Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among US High School Students

Purpose: The purpose of this study is to examine the association between gender expression, peer victimization, and disordered weight-control behaviors (DWCBs) in four population-based samples of U.S. high school students. Methods: Analyses include data from 5,488 U.S. high school students from the 2013 Youth Risk Behavior Surveys in four jurisdictions (Broward County, FL; Chicago, IL; Los Angeles, CA; San Diego, CA). Participants were 56% Hispanic/Latino, 21% black/African American, and 14% white. Two items asked about perceived gender expression; responses were classified into three groups: highly gender conforming (e.g., very masculine boys), moderately gender conforming, gender nonconforming (e.g., feminine boys). Sex-stratified multivariable logistic regression models were used to examine the association between gender expression, peer victimization, and DWCBs in previous month (fasting, using diet pills/liquids/ powders, and purging [vomiting or using laxatives]), controlling for potential confounders. Results: Overall, 12% of respondents reported fasting, 6% reported diet pill use, and 5% reported purging, with significantly higher prevalence among gender nonconforming than among gender conforming male students (p < .001). In adjusted models, gender nonconforming male students had greater odds of fasting (odds ratio [95% confidence interval]: 3.0 [2.0-4.7]), diet pill use (6.1 [3.7-9.9]), and purging (7.2 [3.6-14.8]), relative to moderately conforming males. No significant associations were found among female students. Adding peer victimization to models modestly attenuated the association between gender nonconformity and DWCBs for male students. Conclusions: In probability samples of U.S. high school students, we observed marked differences by gender expression in DWCBs among male students but not among female students. Gender expression-related stigma should be addressed within clinical and school-based interventions to prevent DWCBs. (C) 2020 Society for Adolescent Health and Medicine. All rights reserved.