Gender performance and adolescent health trajectories
Authors: Caroline Moreau
Journal: The Lancet Child & Adolescent Health (2019)

In The Lancet Child & Adolescent Health, Holly Shakya and colleagues1Shakya HB Domingue B Nagata JM et al.Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study.Lancet Child Adolesc Health. 2019; (published online May 30.)http://dx.doi.org/10.1016/S2352-4642(19)30160-9PubMed Scopus (31) Google Scholar adopt a biosocial approach to understanding gender pathways to health during the transition into adulthood. Their Article contributes to two emerging bodies of research: exploring gender socialisation in early adolescence and the concept of gender embodiment,2Krieger N Genders, sexes, and health: what are the connections—and why does it matter?.Int J Epidemiol. 2003; 32: 652-657Crossref PubMed Scopus (433) Google Scholar which describes the ways in which social processes inform physiological responses. Moving away from a biomedical perspective, which typically confounds gender and sex, the authors show how, in early to middle adolescence, gender performance—ie, the degree to which adolescents conform to the behaviours of their same-sex peers—informs health behaviours and outcomes that persist into young adulthood. The study by Shakya and colleagues1Shakya HB Domingue B Nagata JM et al.Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study.Lancet Child Adolesc Health. 2019; (published online May 30.)http://dx.doi.org/10.1016/S2352-4642(19)30160-9PubMed Scopus (31) Google Scholar improves on previous research in several ways. First, the examination of gender performance within sex categories illuminates how gender, as a social phenomenon, informs health beyond the biological contribution of sex. Second, their study highlights the complex association between gender and health, and it shows how both conformity and non-conformity to gender-typed behaviours simultaneously affect behaviours that are risk increasing or protective. Although masculinity promotes healthy physical activity, it can also encourage unhealthy diets, smoking, and alcohol consumption, which are behaviours that jeopardise cardiovascular health in the long term. Similarly, although femininity decreases the risk of substance abuse, it confers greater susceptibility to depression, which contributes to the gender divide in mental health disorders that persist over the life course. Shakya and colleagues1Shakya HB Domingue B Nagata JM et al.Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study.Lancet Child Adolesc Health. 2019; (published online May 30.)http://dx.doi.org/10.1016/S2352-4642(19)30160-9PubMed Scopus (31) Google Scholar demonstrate the enduring and intensifying effect of gender performance on health behaviours by use of a longitudinal design that examined individuals over the course of 13–14 years. This study design allows us to observe not only the temporality of associations, but it also draws attention to the importance of considering adolescence as a “foundation for future health”.3Sawyer SM Afifi RA Bearinger LH et al.Adolescence: a foundation for future health.Lancet. 2012; 379: 1630-1640Summary Full Text Full Text PDF PubMed Scopus (1298) Google Scholar With this long-term perspective, the authors show how gender expression is sustained over the course of adolescence and contributes to health disparities in early adulthood.4Kahn NF Halpern CT Is developmental change in gender-typed behavior associated with adult sexual orientation?.Dev Psychol. 2019; 55: 855-865Crossref PubMed Scopus (7) Google Scholar Finally, the study by Shakya and colleagues1Shakya HB Domingue B Nagata JM et al.Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study.Lancet Child Adolesc Health. 2019; (published online May 30.)http://dx.doi.org/10.1016/S2352-4642(19)30160-9PubMed Scopus (31) Google Scholar provides initial interpretative insights on the gendered pathways to health, including behavioural outcomes, self-reported health status, and biomarkers. Although their results indicate consistent associations between gender expression and depressive symptoms or self-reported diagnosis of depression among women in adulthood, this result was not found for high blood pressure. Self-reported blood pressure was shown to be lower among hypermasculine men, whereas no association was found with objective measures of blood pressure. Such discordance could signal differential gender interactions with the health system, which emerge in adolescence and result in disparities in opportunities to access health promoting interventions. The results of this study call for an immediate application of gender transformative interventions that challenge gender ideologies, from which the performance of gender effects the development of unhealthy bodies. Specifically, the study reaffirms the importance of addressing gender inequities in early adolescence before identities solidify4Kahn NF Halpern CT Is developmental change in gender-typed behavior associated with adult sexual orientation?.Dev Psychol. 2019; 55: 855-865Crossref PubMed Scopus (7) Google Scholar, 5Blum RW Mmari K Moreau C It begins at 10: how gender expectations shape early adolescence around the world.J Adolesc Health. 2017; 61: S3-S4Summary Full Text Full Text PDF PubMed Scopus (86) Google Scholar because gender intensification seems to follow as a social extension of adolescence, peaking in early adulthood.4Kahn NF Halpern CT Is developmental change in gender-typed behavior associated with adult sexual orientation?.Dev Psychol. 2019; 55: 855-865Crossref PubMed Scopus (7) Google Scholar The study findings also stress the need to apply a gender lens towards improving the health of all people, including boys who are disincentivised to adopt healthy behaviours to gain social status.6Patton GC Darmstadt GL Petroni S Sawyer SM A gender lens on the health and well-being of young males.J Adolesc Health. 2018; 62: S6-S8Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar, 7Courtenay WH Constructions of masculinity and their influence on men's well-being- a theory of gender and health.Soc Sci Med. 2000; 50: 1385-1401Crossref PubMed Scopus (2575) Google Scholar Building on the study findings, research efforts should expand on several areas of enquiries to enhance our current knowledge and inform future gender transformative programmes. In light of the diversification of gender identities, a greater understanding of the health implications of gender expressions and discrimination is needed to inform gender-inclusive programmes and to address the social vulnerabilities of gender and sexual minorities.8Blondeel K Say L Chou D et al.Evidence and knowledge gaps on the disease burden in sexual and gender minorities: a review of systematic reviews.Int J Equity Health. 2016; 15: 16Crossref PubMed Scopus (56) Google Scholar Additionally, beyond the behavioural expressions of gender, gender normative expectations and experiences of gender discrimination need further consideration, since they can independently contribute to health disparities. Addressing health inequalities associated with gender also requires a greater understanding of the ways in which gender intersects with other processes of social stratification, including social class, race or ethnicity, caste, or migration, in shaping adolescent behaviours that affect health in the short term and the long term.9Iyer A Sen G Östlin P The intersections of gender and class in health status and health care.Glob Public Health. 2008; 3: 13-24Crossref PubMed Scopus (95) Google Scholar Finally, longer periods of observation are warranted to fully evaluate the contribution of gender to individual health trajectories and to the overall burden of disease. Additional work is needed to identify and quantify the gendered pathways contributing to health disparities, including differences in exposures and vulnerabilities, behaviours, and health-care use and response.10WHOA conceptual framework for action on the social determinants of health: debates, policy & practice, case studies.http://apps.who.int/iris/bitstream/10665/44489/1/9789241500852_eng.pdfDate: 2010Date accessed: October 4, 2018Google Scholar I declare no competing interests. Adolescent gender norms and adult health outcomes in the USA: a prospective cohort studyWe found compelling evidence that adolescent gender expression is correlated with health in adulthood independently of gender expression as an adult. Although more research is needed to identify causal mechanisms, our results suggest that those designing health behaviour interventions should carefully consider integrating gender transformative components into interventions. Full-Text PDF Open Access