical News Today asked lead author Andrea Roberts, PhD, research associate at the Department of Social and Behavioral Health at HSPH, about how this affected the study's central message of strong gender conformity being associated with cancer risk.
If, as the most nonconforming boys and girls were both more likely to smoke - a cancer risk - than the most strongly conforming boys and girls, might it instead be extremes of gender identity that are associated with cancer risk, rather than just strong gender conformity?
She explained that it would not be entirely accurate to assume this, "since the risks differed so much by particular behavior." So the feminine girls who tanned and the masculine boys who chewed tobacco were still more at risk than the nonconforming boys and girls who smoked.
About one third to one half of girls using tanning beds reported being influenced by magazines, TV or movies to do so.
"In general," she continued, "it would be accurate to say that in almost every case that we see sex differences in cancer risk behavior in teens, we also see difference within each sex by gender expression in the same direction."
"Cigarette smoking among boys was the real exception to this, in that cigarette smoking is more common in boys than girls, but was less common in the most masculine boys compared with less masculine boys," she added.
Dr. Roberts speculates that this might be because the least gender-conforming teens are more likely to be excluded or harassed, and so they could be smoking out of stress.
"We know from our own prior research that gender nonconforming kids are more likely to be bullied in adolescence," she told Medical News Today. "We also know from our own research that gender nonconforming kids are more likely to experience child abuse in their families, and to be depressed in adolescence - in particular, gender nonconforming heterosexual boys."
Roberts also cited other studies that display a high bias from high school students against behavior that does not conform to gender norms:
"Perhaps even more so than minority sexual orientation - gay, lesbian, bisexual. There is also good evidence from other studies that teens take up smoking in an attempt to fit in socially and in response to stress."
Socially constructed ideas of gender 'put teens at increased risk for cancer'
Roberts asserts that the study's overall findings indicate that socially constructed ideas of masculinity and femininity heavily influence teens' behaviors and put them at increased risk for cancer.
Speaking in particular about the tobacco and tanning behaviors, she says that although there is nothing inherently gendered about these activities, "these industries have convinced some teens that these behaviors are a way to express their masculinity or femininity."
Senior author S. Bryn Austin, associate professor in the Department of Social and Behavioral Sciences, concludes:
"Engaging in risk behaviors in adolescence likely increases the risk of engaging in similar behaviors in adulthood. 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.'"
Recently, another study found that youths of same-sex orientation are more likely to engage in behaviors associated with cancer risk than heterosexual youths.
Commenting on that study, Dr. Roberts said that although the two studies produced quite different results, they "together show that gender expression - whether nonconformity or the opposite, high masculinity or high femininity - and sexual orientation are distinct things and are associated with risk behaviors in different ways."