Nonconforming Gender Expression and Associated Mental Distress and Substance Use Among High School Students
Nonconforming Gender Expression and Associated Mental Distress and Substance Use Among High School Students
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DOI：
10.1001/jamapediatrics.2018.2140
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发表时间：
2018-11-01
期刊：
影响因子：
26.1
通讯作者：
Kann, Laura K.
中科院分区：
文献类型：
--
作者：
Lowry, Richard;Johns, Michelle M.;Kann, Laura K.
基于性别的文化角色和对个人的期望通常会影响健康行为和结果。性别不一致（GNC）（即，性别表达，不同于社会期望的女性或男性的外观和行为）是一个未充分研究的领域，青少年健康，往往与负面的健康outcomes. ObjectiveTo研究协会的GNC与精神困扰和物质使用的高中生。基于2015年进行的青年风险行为调查（YRBS）数据的横断面研究。背景是美国3个大城市学区（2个在加州，1个在佛罗里达）。参与者是一个种族/民族多样化的人口为基础的样本，6082名高中生代表所有公立学校的学生在9年级至12参加这3个学区。（根据种族/民族、年级、和性别认同），（非常/大部分/有点女性化的男生或非常/大部分/有点男性化的女生）和中等性别比例的学生（同样的女性和男性学生）相对于低性别比学生的参考组（非常/大多/有点男性化的男生或非常/大多/有点女性化的女生）。（15.9%）为白色，891（19.1%）为黑人，3163（55.1%）为西班牙裔，1008（9.9%）为其他人种/种族。女大学生（2919 [研究人群的50.0%]），中度GNC与悲伤和绝望感显著相关（APR，1.22; 95% CI，1.05-1.41），严重考虑自杀（APR，1.41; 95%CI，1.14-1.74），并制定自杀计划（APR，1.52; 95%CI，1.22-1.89）;然而，物质使用与GNC无关。男性学生的（3139 [研究人群的50.0%]），中度GNC与悲伤和绝望感相关（APR，1.55; 95% CI，1.25-1.92）;高GNC与严重考虑自杀未遂相关（APR，1.72; 95%CI，1.16-2.56），制定自杀计划（APR，1.79; 95% CI，1.17-2.73），自杀未遂（APR，2.78; 95% CI，1.75-4.40），以及处方药的非医疗使用（APR，1.81; 95% CI，1.23-2.67），可卡因使用（APR，2.84; 95% CI，1.80-4.47），甲基苯丙胺使用（APR，4.52; 95% CI，2.68-7.61），海洛因使用（APR，4.59; 95% CI，2.48-8.47），和注射药物使用结论和相关性本研究表明，在男女学生中，精神痛苦与GNC相关。在男生中，物质使用似乎也与GNC密切相关。这些研究结果强调并建议实施以学校为基础的计划，以防止物质使用和促进学生的心理健康，包括学生的性别多样性的重要性。
IMPORTANCE The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes.OBJECTIVE To examine the associations of GNC with mental distress and substance use among high school students.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts.MAIN OUTCOMES AND MEASURES Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students).RESULTS Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70).CONCLUSIONS AND RELEVANCE This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students.