nach oben

Erschienen in:

17.03.2017

Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults

verfasst von: Allegra R. Gordon, Nancy Krieger, Cassandra A. Okechukwu, Sebastien Haneuse, Mihail Samnaliev, Brittany M. Charlton, S. Bryn Austin

Erschienen in: Quality of Life Research | Ausgabe 8/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

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.

Methods

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.

Results

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)].

Conclusions

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.

Grossman, A. H., & D’Augelli, A. R. (2006). Transgender youth: invisible and vulnerable. Journal of Homosexuality, 51(1), 111–128. doi:10.1300/J082v51n01_06.CrossRefPubMed

Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN. Retrieved from http://www.glsen.org/article/2013-national-school-climate-survey.

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, D.C.: National Center for Transgender Equality and National Gay and Lesbian Task Force; National Gay and Lesbian Task Force. Retrieved from http://endtransdiscrimination.org/report.html.

Gordon, A. R., & Meyer, I. H. (2007). Gender nonconformity as a target of prejudice, discrimination, and violence against LGB individuals. Journal of LGBT Health Research, 3(3), 55–71.CrossRefPubMed

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. doi:10.1037/0033-2909.129.5.674.CrossRefPubMedPubMedCentral

Meyer, I. H., Schwartz, S., & Frost, D. M. (2008). Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources? Social Science & Medicine (1982), 67(3), 368–379. doi:10.1016/j.socscimed.2008.03.012.CrossRef

Roberts, A. L., Rosario, M., Corliss, H. L., Koenen, K. C., & Austin, S. B. (2012). Childhood gender nonconformity: A risk indicator for childhood abuse and posttraumatic stress in youth. Pediatrics, 129(3), 410–417. doi:10.1542/peds.2011-1804.CrossRefPubMedPubMedCentral

Roberts, A. L., Rosario, M., Slopen, N., Calzo, J. P., & Austin, S. B. (2013). Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: an 11-year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 52(2), 143–152. doi:10.1016/j.jaac.2012.11.006.CrossRefPubMed

Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2010). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46(6), 1580–1589. doi:10.1037/a0020705.CrossRefPubMed

10.

Bontempo, D. E., & D’Augelli, A. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 30(5), 364–374.CrossRef

11.

Plöderl, M., & Fartacek, R. (2007). Childhood gender nonconformity and harassment as predictors of suicidality among gay, lesbian, bisexual, and heterosexual Austrians. Archives of Sexual Behavior, 38(3), 400–410. doi:10.1007/s10508-007-9244-6.CrossRefPubMed

12.

Borrell, L. N., Jacobs, D. R. Jr., Williams, D. R., Pletcher, M. J., Houston, T. K., & Kiefe, C. I. (2007). Self-reported racial discrimination and substance use in the Coronary Artery Risk Development in Adults Study. American Journal of Epidemiology, 166(9), 1068–1079. doi:10.1093/aje/kwm180.CrossRefPubMed

13.

Krieger, N. (2014). Discrimination and health inequities. In Social epidemiology (2nd ed., pp. 63–125). Oxford: Oxford University Press.

14.

Beatty, D. L., Matthews, K. A., Bromberger, J. T., & Brown, C. (2014). Everyday discrimination prospectively predicts inflammation across 7-years in racially diverse midlife women: Study of Women’s Health Across the Nation. The Journal of Social Issues, 70(2), 298–314. doi:10.1111/josi.12061.CrossRefPubMedPubMedCentral

15.

Lepore, S. J., Revenson, T. A., Weinberger, S. L., Weston, P., Frisina, P. G., Robertson, R., … Cross, W. (2006). Effects of social stressors on cardiovascular reactivity in Black and White women. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 31(2), 120–127. doi:10.1207/s15324796abm3102_3.CrossRef

16.

Case, P., Bryn Austin, S., Hunter, D. J., Manson, J. E., Malspeis, S., Willett, W. C., & Spiegelman, D. (2004). Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. Journal of Women’s Health, 13(9), 1033–1047.CrossRefPubMed

17.

Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding (consensus report). Washington, D.C.: Institute of Medicine: committee on lesbian, gay, bisexual, and transgender health issues and research gaps and opportunities. Retrieved from http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx.

18.

Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. American Journal of Public Health, 103(10), 1802–1809. doi:10.2105/AJPH.2012.301110.CrossRefPubMedPubMedCentral

19.

Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100(10), 1953–1960. doi:10.2105/AJPH.2009.174169.CrossRefPubMedPubMedCentral

20.

Ma, H., Saint-hilaire, M., Thomas, C. A., & Tickle-degnen, L. (2016). Stigma as a key determinant of health-related quality of life in Parkinson’s disease. Quality of Life Research, 25(12), 3037–3045. doi:10.1007/s11136-016-1329-z.CrossRefPubMed

21.

Holzemer, W. L., Human, S., Arudo, J., Rosa, M. E., Hamilton, M. J., Corless, I., … Maryland, M. (2009). Exploring HIV stigma and quality of life for persons living with HIV infection. Journal of the Association of Nurses in AIDS Care, 20(3), 161–168. doi:10.1016/j.jana.2009.02.002.CrossRefPubMed

22.

Hutton, V. E., Misajon, R., & Collins, F. E. (2013). Subjective wellbeing and “felt” stigma when living with HIV. Quality of Life Research, 22(1), 65–73. doi:10.1007/s11136-012-0125-7.CrossRefPubMed

23.

Goffman, E. (1963). Stigma; notes on the management of spoiled identity. Englewood Cliffs, NJ, Prentice-Hall

24.

Wylie, S., Corliss, H. L., Boulanger, V., Prokop, L. A., & Austin, S. B. (2010). Socially assigned gender nonconformity: A brief measure for use in surveillance and investigation of health disparities. Sex Roles. doi:10.1007/s11199-010-9798-y.PubMedPubMedCentral

25.

Courtenay, W. H. (2000). Engendering health: A social constructionist examination of men’s health beliefs and behaviors. Psychology of Men & Masculinity, 1(1), 4–15. doi:10.1037/1524-9220.1.1.4.CrossRef

26.

Iwamoto, D. K., Cheng, A., Lee, C. S., Takamatsu, S., & Gordon, D. (2011). “Man-ing” up and getting drunk: the role of masculine norms, alcohol intoxication and alcohol-related problems among college men. Addictive Behaviors, 36(9), 906–911. doi:10.1016/j.addbeh.2011.04.005.CrossRefPubMedPubMedCentral

27.

Pachankis, J. E., Westmaas, J. L., & Dougherty, L. R. (2011). The influence of sexual orientation and masculinity on young men’s tobacco smoking. Journal of Consulting and Clinical Psychology, 79(2), 142–152. doi:10.1037/a0022917.CrossRefPubMed

28.

Hammond, W. P. (2012). Taking it like a man: masculine role norms as moderators of the racial discrimination-depressive symptoms association among African American men. American Journal of Public Health, 102(Suppl 2), S232–S241. doi:10.2105/AJPH.2011.300485.CrossRefPubMedPubMedCentral

29.

Halkitis, P. N., Moeller, R. W., Siconolfi, D. E., Jerome, R. C., Rogers, M., & Schillinger, J. (2008). Methamphetamine and poly-substance use among gym-attending men who have sex with men in New York City. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 35(1), 41–48. doi:10.1007/s12160-007-9005-8.CrossRef

30.

Hammond, W. P., Matthews, D., Mohottige, D., & Agyemang, A. (2010). Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men. Journal of General Internal Medicine, 25(12), 1300–1308.CrossRefPubMedPubMedCentral

31.

Calzo, J. P., Roberts, A. L., Corliss, H. L., Blood, E. A., Kroshus, E., & Austin, S. B. (2014). Physical activity disparities in heterosexual and sexual minority youth ages 12–22 years old: roles of childhood gender nonconformity and athletic self-esteem. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 47(1), 17–27. doi:10.1007/s12160-013-9570-y.CrossRef

32.

Roberts, A. L., Rosario, M., Calzo, J. P., Corliss, H. L., Frazier, L., & Austin, S. B. (2014). Masculine boys, feminine girls, and cancer risk behaviors: An 11-year longitudinal study. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine. doi:10.1016/j.jadohealth.2014.02.020.

33.

Davison, K. K., Schmalz, D. L., & Downs, D. S. (2010). Hop, skip... no! Explaining adolescent girls’ disinclination for physical activity. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 39(3), 290–302. doi:10.1007/s12160-010-9180-x.CrossRef

34.

Granié, M.-A. (2010). Gender stereotype conformity and age as determinants of preschoolers’ injury-risk behaviors. Accident; Analysis and Prevention, 42(2), 726–733. doi:10.1016/j.aap.2009.10.022.CrossRefPubMed

35.

Greytak, E. A., Gill, A., Conron, K. J., Matthews, P. A., Scout Reisner, S. L., … Tamar-Mattis, A. (2014). Identifying transgender and other gender minority respondents on population-based surveys: Special considerations for adolescents, race/ethnicity, socioeconomic status, and intersex status. In J. L. Herman (Ed.), Best Practices for Asking Questions to Identify Transgender and Other Gender Minority Respondents on Population-Based Surveys (pp. 29–43). Los Angeles, CA: The Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/geniuss-report-sep-2014.pdf.

36.

EuroQol Group. (2014). http://www.euroqol.org. Retrieved Jan. 22, 2014 from http://www.euroqol.org/about-eq-5d.html.

37.

Luo, N., Johnson, J. A., Shaw, J. W., Feeny, D., & Coons, S. J. (2005). Self-reported health status of the general adult US population as assessed by the EQ-5D and health utilities index. Medical Care, 43(11), 1078–1086.CrossRefPubMed

38.

Johnson, J. A., Luo, N., Shaw, J. W., Kind, P., & Coons, S. J. (2005). Valuations of EQ-5D health states: are the United States and United Kingdom different? Medical care, 43(3), 221–228.CrossRefPubMed

39.

Agency for Healthcare Research and Quality. (2012). U.S. valuation of the EuroQol EQ-5D(TM) health states (text). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/rice/EQ5Dproj.htm.

40.

van Hout, B., Janssen, M. F., Feng, Y.-S., Kohlmann, T., Busschbach, J., Golicki, D., … Pickard, A. S. (2012). Interim scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L value sets. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 15(5), 708–715. doi:10.1016/j.jval.2012.02.008.CrossRef

41.

Shaw, J. W., Johnson, J. A., & Coons, S. J. (2005). US valuation of the EQ-5D health states: Development and testing of the D1 valuation model. Medical Care, 43(3), 203–220.CrossRefPubMed

42.

Lubetkin, E. I., Jia, H., Franks, P., & Gold, M. R. (2005). Relationship among sociodemographic factors, clinical conditions, and health-related quality of life: Examining the EQ-5D in the U.S. general population. Quality of Life Research, 14(10), 2187–2196. doi:10.1007/s11136-005-8028-5.CrossRefPubMed

43.

Liang, K.-Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73(1), 13–22.CrossRef

44.

Horton, N. J., & Kleinman, K. P. (2007). Much ado about nothing: A comparison of missing data methods and software to fit incomplete data regression models. The American Statistician, 61(1), 79–90. doi:10.1198/000313007X172556.CrossRefPubMedPubMedCentral

45.

Collins, L. M., Schafer, J. L., & Kam, C.-M. (2001). A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychological Methods, 6(4), 330.CrossRefPubMed

46.

Yuan, Y. (2011). Multiple imputation using SAS software. Journal of Statistical Software, 45(6), 1–25.CrossRef

47.

Goldsmith, K. A., Dyer, M. T., Schofield, P. M., Buxton, M. J., & Sharples, L. D. (2009). Relationship between the EQ-5D index and measures of clinical outcomes in selected studies of cardiovascular interventions. Health and Quality of Life Outcomes, 7(1), 96. doi:10.1186/1477-7525-7-96.CrossRefPubMedPubMedCentral

48.

Friedman, M. S., Koeske, G. F., Silvestre, A. J., Korr, W. S., & Sites, E. W. (2006). The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 38(5), 621–623. doi:10.1016/j.jadohealth.2005.04.014.CrossRef

49.

Landolt, M. A., Bartholomew, K., Saffrey, C., Oram, D., & Perlman, D. (2004). Gender nonconformity, childhood rejection, and adult attachment: A study of gay men. Archives of Sexual Behavior, 33(2), 117–128. doi:10.1023/B:ASEB.0000014326.64934.50.CrossRefPubMed

50.

Liu, R. T., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. American Journal of Preventive Medicine, 42(3), 221–228. doi:10.1016/j.amepre.2011.10.023.CrossRefPubMed

51.

Remafedi, G., Farrow, J. A., & Deisher, R. W. (1991). Risk factors for attempted suicide in gay and bisexual youth. Pediatrics, 87(6), 869–875.PubMed

52.

Rieger, G., & Savin-Williams, R. C. (2012). Gender nonconformity, sexual orientation, and psychological well-being. Archives of Sexual Behavior, 41(3), 611–621. doi:10.1007/s10508-011-9738-0.CrossRefPubMed

53.

Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460.CrossRef

54.

Keeshin, B. R., Cronholm, P. F., & Strawn, J. R. (2012). Physiologic changes associated with violence and abuse exposure: An examination of related medical conditions. Trauma, Violence & Abuse, 13(1), 41–56. doi:10.1177/1524838011426152.CrossRef

55.

Corliss, H. L., Rosario, M., Wypij, D., Wylie, S. A., Frazier, A. L., & Austin, S. B. (2010). Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents. Addictive Behaviors, 35(5), 517–521. doi:10.1016/j.addbeh.2009.12.019.CrossRefPubMedPubMedCentral

56.

Corliss, H. L., Rosario, M., Wypij, D., Fisher, L. B., & Austin, S. B. (2008). Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: Findings from the Growing Up Today Study. Archives of Pediatrics & Adolescent Medicine, 162(11), 1071–1078. doi:10.1001/archpedi.162.11.1071.CrossRef

57.

Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., … Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction (Abingdon, England), 103(4), 546–556. doi:10.1111/j.1360-0443.2008.02149.x.CrossRef

58.

Austin, S. B., Ziyadeh, N. J., Calzo, J. P., Kennedy, G. A., Roberts, A. L., Haines, J., & Scherer, E. A. (2016). Gender expression associated with BMI in a prospective cohort study of U.S. adolescents. Obesity, 24(2), 506–515. doi:10.1002/oby.21338.CrossRefPubMedCentral

59.

Okifuji, A., & Hare, B. D. (2015). The association between chronic pain and obesity. Journal of Pain Research, 8, 399–408. doi:10.2147/JPR.S55598.CrossRefPubMedPubMedCentral

60.

Sønderlund, A. L., O’Brien, K., Kremer, P., Rowland, B., De Groot, F., Staiger, P., … Miller, P. G. (2014). The association between sports participation, alcohol use and aggression and violence: a systematic review. Journal of Science and Medicine in Sport /Sports Medicine Australia, 17(1), 2–7. doi:10.1016/j.jsams.2013.03.011.CrossRef

61.

Sorenson, S. B. (2011). Gender disparities in injury mortality: Consistent, persistent, and larger than you’d think. American Journal of Public Health, 101(Suppl 1), S353–S358. doi:10.2105/AJPH.2010.300029.CrossRefPubMedPubMedCentral

62.

Rieger, G., Linsenmeier, J. A. W., Gygax, L., & Bailey, J. M. (2008). Sexual orientation and childhood gender nonconformity: Evidence from home videos. Developmental Psychology, 44(1), 46–58. doi:10.1037/0012-1649.44.1.46.CrossRefPubMed

Titel: Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults
verfasst von: Allegra R. Gordon
Nancy Krieger
Cassandra A. Okechukwu
Sebastien Haneuse
Mihail Samnaliev
Brittany M. Charlton
S. Bryn Austin
Publikationsdatum: 17.03.2017
Verlag: Springer International Publishing
Erschienen in: Quality of Life Research / Ausgabe 8/2017
Print ISSN: 0962-9343
Elektronische ISSN: 1573-2649
DOI: https://doi.org/10.1007/s11136-017-1545-1

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2017

Pathways linking obesity to health-related quality of life

Erratum to: The patient-reported outcome content of international ovarian cancer randomised controlled trial protocols

The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L

Erratum to: Using a discrete choice experiment to value the QLU-C10D: feasibility and sensitivity to presentation format

Health-related quality of life in patients receiving long-term opioid therapy: a systematic review with meta-analysis

Development and refinement of the WAItE: a new obesity-specific quality of life measure for adolescents