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. Author manuscript; available in PMC: 2019 Apr 1.
Published in final edited form as: Psychol Men Masc. 2018 Apr;19(2):314–318. doi: 10.1037/men0000093

Are men’s misogynistic attitudes associated with poor mental health and substance use behaviors? An exploratory study of men in Tijuana, Mexico

Paul J Fleming a, Thomas L Patterson b, Claudia V Chavarin b, Shirley J Semple b, Carlos Magis-Rodriguez c, Eileen V Pitpitan d
PMCID: PMC5920542  NIHMSID: NIHMS835974  PMID: 29713247

Abstract

Men’s misogynistic attitudes (i.e., dislike or contempt for women) have been shown to be associated with men’s perpetration of physical/sexual violence against women and poor health outcomes for women. However, these attitudes have rarely been examined for their influence on men’s own health. This paper examines the socio-demographic, substance use, and mental health correlates of misogynistic attitudes among a binational sample of men (n=400) in Tijuana, Mexico with high-risk substance use and sexual behaviors. We used a 6-item scale to measure misogynistic attitudes (α = .72), which was developed specifically for this context. We used descriptive statistics to describe our sample population and the extent to which they hold misogynistic attitudes. Then, using misogynistic attitudes as our dependent variable, we conducted bivariate linear regression and multivariable linear regression to examine the relationship between these attitudes and socio-demographic characteristics, substance use behaviors (i.e., use of alcohol, marijuana, heroin, methamphetamines, cocaine), and mental health (i.e., depression, self-esteem). In the multivariable model, we found significant relationships between misogynistic attitudes and education level (t = −4.34, p < 0.01), heroin use in the past 4 months (t = 2.50, p = 0.01), and depressive symptoms (t = 3.37, p < 0.01). These findings suggest that misogynistic attitudes are linked to poor health outcomes for men and future research needs to further explore the temporality of these relationships and identify strategies for reducing men’s misogynistic attitudes with the ultimate aim of improving the health and well-being of both women and men.

Keywords: masculinity, male clients, violence, alcohol, drugs

Introduction

Misogyny by men – a “hatred or dislike of, or prejudice against women” (“Misogyny”, 2002) – has often been highlighted as an important factor influencing poor health outcomes among women. Primarily, this body of research has focused on how men’s misogynistic attitudes or hostility towards women can result in perpetration of sexual or physical violence against women or other harm to women (Parrott & Zeichner, 2003; Jewkes, Sikweyiya, Morrell, & Dunkle, 2011; Malamuth, Linz, Heavey, Barnes, & Acker, 1995).

There is limited empirical research on whether or not misogynistic attitudes are associated with poor health outcomes among men. Theoretical perspectives suggest that men develop misogynistic attitudes as a result of strict masculine gender norms and that these attitudes may be linked to emotional suppression and forms of self-harm among men (Reeser, 2010; Courtenay, 2000; Connell, 1995; Kauffman, 1996). Thus, cultural contexts where masculine gender norms are particularly strict are likely to breed misogynistic attitudes (de Moya, 2004; Gutmann, 2006). As Kauffman states,

“Men become pressure cookers. The failure to find safe avenues of emotional expression and discharge means that a whole range of emotions are transformed into anger and hostility. Part of the anger is directed at oneself in the form of guilt, self-hate, and various physiological and psychological symptoms…part of it is directed at women.” (p. 595)

These theoretical perspectives suggest that misogynistic attitudes would be associated with poor mental health outcomes for men and research has shown that men have a propensity to use alcohol or drugs to cope with negative emotion (Erskine et al., 2010; Addis, 2008). Addis (2008) describes the ‘Masked Depression’ framework for men, which emphasizes that men may suppress their emotions (including depressive symptoms), which in turn drives behaviors such as substance use/abuse. Norms of masculinity play an important role in this dynamic since men are socialized to believe that expressing emotions is feminine and that to be masculine they should reject femininity (Courtenay, 2000; Addis & Cohane, 2005; O’Neil, 1981). Though, importantly, these dynamics may play out differently in varied cultural contexts (Gilmore, 1990). This interplay between masculine norms, mental health, and substance use has been shown in empirical research (Isenhart, 1993; McCreary, Newcomb, Sadava, 1999; Erskine, Georgiou, Kvavilashvili, 2010), but misogynistic attitudes specifically have rarely been examined in empirical studies.

Misogyny has been measured in different ways in the literature. The Hypermasculinity Inventory – a widely used scale in psychosocial research – includes a sub-scale titled ‘Calloused Sex Attitudes towards Women’ that is closely related to misogynistic attitudes (Mosher and Sirkin, 1984). For example, items from this sub-scale include: “Get a woman drunk, high, or hot and she’ll let you do whatever you want,” “The only woman worthy of respect is your own mother,” and “You have to fuck some women before they know who is boss.” Only a few studies using the Hypermasclinity Inventory and men’s health outcomes report separate analyses of this sub-scale. These studies found that the Calloused Attitudes towards Women sub-scale is associated with men’s use of alcohol and other substances (Mosher and Sirkin 1984; Norris & Kerr 1993), and perpetration of aggression and assault (Mosher and Sirkin, 1984; Abbey and McAuslan 2004). Given the unique cultural context, our research team has created and used a measure of misogyny specifically for men at-risk for HIV in Tijuana, Mexico. Our previous research focused on HIV-related behaviors showed that increased misogynistic attitudes was associated with less frequent HIV testing (AUTHORS, under review) and increased number of unprotected sex acts with female sex workers (AUTHORS, 2010). However, we have not examined whether misogyny is correlated with men’s mental health outcomes or substance use behaviors.

This paper aims to conduct exploratory analyses examining socio-demographic, substance use, and mental health correlates of misogynistic attitudes among a sample of men in Tijuana, Mexico with high-risk sexual and/or substance use behaviors. We hypothesize that men with greater misogynistic attitudes will be more likely to engage in substance use and have poor mental health outcomes.

Methods

Recruitment and Sample

We used baseline data we collected in Tijuana, Mexico from a binational sample – men from the United States (US) and from Mexico – with high-risk sexual and/or substance use behaviors who were enrolled in a sexual risk reduction intervention known as Hombre Seguro (“Safe Men”). Tijuana, Mexico and San Diego County, US share one of the world’s busiest land border crossings and combine to form one of the largest bi-national metropolises. While the sample includes men living in Mexico and the U.S., there are Latinos and non-Latinos living on each side of the border and substantial cultural overlap between both groups; thus, though the group is not homogenous, they should not be considered to be two distinct groups.

To be eligible for the Hombre Seguro study, men had to be living in either Tijuana or San Diego County, over 18 years old, HIV-negative, and report having had unprotected sex with a female sex worker in Tijuana at least once during the previous four months. Between September 2010 and October 2012, we used time-location sampling within each neighborhood in Tijuana to recruit these men. For more details on sampling, see AUTHORS (2014).

Survey and Measures

Interviews were conducted in either Spanish or English by trained, bilingual interviewers. We administered measures using computer assisted personal interviewing (CAPI).

Socio-demographic characteristics

We assessed age, education, ethnicity (Hispanic vs. non-Hispanic), place of residence (U.S. vs. Mexico), employment status, marital status, sexual orientation, and whether they have been incarcerated in the previous 4 months.

Substance Use Behaviors

To measure alcohol use, we asked participants to complete the 10-item Alcohol Use Disorders Identification Tests (AUDIT) (Saunders et al., 1993). We used the AUDIT as a continuous variable where a higher score represents more harmful drinking. In separate items, we also asked men if they used marijuana, methamphetamine, cocaine, or heroin within the previous 4 months.

Mental health

Depressed mood was measured using the 10-item Center for Epidemiologic Studies Depression Scale (Radloff, 1977). Scale items are clinically derived and have undergone extensive reliability and validation testing (α = 0.78). Self-esteem was measured using the eight item Rosenberg Self-Esteem scale (α = 0.56) (Rosenberg, 1989).

Misogyny

Misogyny is defined as hatred or strong prejudice against women simply because they are female. We use a 6-item misogyny scale (α = .72) which was developed specifically for use with this population (men from the US or Mexico with high-risk sexual and/or substance use behaviors) based on previous formative qualitative work and a review of the literature. Our measure is continuous where a higher score represents more misogynistic attitudes.

Analysis

Data were analyzed in three stages. First, we examined descriptive statistics on misogynistic attitudes among the sample. Next, we used t-tests and chi-squared tests to assess the bivariate relationship between men’s misogyny score and socio-demographic, substance use, and mental health variables. We then used multivariable linear regressions to examine the independent relationship between misogynistic attitudes (continuous) and socio-demographic, substance use, and mental health variables. We use standardized beta coefficients to aid interpretation.

Ethics Statement

The study protocol was submitted, reviewed and approved by Institutional Review Boards in the US (University of California, San Diego) and Mexico (Comite de Etica sobre Salud Y Poblacion).

Results

Men in our sample (n=400) ranged in age between 18 and 73 (mean=38.0, SD=10.8) and most men had less than 12 years of schooling (see Table 1). The sample was predominantly Hispanic/Latino (88.0%). Almost two-thirds (62.6%) were currently employed and 18.6% of respondents had been to jail in the past 4 months. A third (30.6%) of men were married and 11.5% identified as gay or bisexual. Among the sample, the mean misogyny score was 2.18 (range: 1–4; SD = 0.32). See Table 2 for Misogyny scale items and responses.

Table 1.

Socio-demographic, substance use, and mental health characteristics of sample (n=400) and their bivariate and multivariable associations with men’s misogyny scores

 Bivariate associations
Multivariable associations
N / mean (% / SD) β t value p β t value p
SOCIO-DEMOGRAPHIC FACTORS
 Mean Age (mean, SD) 37.8 (10.7) 0.001 0.56 0.58 −0.011 −0.23 0.82
 Mean years of education (mean, SD) 9.2 (3.4) −0.023 −4.99 <0.01 −0.222 −4.34 <0.01
 Hispanic/Latino (vs. non-Hispanic) 87.5 (350) 0.042 0.88 0.38 −0.030 −0.57 0.57
 Lives in U.S. (vs. Mexico) 49.3 (197) 0.052 1.63 0.10 −0.004 −0.08 0.94
 Employed 62.5 (250) −0.074 −2.25 0.03 −0.074 −1.51 0.13
 Married/common law 31.5 (126) −0.035 −1.00 0.32 −0.064 −1.30 0.19
 Gay/bisexual 11.0 (44) 0.121 2.39 0.02 0.076 1.55 0.12
 Been to jail, past 4 months 19.3 (77) 0.032 0.80 0.42 −0.035 −0.72 0.47
SUBSTANCE USE
 AUDIT Score (mean, SD) 9.9 (10.0) 0.004 2.23 0.03 0.095 1.81 0.07
 Marijuana use, past 4m 53.8 (215) −0.015 −0.47 0.63 −0.074 −1.40 0.16
 Any heroin use, past 4m 29.5 (118) 0.092 2.64 0.01 0.127 2.50 0.01
 Any cocaine use, past 4m 30.0 (120) 0.053 1.52 0.13 −0.014 −0.26 0.80
 Any meth use, past 4m 66.5 (266) −0.021 −0.62 0.53 −0.087 −1.61 0.11
MENTAL HEALTH
 Depression Score (mean, SD) 0.9 (0.5) 0.170 5.32 <0.01 0.180 3.37 <0.01
 Self-Esteem Score (mean, SD) 2.7 (0.3) −0.259 −4.93 <0.01 −0.084 −1.58 0.12
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Table 2.

Misogyny Scale items: percent who agree/strongly agree

Agree/Strongly Agree
Misogyny n %
1. In my opinion, women are bad news 69 17.3
2. Women are only good for one thing, and that is sex 87 21.8
3. I avoid women except when it comes to sex 85 21.3
4. It wouldn’t bother me to hurt a woman physically 61 15.3
5. Women have never treated me very well 90 22.5
6. Sex is the only reason why I pursue women 106 26.5
Mean misogyny score among sample (range) and SD* 2.18 (1–4) 0.32
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*

Misogyny score is men’s average response to the six items (1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly Agree)

Results from bivariate associations between misogynistic attitudes and independent variables are reported in Table 1. Men with higher misogyny scores (i.e. on average agreed/strongly agreed with 6 items) had lower education (t = −4.99, p < 0.01), were more likely to be unemployed (t = −2.25, p = 0.03), more likely to identify as gay/bisexual (t = 2.39, p = 0.02), had a higher AUDIT score (t = 2.23, p = 0.03), more likely to have used heroin in the previous 4 months (t = 2.64, p = 0.01), reported more depressive symptoms (t = 5.32, p < 0.01), and reported lower self-esteem (t = −4.93, p < 0.01). All other bivariate relationships were non-significant.

Our multivariable results are reported in Table 1. After controlling for all other variables in the model, years of education was the only socio-demographic variable that remained significant (t = −4.34, p < 0.01). For substance use variables, the significant bivariate relationship between misogynistic attitudes and heroin use remained significant (t = 2.50, p = 0.01) but the relationship with AUDIT score became marginally non-significant (t = 1.81, p = 0.07) after controlling for other variables in the model. For the mental health items, the significant positive relationship between misogynistic attitudes and depressive symptoms remained significant (t = 3.37, p < 0.01) but the negative relationship with self-esteem became marginally non-significant (t = −1.58, p = 0.12) when controlling for other factors. (t = 3.37, p < 0.01) (t = 2.50, p = 0.01)

Discussion

Using a sample of men with high-risk sexual and substance use behaviors in Tijuana, Mexico, we found that misogynistic attitudes are significantly associated with mental health outcomes and substance use behaviors. These preliminary findings contribute to the limited empirical evidence documenting the relationship between misogynistic attitudes and men’s health outcomes.

Our empirical findings support the theoretical ideas that men’s hatred/prejudice against women is connected to men’s mental health and substance use (Kaufman, 1987; Connell, 1995, Reeser, 2010). As hypothesized, men who held more misogynistic attitudes also had poor mental health outcomes. Our hypotheses related to substance use were somewhat confirmed. We saw bivariate associations between misogynistic attitudes and AUDIT score and multivariable associations with heroin use. However, AUDIT score was marginally non-significant when controlling for other factors in the model. This may be because the sample we used already had a high level of drinking. We also documented that low levels of education and being unemployed were associated with more misogynistic attitudes. Men with low education and who are unemployed may be particularly sensitive to shifting economic conditions that are increasingly providing employment opportunity for women (Artazcoz, Benach, Borrell, Cortès, 2004; Coyle & Morgan-Sykes, 1998). Though our bivariate findings showed that, compared to heterosexual men, gay/bisexual men are more likely to hold misogynistic attitudes, these were not sustained in the multivariable model. Responses from gay/bisexual men may be conflating their sexual preferences for men with a dislike for women. It is also possible that internalized homophobia may cause gay/bisexual men to compensate by reported more misogynistic views. Given the exploratory nature of this study, this relationship merits further data collection to test whether any of these hypotheses are true.

Our finding should be considered alongside certain study limitations. First, our sample is unique and thus our findings do not necessarily generalize to a general population of men in the U.S. or Mexico. Second, our measure of misogynistic attitudes was developed from formative research with the study population, but may not necessarily fully encompass all relevant factors for misogyny. Thus, interpretations of our data should keep specific scale items in mind. Third, our study does not explore cultural elements of misogyny. Future studies should assess whether Mexican culture and U.S. culture share similar dimensions of misogyny, whether or not there are racial/ethnic differences in misogynistic views, and whether or not the relationships tested in this paper are valid across a range of racial/ethnic groups. Third, our measure of self-esteem had low internal consistency and thus future studies should explore this relationship with a more robust and reliable. Finally, our data is cross-sectional and we cannot make claims about the temporality of misogynistic attitudes and mental health/substance use outcomes.

Given the growth of misogynistic views in the public discourse because of the democratization of mass communication (e.g. Twitter, Facebook) and new populist political movements, it is important to undertake research that untangles the relationship between misogynistic attitudes and various health and social outcomes for men and women (Ruben, 2016). Our exploratory study provides preliminary evidence but more research is needed. First, it will be important to tease apart the temporality between misogynistic attitudes, mental health, substance use, and unemployment. Second, more research is needed to identify strategies for measuring misogynistic attitudes. Our scale was devoted specifically to our population of men who engage in high-risk behaviors and are clients of female sex workers. Third, cultural factors (e.g. gender norms in Mexico) are likely to influence our findings and future studies should examine this in different cultural settings. Ultimately, more formative research is needed to develop a more robust scale of misogyny for a wider range of men. Finally, it will be important to more fully examine the antecedents of misogynistic attitudes using mixed methods to identify the ways in which these attitudes develop.

Conclusion

Despite increasing gender equality, misogynistic attitudes among certain men remain. These attitudes are concerning by themselves because of their negative impact on women, but they appear to also harm men. To improve the health and well-being of both women and men, we need further research on misogynistic attitudes to develop strategies to reduce the prevalence of these harmful attitudes among men in high-risk populations.

Acknowledgments

This study was funded by the National Institute on Drug Abuse (NIDA; R01DA029008). Preparation of this manuscript was supported by a NIDA Training Grant (T32 DA023356) and a NIDA Mentored Career Development Award (K01DA036447-01).

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