Male gender expression in schools is associated with substance abuse later in life

Group of male teenage students walking together

A new study led by researchers at the University of Chicago found that changes in male gender expression from adolescence to young adulthood align closely with the gender norms present in individuals’ school environments, and that these trajectories are associated with subsequent patterns of substance abuse.

Amidst a growing consensus among social science researchers that separates gender from biological sex, gender has come to be defined as a constellation of expected behaviors, attributes, preferences and beliefs typically associated with a specific gender identity. Prior research shows that traditional models of male gender identity, constructed over time through sociocultural processes and interactions, can be a risk factor for unhealthy behaviors.

With that background, the UChicago researchers set out to explore how sociocultural pressures around male gender in particular might evolve in relation to environmental factors, and how that change could impact a person's long-term health in specific ways.

“There’s a real misconception that men aren’t particularly sensitive or emotional,” said Nathaniel Glasser, MD, a general internist and pediatrician at UChicago Medicine and lead author on the paper. “In reality, I think men’s emotions simply present differently because of the impact of sociocultural narratives telling them not to express emotions through tears or words that construe weakness. And they can face especially harsh social and psychological penalties if they fail to live up to the norms of their gender identity.”

“We set out to investigate how that often-overlooked sensitivity among cisgender men might manifest in a reluctance to engage in healthy behaviors, as well as an over-engagement in health risk behaviors in an effort to convey dominance and reduce vulnerability,” Glasser said.

Impact of gender dynamics within school environments

The UChicago researchers used data from a nationally representative longitudinal cohort study called Add Health. In the initial round of data collection in the 1990s, the study enrolled large numbers of participants who attended the same schools, which enabled granular social network mapping and analyses. Rather than being limited to analyzing data from individuals out of context, researchers could find out how each person compared to their peers in gender expression and who they identified as people close to them.

Using a previously validated technique, Glasser and his colleagues Jacob Jameson, Elizabeth Tung, Stacy Lindau and Harold Pollack measured male gender expression quantitatively by analyzing survey responses to survey items that were found to be answered most differently by male versus female respondents, such as frequency of crying and military service. Importantly, this empirically derived method helped them avoid projecting today’s gender norms onto adolescents in the 1990s.

The researchers found that the way adolescent boys at a school are enacting their gender has a significant impact on other males who attend that school, shaping the ways those same males respond to sociocultural pressures around male gender as young adults. That in turn predicts their likelihood of engaging in substance abuse.

Adolescent boys whose gender expression was further from their school’s norm showed the greatest change in their gender expression as young adults, shifting toward that local norm of their school. Those who displayed the greatest changes were also the most likely to abuse substances including alcohol, cigarettes, marijuana and recreational drugs as young adults.

“These results add quantitative evidence to a conclusion that others have already drawn qualitatively: local expectations shape people’s understanding of their identity and how they perform it to their peers,” said senior author Harold Pollack, PhD, the Helen Ross Distinguished Service Professor at the UChicago Crown Family School of Social Work, Policy and Practice.

Countering the narrative to promote health

Based on these results, Pollack suggested public health experts could play a role in countering detrimental cultural narratives, such as when advertisers use gender-based messaging to promote harmful products like tobacco, alcohol or gambling platforms.

“It’s important to understand what motivates people,” he said. “If someone has a male gender expression where they put a lot of weight on self-reliance and strength and being a source of strength for the people around them, we can help them see that one of the ways to do that is by attending to their health.”

This study is part of a larger body of research around the tangible health effects of social pressures, especially those related to gender identity and expression. The results have the potential to shape paradigms in public health research and in clinical practice.

“We need to start taking social pressures more seriously as health determinants,” Glasser said. “If someone thinks using a product or following a doctor’s recommendation will undermine their identity or status or cause some kind of embarrassment, it is worth considering that social barrier as seriously as affordability or transportation issues.”

The study, “Associations of Adolescent School Social Networks, Gender Norms, and Adolescent-to-Adult Changes in Male Gender Expression With Adult Substance Abuse,” was published in the Journal of Adolescent Health in January 2024. In addition to Pollack and Glasser, co-authors were Jacob Jameson of Harvard University and Elizabeth Tung and Stacy Lindau of University of Chicago.

Nathaniel J. Glasser, MD

Nathaniel J. Glasser, MD, is an Instructor of Medicine at UChicago Medicine and specializes in internal medicine, primary care and pediatrics.

See Dr. Glasser's bio