Masculine boys, feminine girls, and cancer risk behaviors: an 11-year longitudinal study

J Adolesc Health. 2014 Sep;55(3):373-9. doi: 10.1016/j.jadohealth.2014.02.020. Epub 2014 Apr 16.


Objective: Cancer risk behaviors often begin in adolescence and persist through adulthood. Tobacco use, indoor tanning, and physical inactivity are highly prevalent, socially patterned cancer risk behaviors, and their prevalence differs strongly by sex. It is therefore possible that these behaviors also differ by gender expression within the sexes due to social patterning.

Methods: We examined whether five cancer risk behaviors differed by childhood gender expression within the sexes and whether patterns of media engagement (e.g., magazine readership and trying to look like media personalities) explained possible differences, in a U.S. population-based cohort (N = 9,435).

Results: The most feminine girls had higher prevalence of indoor tanning (prevalence risk ratio [pRR] = 1.32, 95% confidence interval [CI] = 1.23-1.42) and physical inactivity (pRR = 1.16, 95% CI = 1.01-1.34) and lower prevalence of worse smoking trajectory (prevalence odds ratio = .75, 95% CI = .65-.88) and smoking cigars (pRR = .61, 95% CI = .47-.79) compared with least feminine girls. Media engagement accounted for part of the higher prevalence of indoor tanning. The most masculine boys were more likely to chew tobacco (pRR = 1.78, 95% CI = 1.14-2.79) and smoke cigars (pRR = 1.55, 95% CI = 1.17-2.06) but less likely to follow a worse smoking trajectory (prevalence odds ratio = .69, 95% CI = .55-.87) and be physically inactive (pRR = .54, 95% CI = .43-.69) compared with least masculine boys.

Conclusions: We found some strong differences in patterns of cancer risk behaviors by gender expression within the sexes. Prevention efforts that challenge the "masculinity" of smoking cigarettes and cigars and chewing tobacco and the "femininity" of indoor tanning to reduce their appeal to adolescents should be explored.

Keywords: Cancer; Chewing tobacco; Cigar smoking; Cigarette smoking; Femininity; Masculinity; Physical activity; Tanning.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Female
  • Femininity*
  • Humans
  • Longitudinal Studies
  • Male
  • Masculinity*
  • Mass Media
  • Neoplasms / epidemiology
  • Neoplasms / etiology*
  • Prevalence
  • Risk Factors
  • Risk-Taking*
  • Sedentary Behavior
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Tanning / statistics & numerical data
  • Tobacco, Smokeless / adverse effects
  • United States / epidemiology