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Sundararajan R, Mwanga-Amumpaire J, King R, Ware NC. Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda. BMJ Open 2020; 10:e033410. [PMID: 32317259 PMCID: PMC7204928 DOI: 10.1136/bmjopen-2019-033410] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Medical pluralism, or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings. Traditional healers are ubiquitous providers in most regions, including the study site of southwestern Uganda. Where both informal and formal healthcare services are both available, patients do not engage with both options equally. It is not well understood why patients choose to engage with one healthcare modality over the other. The goal of this study was to explain therapeutic itineraries and create a conceptual framework of pluralistic health behaviour. METHODS In-depth interviews were conducted from September 2017 to February 2018 with patients seeking care at traditional healers (n=30) and at an outpatient medicine clinic (n=30) in Mbarara, Uganda; the study is nested within a longitudinal project examining HIV testing engagement among traditional healer-using communities. Inclusion criteria included age ≥18 years, and ability to provide informed consent. Participants were recruited from practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilisation. RESULTS We identified three broad categories relevant to healthcare utilisation: (1) traditional healers treat patients with 'care'; (2) biomedicine uses 'modern' technologies and (3) peer 'testimony' influences healthcare engagement. These categories describe variables at the healthcare provider, healthcare system and peer levels that interrelate to motivate individual engagement in pluralistic health resources. CONCLUSIONS Patients perceive clear advantages and disadvantages to biomedical and traditional care in medically pluralistic settings. We identified factors at the healthcare provider, healthcare system and peer levels which influence patients' therapeutic itineraries. Our findings provide a basis to improve health outcomes in medically pluralistic settings, and underscore the importance of recognising traditional healers as important stakeholders in community health.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Rachel King
- Global Health Sciences, UCSF Medical Center, San Francisco, California, USA
| | - Norma C Ware
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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DeLong SM, Brooks MI, Aliou S, Lundgren R, Corneliess C, Johns NE, Challa S, Carter N, Lauro G, Silverman JG. Married very young adolescent girls in Niger at greatest risk of lifetime male partner reproductive coercion and sexual violence. PLoS One 2020; 15:e0231392. [PMID: 32282817 PMCID: PMC7153890 DOI: 10.1371/journal.pone.0231392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this analysis was to compare and contrast reproductive health (RH), gender equity attitudes, and intimate partner violence (IPV) among married very young adolescent (VYA) girls with married older adolescent girls and young women (AGYW) in rural Niger given limited literature on the topic. METHODS We conducted an exploratory analysis of baseline data from the Reaching Married Adolescents Trial in Dosso region, Niger. We report counts and percents, by age group (13-14 years (VYA), 15-16 years, 17-19 years), of AGYW's self-efficacy to use family planning (FP), accurate knowledge of FP, current use of modern FP, and unintended last pregnancy (UIP); lifetime reproductive coercion (RC), physical IPV, and sexual IPV; and gender equity attitudes. We also assess whether percents differ between VYA and older groups using Pearson's Chi-Square and Fisher's exact p-values. Results are stratified by parity. Finally, we use logistic regression to consider associations. RESULTS There were 49 VYA, 248 girls aged 15-16, and 775 AGYW aged 17-19 in our sample (n = 1072). Accurate knowledge of FP, self-efficacy to use FP, current use of modern FP, and UIP increased with age; all percents between VYA and AGYW 17-19 were marginally or statistically significantly different. We also saw VYA report higher lifetime RC and sexual IPV versus older groups, with sexual IPV statistically different between VYA and girls 17-19. Parous VYA reported a significantly higher percent of lifetime RC versus older AGYW. Among 17-19 year-olds, odds of current use of FP were higher among AGYW who reported physical IPV, and odds of UIP were higher among those reporting more gender equitable attitudes, both adjusted for parity. CONCLUSIONS We observed differences in RH, RC, and sexual IPV among married VYA and older AGYW in rural Niger. VYA should be prioritized in research to confirm and further understand their RH needs.
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Affiliation(s)
- Stephanie M. DeLong
- University of California, San Diego, La Jolla, California, United States of America
| | - Mohamad I. Brooks
- Pathfinder International, Watertown, Massachusetts, United States of America
| | | | - Rebecka Lundgren
- University of California, San Diego, La Jolla, California, United States of America
| | - Caitlin Corneliess
- Pathfinder International, Watertown, Massachusetts, United States of America
| | - Nicole E. Johns
- University of California, San Diego, La Jolla, California, United States of America
| | - Sneha Challa
- University of California, San Diego, La Jolla, California, United States of America
| | - Nicole Carter
- University of California, San Diego, La Jolla, California, United States of America
| | - Giovanna Lauro
- Promundo–United States, Washington, DC, United States of America
| | - Jay G. Silverman
- University of California, San Diego, La Jolla, California, United States of America
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153
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Maina BW, Orindi BO, Sikweyiya Y, Kabiru CW. Gender norms about romantic relationships and sexual experiences among very young male adolescents in Korogocho slum in Kenya. Int J Public Health 2020; 65:497-506. [PMID: 32270236 PMCID: PMC7275025 DOI: 10.1007/s00038-020-01364-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives To investigate the association between gender norms about romantic relationships and sexual experiences of very young male adolescents (VYMA) living in Korogocho slum in Nairobi, Kenya. Methods We used cross-sectional data from a sample of 426 VYMA living in Korogocho slum. We conducted an exploratory factor analysis and confirmatory factor analysis to, respectively, explore and validate the factor structure underlying gender norms scale items. We used structural equation modelling to assess the association between gender norms and sexual experiences of VYMA. Results We found high endorsement of heteronormative beliefs about romantic relationships and low endorsement of sexual double standards. Sexual experience was associated with low endorsement of heteronormative beliefs, being pre-pubertal, school absenteeism and being below recommended grade for age. Sharing a sleeping room with more than two people, been born outside Nairobi, and living in households headed by older persons lowered the likelihood of sexual experience. Conclusions Our findings underscore the need for further research to understand how gender norms evolve as young boys transition through adolescence to adulthood and how these changes impact on sexual behaviors Electronic supplementary material The online version of this article (10.1007/s00038-020-01364-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beatrice W. Maina
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Benedict O. Orindi
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Yandisa Sikweyiya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Caroline W. Kabiru
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Council, Nairobi, Kenya
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154
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Stark L, Seff I, Weber AM, Cislaghi B, Meinhart M, Bermudez LG, Atuchukwu V, Onotu D, Darmstadt GL. Perpetration of intimate partner violence and mental health outcomes: sex- and gender-disaggregated associations among adolescents and young adults in Nigeria. J Glob Health 2020; 10:010708. [PMID: 32257165 PMCID: PMC7101086 DOI: 10.7189/jogh.10.010708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The association between intimate partner violence (IPV) victimisation and poor mental health outcomes is well established. Less is known about the correlation between IPV perpetration and mental health, particularly among adolescents and young adults. Using data from the nationally representative Violence Against Children Survey, this analysis examines the association between IPV perpetration and mental health for male and female adolescents and young adults in Nigeria. Methods Multivariate logistic regression models were used to examine associations between ever-perpetration of IPV and four self-reported mental health variables: severe sadness, feelings of worthlessness, suicide ideation, and alcohol use. Models were sex-disaggregated, controlled for age, marital status, and schooling, and tested with and without past exposure to violence. Standard errors were adjusted for sampling stratification and clustering. Observations were weighted to be representative of 13-24 year-olds in Nigeria. Results Males were nearly twice as likely as females to perpetrate IPV (9% v. 5%, respectively; P < 0.001), while odds of perpetration for both sexes were higher for those ever experiencing IPV (adjusted odds ratio (aOR) = 4.60 for males; aOR = 2.71 for females). Female perpetrators had 2.73 higher odds of reporting severe sadness (95% confidence interval CI = 1.44, 5.17; P = 0.002) and 2.72 times greater odds of reporting suicide ideation (1.28, 5.79; P = 0.010) than non-perpetrating females, even when controlling for past-year violence victimisation. In contrast, male perpetrators had 2.65 times greater odds of feeling worthless (1.09, 6.43; P = 0.031), and 2.36 times greater odds of reporting alcohol use in the last 30 days (1.50, 3.73; P < 0.001), as compared to non-perpetrating males. Conclusions Among adolescents and young adults in Nigeria, IPV perpetration and negative mental health outcomes are associated but differ for males and females. Mindful of the cross-sectional nature of the data, it is possible that socially determined gender norms may shape the ways in which distress from IPV perpetration is understood and expressed. Additional research is needed to clarify these associations and inform violence prevention efforts.
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Affiliation(s)
- Lindsay Stark
- George Warren Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ilana Seff
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ann M Weber
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Melissa Meinhart
- Columbia University School of Social Work, New York, New York, USA
| | | | | | - Dennis Onotu
- US Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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155
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Gracia E, Lila M, Santirso FA. Attitudes Toward Intimate Partner Violence Against Women in the European Union: A Systematic Review. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000392] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. Attitudes toward intimate partner violence against women (IPVAW) are increasingly recognized as central to understanding of this major social and public health problem, and guide the development of more effective prevention efforts. However, to date this area of research is underdeveloped in western societies, and in particular in the EU. The present study aims to provide a systematic review of quantitative studies addressing attitudes toward IPVAW conducted in the EU. The review was conducted through Web of Science, PsychINFO, Medline, EMBASE, PUBMED, and the Cochrane Library, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. This review aimed to identify empirical studies conducted in the EU, published in English in peer-reviewed journals from 2000 to 2018, and analyzing attitudes toward IPVAW. A total of 62 of 176 eligible articles were selected according to inclusion criteria. Four sets of attitudes toward IPVAW were identified as the main focus of the studies: legitimation, acceptability, attitudes toward intervention, and perceived severity. Four main research themes regarding attitudes toward IPVAW emerged: correlates of attitudes, attitudes as predictors, validation of scales, and attitude change interventions. Although interest in this research area has been growing in recent years, the systematic review revealed important gaps in current knowledge on attitudes toward IPVAW in the EU that limits its potential to inform public policy. The review outlines directions for future study and suggests that to better inform policy making, these future research efforts would benefit from an EU-level perspective.
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Affiliation(s)
- Enrique Gracia
- Department of Social Psychology, University of Valencia, Spain
| | - Marisol Lila
- Department of Social Psychology, University of Valencia, Spain
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156
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Anwar Y, Sall M, Cislaghi B, Miramonti A, Clark C, Bar Faye M, Canavera M. Assessing gender differences in emotional, physical, and sexual violence against adolescents living in the districts of Pikine and Kolda, Senegal. CHILD ABUSE & NEGLECT 2020; 102:104387. [PMID: 32036291 DOI: 10.1016/j.chiabu.2020.104387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/18/2019] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Locally representative research and data on violence against children are important to understand the nature and scale of the issue and to inform effective prevention and response programs and policies. In Senegal, few population-level data estimating the prevalence of physical, emotional, or sexual violence against adolescents exist. OBJECTIVE This study assesses whether the gender of adolescents in two Senegalese districts is associated with having experienced emotional, physical, or sexual violence and whether such associations vary depending on district of residence and poverty status. PARTICIPANTS AND SETTING The sample comprised of 833 adolescents aged 13-18 residing in the peri-urban district of Pikine and rural district of Kolda. METHODS Cross-sectional population-based household survey data were analyzed using logistic regression models. RESULTS Adolescent boys had 1.6 times greater odds than adolescent girls of having experienced emotional abuse in the past month (adjusted OR = 1.6, 95 % CI 1.1, 2.5) in Pikine. Adolescents living in Pikine and in households with low poverty scores were more likely to have experienced physical abuse in the past month. Gender was a significant predictor of sexual abuse in Kolda, where the prevalence of sexual abuse among adolescent girls was twofold higher compared to boys (adjusted OR = 2.09, 95 % CI 1.03, 4.23). CONCLUSIONS Boys in Pikine were more likely to experience emotional violence, and girls in Kolda were at a significantly higher risk of experiencing sexual violence. Prevention and response programs must consider gender and geographic variation to maximize their potential to effectively reduce violence against children.
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Affiliation(s)
- Yasmine Anwar
- Care and Protection of Children (CPC) Learning Network, Mailman School of Public Health, Columbia University, New York, United States.
| | - Mohamoudou Sall
- Institut de Population, Développement et Santé de la Reproduction (IPDSR), Université Cheikh Anta Diop de Dakar, Senegal.
| | | | | | - Courtney Clark
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, United States.
| | - Moussé Bar Faye
- Ecole Nationale des Travailleurs Sociaux Spécialisés, Dakar, Senegal.
| | - Mark Canavera
- Care and Protection of Children (CPC) Learning Network, Mailman School of Public Health, Columbia University, New York, United States.
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157
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Kidman R, Kohler HP. Emerging partner violence among young adolescents in a low-income country: Perpetration, victimization and adversity. PLoS One 2020; 15:e0230085. [PMID: 32142550 PMCID: PMC7059948 DOI: 10.1371/journal.pone.0230085] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/20/2020] [Indexed: 11/22/2022] Open
Abstract
Background Intimate partner violence (IPV) is prevalent in high- as well as low-income contexts. It results in a substantial public health burden and significant negative socioeconomic and health outcomes throughout the life-course. However, limited knowledge exists about IPV during early adolescence. This period is critical during the transition to adulthood for at least two reasons: it is when the majority of adolescents in low-income countries first encounter dating, sexuality and partnerships, often with older adolescents or adults, and it is also the period when lifelong patterns of violence and norms about acceptable IPV are formed. The current study is one of the first to measure IPV prevalence among young adolescents in a low-income setting, examine the potential etiology, and investigate relationships with gender ideology, poverty, mental health and childhood adversity. Methods We surveyed 2,089 adolescents aged 10–16 in Malawi using standardized instruments. We estimated the prevalence of IPV, and use multivariate logistic regression to test potential correlates. Results More than a quarter (27%) of ever-partnered adolescents in Malawi report being victimized. A substantial proportion of both male and female adolescents (15%) report committing violence against their partner. Girls were more likely than boys to report being a victim of sexual IPV (24% versus 8%), and boys more likely to perpetrate such (9% versus 1%). Almost 10% of the sample had both committed and been a victim of IPV. Cumulative childhood adversity (e.g., physical abuse, witnessing domestic violence) was a consistent and strong correlate of IPV victimization (adjusted odds ratio (aOR) 1.30) and of perpetration (aOR 1.35). Depression and PTSD were likewise associated with IPV victimization in the overall sample. Notably, gender ideology was not predictive of either victimization or perpetration, even among boys. Conclusions IPV is common for both male and female young Malawian adolescents, and includes both victimization and perpetration. IPV compounds other adversities experienced by adolescents in this low-income setting, and it is rarely alleviated through help from the health system or other formal support. These findings underscore the need to intervene early when interventions can still break destructive pathways and help foster healthier relationships. This focus on early adolescence is particularly critical in low-income countries given the early onset and rapid pace of the transition to adulthood, with sexual activity, dating and partnership thus being common already in young adolescence. Promising interventions would be those that reduce violence against or around children, as well as those that reduce the impacts of such trauma on mental health during adolescence.
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Affiliation(s)
- Rachel Kidman
- Department of Family, Population and Preventive Medicine, Core Faculty, Program in Public Health, Stony Brook University (State University of New York), Stony Brook, NY, United States of America
- * E-mail:
| | - Hans-Peter Kohler
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
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158
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Meiksin R, Crichton J, Dodd M, Morgan GS, Williams P, Willmott M, Allen E, Tilouche N, Sturgess J, Morris S, Barter C, Young H, Melendez-Torres GJ, Taylor B, Reyes HLM, Elbourne D, Sweeting H, Hunt K, Ponsford R, Campbell R, Bonell C. A school intervention for 13- to 15-year-olds to prevent dating and relationship violence: the Project Respect pilot cluster RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
‘Dating and relationship violence’ is intimate partner violence during adolescence. Among dating adolescents in England, 66–75% of girls and 32–50% of boys report victimisation. Multicomponent school-based interventions might reduce dating and relationship violence. We optimised and piloted Project Respect, a new intervention in secondary schools in England, and study methods, to assess the value of a Phase III randomised controlled trial.
Objectives
To optimise Project Respect and to then conduct a pilot randomised controlled trial in southern England, addressing whether or not progression to a Phase III trial is justified in terms of prespecified criteria. To assess which of two dating and relationship violence scales is optimal, to assess response rates and to consider any necessary refinements.
Design
Optimisation activities aimed at intervention development and a pilot randomised controlled trial.
Setting
Optimisation in four secondary schools across southern England, varying by region and local deprivation. A pilot cluster randomised controlled trial in six other such schools (four intervention schools and two control schools), varying by region, attainment and local deprivation.
Participants
School students in years 8–10 at baseline and staff.
Interventions
Schools were randomised to the intervention or control arm in a 2 : 1 ratio; intervention comprised staff training, mapping ‘hotspots’ in school for dating and relationship violence, modifying staff patrols, school policy review, informing parents and carers, an application supporting student help-seeking, and a classroom curriculum for students in years 9 and 10 (including student-led campaigns).
Main outcome measures
Prespecified criteria for progression to Phase III of the trial, concerning acceptability, feasibility, fidelity and response rates. Primary health outcomes were assessed using the Safe Dates and short Conflicts in Adolescent Dating Relationships Inventory measures collected and analysed by individuals who were masked to allocation. Feasibility of economic analysis was assessed.
Data sources
Baseline and follow-up student and staff surveys, interviews, observations and logbooks.
Results
The intervention was optimised and approved by the Study Steering Committee. The student response rates in intervention and control groups were 1057 (84.8%) and 369 (76.6%) at baseline, and 1177 (76.8%) and 352 (83.4%) at follow-up, respectively. Safe Dates and the short Conflicts in Adolescent Dating Relationships Inventory had high levels of completion and reliability. At follow-up, prevalence of past-year dating and relationship violence victimisation was around 35% (Safe Dates scale and short Conflicts in Adolescent Dating Relationships Inventory). Staff response rates were very low. Training occurred in all four schools, with suboptimal fidelity. The curriculum was delivered with optimal fidelity in three schools. Other components were delivered inconsistently. Dating and relationship violence was addressed in control schools via violence prevention and responses, but not systematically. Intervention acceptability among students and staff was mixed. An economic evaluation would be feasible.
Limitations
One school did not undertake baseline surveys. Staff survey response rates were low and completion of the logbook was patchy.
Conclusions
Our findings suggest that progression to a Phase III trial of this intervention is not indicated because of limited fidelity and acceptability.
Future work
High prevalence of dating and relationship violence highlights the ongoing need for effective intervention. Potential intervention refinements would include more external support for schools and enhanced curriculum materials. Any future randomised controlled trials could consider having a longer lead-in from randomisation to intervention commencement, using the short Conflicts in Adolescent Dating Relationships Inventory as the primary outcome and not relying on staff surveys.
Trial registration
Current Controlled Trials ISRCTN65324176.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca Meiksin
- Department of Public Health, Society and Environments, London School of Hygiene & Tropical Medicine, London, UK
| | - Jo Crichton
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Dodd
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Gemma S Morgan
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Pippa Williams
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Micky Willmott
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Nerissa Tilouche
- Department of Public Health, Society and Environments, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - Christine Barter
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Honor Young
- School of Social Sciences, Cardiff University, Cardiff, UK
| | | | | | | | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Sweeting
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Ponsford
- Department of Public Health, Society and Environments, London School of Hygiene & Tropical Medicine, London, UK
| | - Rona Campbell
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Bonell
- Department of Public Health, Society and Environments, London School of Hygiene & Tropical Medicine, London, UK
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Casey SE, Gallagher MC, Kakesa J, Kalyanpur A, Muselemu JB, Rafanoharana RV, Spilotros N. Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey. PLoS Med 2020; 17:e1003086. [PMID: 32231356 PMCID: PMC7108687 DOI: 10.1371/journal.pmed.1003086] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adolescent girls in humanitarian settings are especially vulnerable as their support systems are often disrupted. More than 20 years of violence in the Democratic Republic of the Congo (DRC) has weakened the health system, resulting in poor sexual and reproductive health (SRH) outcomes for women. Little evidence on adolescent contraceptive use in humanitarian settings is available. CARE, International Rescue Committee (IRC), and Save the Children, in collaboration with the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative, Columbia University, have supported the Ministry of Health (MOH) since 2011 to provide good quality contraceptive services in public health facilities in conflict-affected North and South Kivu. In this study, we analyzed contraceptive use among sexually active young women aged 15-24 in the health zones served by the partners' programs. METHODS AND FINDINGS The partners conducted cross-sectional population-based surveys in program areas of North and South Kivu using two-stage cluster sampling in six health zones in July-August 2016 and 2017. Twenty-five clusters were selected in each health zone, 22 households in each cluster, and one woman of reproductive age (15-49 years) was randomly selected in each household. This manuscript presents results from a secondary data analysis for 1,022 women aged 15-24 who reported ever having sex: 326 adolescents (15-19 years) and 696 young women (20-24 years), 31.7% (95% confidence interval [CI] 29.5-34.1), of whom were displaced at least once in the previous five years. Contraceptive knowledge was high, with over 90% of both groups able to name at least one modern contraceptive method. Despite this high knowledge, unmet need for contraception was also high: 31.7% (95%CI 27.9-35.7) among 15-19-year-olds and 40.1% (95% CI 37.1-43.1, p = 0.001) among 20-24-year-olds. Current modern contraceptive use (16.5%, 95% CI 14.7-18.4) was similar in both age groups, the majority of whom received their method from a supported health facility. Among current users, more than half of 15-19-year-olds were using a long-acting reversible contraceptive (LARC; 51.7%, 95% CI 41.1-61.9) compared to 36.5% of 20-24-year-olds (95% CI 29.6-43.9, p = 0.02). Age, younger age of sexual debut, having some secondary education, being unmarried, and having begun childbearing were associated with modern contraceptive use. The main limitations of our study are related to insecurity in three health zones that prevented access to some villages, reducing the representativeness of our data, and our defining sexually active women as those who have ever had sex. CONCLUSIONS In this study, to our knowledge one of the first to measure contraceptive prevalence among adolescents in a humanitarian setting, we observed that adolescent and young women will use modern contraception, including long-acting methods. Meaningful engagement of adolescent and young women would likely contribute to even better outcomes. Creating an enabling environment by addressing gender and social norms, however, is key to reducing stigma and meeting the demand for contraception of young women. As we continue to build such supportive environments, we can see that they will use effective contraception when contraceptive services, including short- and long-acting methods, are available, even in protracted crisis settings.
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Affiliation(s)
- Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | | | - Jessica Kakesa
- International Rescue Committee, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Nathaly Spilotros
- International Rescue Committee, New York, New York, United States of America
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Sommer M, Daly G, Kabiru C, Lhaki P, Okwaro N, Chandra-Mouli V. Strengthening health care worker engagement with early adolescence in low- and middle-income countries: an overdue area for action. Int J Adolesc Med Health 2020; 34:/j/ijamh.ahead-of-print/ijamh-2019-0171/ijamh-2019-0171.xml. [PMID: 32031974 DOI: 10.1515/ijamh-2019-0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
The very young adolescent population (ages 10-14) is currently under-served by health care systems, particularly in low- and middle-income countries. Although there is a substantial and growing effort to reach adolescents with the health services and commodities they need, such efforts often overlook the period of early adolescence given this population's lower vulnerability to risk-taking behaviors. However, early adolescence is a period of significant change, with the onset of puberty introducing physiological, emotional, and social changes in girls' and boys' lives. This period also represents a time of intensifying gendered norms, and the transition of youth from childhood focused health care (e.g. deworming programs, nutrition interventions) to additional mid- and older adolescent related care [e.g. human papilloma virus (HPV) vaccine, and contraceptive provision). Strengthening young adolescents' engagement with health care workers around preventative and promotive health behaviors could have profound impacts on their health and wellbeing, which in turn could have cascading effects across the course of their lives. Critically, young adolescents would gain trust in health care systems, and be more likely to return when significant health issues arise later in adolescence or adulthood. Such an effort requires sensitizing health care workers and building their capacity to respond to young adolescents' unique needs, by defining a package of actions that they are mandated to provide, training them, providing them with desk reference tools, and putting in place systems to provide supportive supervision and collaborative learning on the one hand, and encouraging caregivers to connect their pubescent-aged boys and girls with the health care system, on the other hand. This paper presents an argument for increased focus in particular on building attitudes and capacities of health care workers on engaging with early adolescents, applying Principle 3 of the Society of Adolescent Medicine's position paper entitled "Health Care Reform and Adolescents."
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, USA
| | - Garrison Daly
- Mailman School of Public Health, Columbia University, New York, USA
| | | | | | | | - Venkatraman Chandra-Mouli
- WHO Department of Reproductive Health and Research/Human Reproduction Programme, Geneva, Switzerland
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161
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Levy JK, Darmstadt GL, Ashby C, Quandt M, Halsey E, Nagar A, Greene ME. Characteristics of successful programmes targeting gender inequality and restrictive gender norms for the health and wellbeing of children, adolescents, and young adults: a systematic review. Lancet Glob Health 2020; 8:e225-e236. [PMID: 31879212 PMCID: PMC7025324 DOI: 10.1016/s2214-109x(19)30495-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/23/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the context of the Sustainable Development Goals and the shifting global burden of disease, this systematic review analyses the evidence from rigorously evaluated programmes that seek to transform the gendered social norms undermining the health and wellbeing of children, adolescents, and young adults. The aim of this study was threefold: to describe the landscape of gender-transformative programmes that attempt to influence health-related outcomes; to identify mechanisms through which successful programmes work; and to highlight where gaps might exist in implementation and evaluation. METHODS We systematically reviewed rigorous evaluations published between Jan 1, 2000, and Nov 1, 2018 of programmes that sought to decrease gender inequalities and transform restrictive gender norms to improve the health and wellbeing of 0-24 year olds. We included rigorously evaluated health programmes that met the Interagency Gender Working Group definition of gender-transformative programming, regardless of where in the world they were implemented and what area of health they focused on. FINDINGS Among 22 993 articles identified by our search, 61 evaluations of 59 programmes met review criteria. Programmes were concentrated in sub-Saharan Africa (25 [42%]), south Asia (13 [22%]), and North America (13 [22%]) and mainly measured health indicators related to reproductive health (29 [48%]), violence (26 [43%]), or HIV (18 [30%]). Programmes most frequently focused on improving the individual power of the beneficiaries, rather than working on broader systems of inequality. 45 (74%) of the evaluations measured significant improvements in health-related and gender-related indicators; however, only ten (16%) showed evidence of, or potential for, broader norm change. These ten programmes worked with sectors beyond health, included multiple stakeholders, implemented diversified strategies, and fostered critical awareness and participation among affected community members. INTERPRETATION This review can accelerate efforts to improve global health by leading to more strategic investment in programmes that promote gender equality and target restrictive gender norms among young people. Such programmes can lead to a lifetime of improved health and wellbeing by challenging not only attitudes and behaviours related to gender at an early age, but also the gendered systems that surround them. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Jessica K Levy
- Brown School at Washington University in St Louis, St Louis, MO, USA; Iris Group, Chapel Hill, NC, USA.
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Caitlin Ashby
- Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Mary Quandt
- Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Erika Halsey
- Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Aishwarya Nagar
- Brown School at Washington University in St Louis, St Louis, MO, USA; Iris Group, Chapel Hill, NC, USA
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Kågesten A, Chandra-Mouli V. Gender-transformative programmes: implications for research and action. LANCET GLOBAL HEALTH 2020; 8:e159-e160. [DOI: 10.1016/s2214-109x(19)30528-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
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163
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Gupta AK, Santhya KG. Promoting Gender Egalitarian Norms and Practices Among Boys in Rural India: The Relative Effect of Intervening in Early and Late Adolescence. J Adolesc Health 2020; 66:157-165. [PMID: 31227386 DOI: 10.1016/j.jadohealth.2019.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Although the importance of exposing adolescent boys to gender transformative programs has been recognized, such programs are limited in India. Studies that assessed the relative effect of intervening in early compared with late adolescence are even more limited. This article examines the differential effect of exposing boys to a gender transformative program in early and late adolescence on their gender role attitudes and practices. METHODS We used data from a cluster randomized trial of a gender transformative life-skills education cum sports-coaching program for younger boys (aged 13-14 years) and older boys (aged 15-19 years) (N = 962) and used generalized estimating equation model to examine the differential effect. RESULTS The intervention had a greater effect in helping younger than older boys to espouse gender-egalitarian attitudes (β = .669; p < .001 vs. β = .344; p < .001) and attitudes rejecting men's controlling behaviors (β = .973; p < .003 vs. β = .453; p < .088), men's perpetration of wife beating (β = .423; p < .002 vs. β = .282; p < .035), and violence on unmarried girls (β = .332; p < .038 vs. β = .306; p < .045). Younger boys had higher odds of reporting that their peers would respect them for acting in gender-equitable ways (odds ratio [OR] = 2.15; p < .003) compared with older boys (OR = 1.78; p < .014). However, younger boys had lower odds of intervening to stop incidents of violence that they had witnessed, compared with older boys (OR = 2.17; p < .03 vs. OR = 2.56; p < .002). These differences remained significant even when difference in regular exposure to the intervention was adjusted. CONCLUSIONS Gender transformative programs are likely to be more effective in changing traditional attitudes and practices among boys if they target them during early adolescence compared with late adolescence.
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Affiliation(s)
| | - K G Santhya
- Population Council, India Habitat Centre, New Delhi, India
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164
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Evans R, Widman L, Kamke K, Stewart JL. Gender Differences in Parents' Communication With Their Adolescent Children about Sexual Risk and Sex-Positive Topics. JOURNAL OF SEX RESEARCH 2020; 57:177-188. [PMID: 31517541 DOI: 10.1080/00224499.2019.1661345] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A healthy sexual self-concept that captures an understanding of the risky and the positive aspects of sexuality is imperative to life-long well-being. Parents have a unique opportunity to instill knowledge of sexual risk as well as confidence and comfort around sexuality in their adolescents. Although parent-child communication about sexual risk is fairly common, less is known regarding the frequency of parent-child communication about sex-positive topics, such as sexual desire and satisfaction. This study examined the frequency of parents' communication with their children about sexual risk and sex-positive topics among a sample of 901 parents of 13-17-year-old adolescents (parent Mage= 40.61; 71% mothers) from across the U.S. Parents reported on sexual communication with their adolescent children (child Mage = 14.68; 50% daughters). We examined gender differences in communication patterns. Few parents communicated with their adolescents about sex-positive topics. Only 38% discussed sexual satisfaction, 38% discussed different types of sexual practices (e.g., oral sex), and 55% discussed sexual desire. Parents communicate more about sexual risk than sex-positive topics with their adolescents and this discrepancy was largest for mothers of daughters. Fathers of daughters communicate the least about sex-positive topics. Implications for intervention development and future research on sexual communication are discussed.
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Affiliation(s)
- Reina Evans
- Department of Psychology, North Carolina State University
| | - Laura Widman
- Department of Psychology, North Carolina State University
| | - Kristyn Kamke
- Department of Psychology, North Carolina State University
| | - J L Stewart
- Department of Psychology, North Carolina State University
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165
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Structural determinants of gender inequality: why they matter for adolescent girls’ sexual and reproductive health. BMJ 2020. [PMCID: PMC7461912 DOI: 10.1136/bmj.l6985] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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166
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Nagata JM, Domingue BW, Darmstadt GL, Weber AM, Meausoone V, Cislaghi B, Shakya HB. Gender Norms and Weight Control Behaviors in U.S. Adolescents: A Prospective Cohort Study (1994-2002). J Adolesc Health 2020; 66:S34-S41. [PMID: 31866036 PMCID: PMC6928570 DOI: 10.1016/j.jadohealth.2019.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this article was to determine the relationship between gender norms and weight control behaviors in U.S. adolescents. METHODS We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (N = 9,861), at baseline in 1994-1995 (ages 11-18 years, Wave I), 1-year follow-up (ages 12-19 years, Wave II), and 7-year follow-up (ages 18-26 years, Wave III). The primary exposure variable was a measure of one's gender normativity based on the degree to which males and females behave in ways that are similar to the behaviors of their same-gender peers. The outcome variable was an individual's weight control attempts (trying to lose or gain weight) and behaviors (dieting, fasting/skipping meals, vomiting, or weight-loss pills/laxatives/diuretics to lose weight or ate different/more foods than usual or taking supplements to gain weight). RESULTS In logistic regression analyses controlling for potential confounders, a higher baseline individual gender normativity score (higher femininity in females and higher masculinity in males) was associated with weight loss attempts (β = .10; p = .01) and weight loss behaviors (β = .18; p < .001) in girls but was associated with weight gain attempts (β = .18; p < .001) and behaviors (β = .16; p < .001) in boys at 1-year follow-up. Higher individual gender normativity score was protective of weight loss attempts (β = -.15; p < .001) and weight loss behaviors (β = -.17; p < .001) in males but not females at 7-year follow-up. Loess plots provided visualizations of significant relationships. CONCLUSIONS Gender norms may reinforce a thinner body ideal for girls but a larger ideal for boys.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada
| | - Valerie Meausoone
- Stanford Center for Population Health Sciences, Stanford University, Stanford, California
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Holly B Shakya
- Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, California
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167
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Flores-Torres MH, Comerford E, Signorello L, Grodstein F, Lopez-Ridaura R, de Castro F, Familiar I, Ortiz-Panozo E, Lajous M. Impact of adverse childhood experiences on cardiovascular disease risk factors in adulthood among Mexican women. CHILD ABUSE & NEGLECT 2020; 99:104175. [PMID: 31710961 DOI: 10.1016/j.chiabu.2019.104175] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/12/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Childhood adversities are prevalent worldwide and might affect adult cardiovascular health. However, in middle-income countries such as Mexico, research on the impact of childhood adversities on cardiovascular disease (CVD) in adulthood is lacking. OBJECTIVE To evaluate the prevalence of adverse childhood experiences (ACEs) and their association with risk factors for CVD in adult Mexican women. PARTICIPANTS AND SETTING The study population comprised 9853 women from the Mexican Teachers´ Cohort. METHODS Participants responded to an online questionnaire including a 10-item instrument on ACEs and questions on CVD risk factors, between 2014 and 2017. Multivariate logistic regression models were used to evaluate the association between ACEs and adult behavioral and medical CVD risk factors. RESULTS About 61% of participants reported at least one ACE and 14% reported four or more. After multivariable adjustment, women who reported ≥4 ACEs had 58% (95%CI 1.37, 1.81) higher odds of having ever smoked and 17% (95%CI 0.69, 0.99) lower odds of being physically active, compared with women who reported no ACEs. Women who reported ≥4 ACEs also had higher odds of hypertension (OR = 1.19; 95%CI 1.00, 1.43), diabetes (OR = 1.49; 95%CI 1.13, 1.96), high cholesterol (OR = 1.49; 95%CI 1.26, 1.75), and obesity (OR = 1.37; 95%CI 1.19, 1.57). In addition, individual ACE components were independently associated with several CVD risk factors. CONCLUSION ACEs are common and associated with CVD risk factors in adult Mexican women.
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Affiliation(s)
- Mario H Flores-Torres
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Erin Comerford
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States
| | - Lisa Signorello
- Division of Cancer Prevention, National Cancer Institute, NIH, 9609 Medical Center Drive, Bethesda, MD, 20892-9712, United States
| | - Francine Grodstein
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States
| | - Ruy Lopez-Ridaura
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Filipa de Castro
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, 220 Trowbridge Rd, East Lansing, MI, 48824, United States
| | - Eduardo Ortiz-Panozo
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico
| | - Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, 7ª Cerrada Fray Pedro de Gante # 50, Mexico City, 14000, Mexico; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States.
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168
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The Influence of Schooling on the Stability and Mutability of Gender Attitudes: Findings From a Longitudinal Study of Adolescent Girls in Zambia. J Adolesc Health 2020; 66:S25-S33. [PMID: 31866034 DOI: 10.1016/j.jadohealth.2019.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Inequitable gender norms are thought to harm lifelong health and well-being. We explore the process of gender attitude change and the role of schooling in shifting or reinforcing gender norms among adolescent girls in Zambia. METHODS We used longitudinal data collected from unmarried, vulnerable girls (aged 10-19 years) as part of the Adolescent Girls Empowerment Program. We conducted random effects multinomial logistic regression to determine whether schooling-related factors were associated with shifts in adolescent girls' gender attitudes across three survey rounds and explored whether these relationships varied by age. RESULTS Mean gender attitude scores at the aggregate level remained stable over time among rural girls and improved slightly for urban girls. At the individual level, about half the girls had relatively unchanged scores, whereas the other half shifted to higher or lower scores between rounds. Rural and urban girls currently attending school were more likely to have relatively stable equitable attitudes than stable, inequitable attitudes, or attitudes that shifted to inequitable. Educational attainment was not associated with shifts in gender attitudes among rural girls. Urban girls with higher educational attainment were more likely to have relatively stable equitable attitudes than stable, inequitable attitudes, or attitudes that shifted to inequitable or more equitable. CONCLUSIONS Patterns of gender attitude stability and change differed more for urban girls than rural girls and varied by age and schooling-related factors. In general, schooling appears to be an institutional lever that holds promise for shifting gender attitudes toward greater equality. Our study highlights the importance of looking longitudinally at the effects of social context and reinforces calls for targeted, context-specific interventions for this age group.
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169
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Osborne V, Serdarevic M, Striley CW, Nixon SJ, Winterstein AG, Cottler LB. Age of First Use of Prescription Opioids and Prescription Opioid Non-Medical Use among Older Adolescents. Subst Use Misuse 2020; 55:2420-2427. [PMID: 33059498 DOI: 10.1080/10826084.2020.1823420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Non-medical use (NMU) of prescription opioids is of concern due to the opioid epidemic in the United States. Objective: We examined sex differences in the effect of age of first use of prescription opioids on prescription opioid NMU among 17- and 18-year olds. Methods: The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) recruited youth 10-18 years from 10 United States cities between 2008 and 2011 (n = 11,048). The cross-sectional survey included questions on past 30 day prescription opioid use (10,965 provided responses; 278 age 17 to 18 years who used opioids in past 30 days), with NMU defined as non-oral use and/or use of someone else's opioids. Nonparametric survival analysis with lifetable estimates was used to examine age at first use. Binomial logistic regression was conducted predicting any NMU, adjusted for covariates. Results: Among 278 youth 17 to 18 years, a significant difference in age of first use between those with MU only and any NMU (p < .0001) was observed. Each one year increase in age resulted in a 33% decrease in the odds of any prescription opioid NMU compared to MU only, after controlling for covariates (Odds Ratio = 0.67, 95% Confidence Interval: 0.47,0.96). Sex differences in age at first use were not observed. Conclusions: Risk of past 30 day prescription opioid NMU decreased by a third for each one year increase in age of first use, after adjustment for other covariates. Use of prescription opioids in young adolescents may need to be limited where possible and researched further.
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Affiliation(s)
- Vicki Osborne
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA.,Drug Safety Research Unit, Southampton, UK
| | - Mirsada Serdarevic
- Center for Outcomes Research, JPS Health Network, Fort Worth, Texas, USA.,Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
| | - Catherine W Striley
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Sara J Nixon
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - Linda B Cottler
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
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170
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Juan C, Edmeades J, Petroni S, Kapungu C, Gordon R, Ligiero D. Associations between mental distress, poly-victimisation, and gender attitudes among adolescent girls in Cambodia and Haiti: an analysis of Violence Against Children surveys. J Child Adolesc Ment Health 2019; 31:201-213. [PMID: 31805842 DOI: 10.2989/17280583.2019.1678476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aims to explore the effects of poly-victimisation (defined as the experience of multiple different forms of violence, including physical, emotional, and/or sexual) and gender attitudes on mental distress and suicidal ideation among adolescent girls, using cross-sectional nationally representative household survey data from Cambodia and Haiti. Data used were from 555 and 675 adolescent girls aged 13 to 19 from the 2013 Cambodia and 2012 Haiti Violence Against Children Surveys, respectively. Weighted bivariate and multivariate logistic regression analyses were used to assess the relationship between poly-victimisation and gender attitudes with severe mental distress and suicidal ideation, controlling for a range of factors. The results suggest that poly-victimisation is associated with severe mental distress and suicidal ideation among adolescent girls in both countries. Gender attitudes can serve as either a risk or protective factor. For example, in Haiti, respondents who agreed that women should tolerate violence to keep their family together were more likely to experience mental distress, but less likely to have had suicidal thoughts. The study's findings illustrate the need for further research on how gender norms and attitudes as well as experiences of multiple different forms of violence impact adolescent mental health.
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Affiliation(s)
- Christina Juan
- The Demographic and Health Surveys Program, ICF, Washington, USA
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171
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Baird S, Bhutta ZA, Hamad BA, Hicks JH, Jones N, Muz J. Do restrictive gender attitudes and norms influence physical and mental health during very young Adolescence? Evidence from Bangladesh and Ethiopia. SSM Popul Health 2019; 9:100480. [PMID: 31993481 PMCID: PMC6978471 DOI: 10.1016/j.ssmph.2019.100480] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/31/2019] [Accepted: 09/10/2019] [Indexed: 01/13/2023] Open
Abstract
Adolescence is seen as a window of opportunity for intervention but also as a time during which restrictive gender attitudes and norms become more salient. This increasingly gendered world has the potential to profoundly influence adolescents' capabilities, including their physical and mental health. Using quantitative data on 6,500 young adolescents (10-12) from the Gender and Adolescence: Global Evidence (GAGE) program, this paper analyses the association between restrictive gender attitudes (RGAs) at the individual level and restrictive gender norms (RGNs) at the community level and physical and mental health in Bangladesh and Ethiopia. We find significant associations between RGAs and RGNs and height-for-age z-scores, body mass index z-scores, self-reported health, adolescent hunger, psychological well-being, and self-esteem. We find no relationship between RGAs or RGNs and illness. We also find heterogeneity across country and urbanicity. We find surprisingly limited variation by gender, and the differences we do see point to important vulnerabilities for both boys and girls. Our results point to the powerful role that distal factors such as culture and beliefs, as manifested through RGAs and RGNs, can play in shaping health outcomes for both boys and girls and suggest important next steps for future research and policy.
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Affiliation(s)
- Sarah Baird
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C, 20052, USA
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, 525 University Avenue, Suite 702, Toronto, Canada
- Canada and Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Bassam Abu Hamad
- School of Public Health, Al Quds University, Abu Dees, POB 89, Jerusalem, Palestinian Authority
| | - Joan Hamory Hicks
- Department of Economics, University of Oklahoma, 308 Cate Center Drive, Norman, OK, 73072, USA
| | - Nicola Jones
- Overseas Development Institute, 203 Blackfriars Rd, London, UK
| | - Jennifer Muz
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C, 20052, USA
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172
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Ruane-McAteer E, Amin A, Hanratty J, Lynn F, Corbijn van Willenswaard K, Reid E, Khosla R, Lohan M. Interventions addressing men, masculinities and gender equality in sexual and reproductive health and rights: an evidence and gap map and systematic review of reviews. BMJ Glob Health 2019; 4:e001634. [PMID: 31565410 PMCID: PMC6747894 DOI: 10.1136/bmjgh-2019-001634] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Working with men/boys, in addition to women/girls, through gender-transformative programming that challenges gender inequalities is recognised as important for improving sexual and reproductive health and rights (SRHR) for all. The aim of this paper was to generate an interactive evidence and gap map (EGM) of the total review evidence on interventions engaging men/boys across the full range of WHO SRHR outcomes and report a systematic review of the quantity, quality and effect of gender-transformative interventions with men/boys to improve SRHR for all. METHODS For this EGM and systematic review, academic and non-academic databases (CINAHL, Medline, PsycINFO, Social Science Citation Index-expanded, Cochrane Library, Campbell Collaboration, Embase, Global Health Library and Scopus) were searched using terms related to SRHR, males/masculinities, systematic reviews and trials (January 2007-July 2018) with no language restrictions for review articles of SRHR interventions engaging men/boys. Data were extracted from included reviews, and AMSTAR2 was used to assess quality. Outcomes were based on WHO reproductive health strategy. RESULTS From the 3658 non-duplicate records screened, the total systematic reviews of interventions engaging men/boys in SRHR was mapped through an EGM (n=462 reviews) showing that such interventions were relatively evenly spread across low-income (24.5%), middle-income (37.8%) and high-income countries (37.8%). The proportion of reviews that included gender-transformative interventions engaging men/boys was low (8.4%, 39/462), the majority was in relation to violence against women/girls (n=18/39, 46.2%) and conducted in lower and middle-income countries (n=25/39, 64%). Reviews of gender-transformative interventions were generally low/critically low quality (n=34/39, 97.1%), and findings inconclusive (n=23/39, 59%), but 38.5% (n=15/39) found positive results. CONCLUSION Research and programming must be strengthened in engagement of men/boys; it should be intentional in promoting a gender-transformative approach, explicit in the intervention logic models, with more robust experimental designs and measures, and supported with qualitative evaluations.
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Affiliation(s)
- Eimear Ruane-McAteer
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Avni Amin
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneve, Switzerland
| | - Jennifer Hanratty
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Fiona Lynn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Kyrsten Corbijn van Willenswaard
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
| | - Esther Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Rajat Khosla
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneve, Switzerland
| | - Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
- Centre for Evidence and Social Innovation (CESI), Queen's University Belfast, Belfast, United Kingdom
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Shakya HB, Domingue B, Nagata JM, Cislaghi B, Weber A, Darmstadt GL. Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:529-538. [PMID: 31155319 PMCID: PMC6686658 DOI: 10.1016/s2352-4642(19)30160-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has documented differences in health behaviours between men and women, with differential risks and health outcomes between the sexes. Although some sex-specific differences in health outcomes are caused by biological factors, many others are socially driven through gender norms. We therefore aimed to assess whether gender expression as an adolescent, determined by the degree to which an individual's behvaiours were typical of their gender, were associated with health behaviours and outcomes in adulthood. METHODS In this prospective cohort study, we used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US adolescents from whom data were collected during adolescence (ages 11-18 years) and adulthood (ages 24-32 years). We created a measure of gender expression that was based on the degree to which male and female adolescents and adults behave in stereotypically masculine (for men) or feminine (for women) ways relative to their same-gender peers. Adolescents were assessed for baseline sociodemographic characteristics and gender expression, and these participants were later assessed, during adulthood, for their gender expression and health behaviours and outcomes, which included depression, self-rated health, drug and alcohol use, cardiovascular risk factors, experience of sexual violence, diet, and obesity. These data were collected via surveys, except for body-mass index, cholesterol, and blood pressure, which were collected as biomarkers. FINDINGS Between April and December, 1995, self-reported data were collected from 10 480 female and 10 263 male adolescents; similar data were subsequently collected in several waves in this cohort, with a final collection between January, 2008, and February, 2009, when participants were aged 24-32 years. We used data from this final wave and from baseline, and our study represents a secondary analysis of these data. Of these participants, complete follow-up data from 6721 (80%) adult women and 5885 (80%) adult men were available. Gender expression was stable for men and women from adolescence to adulthood. High masculinity (vs low masculinity) in adolescent and adult men was positively associated with smoking in the past month, use of marijuana and recreational drugs, prescription drug misuse (adult gender expression only), and consumption of fast food and soda (adolescent gender expression only) in the past week. However, higher masculine gender expression in adult men was negatively associated with diagnosed depression and high cholesterol in adulthood, and masculine gender expression in adolescent and adult men was negatively associated with high blood pressure in adults. High femininity (vs low femininity) in adolescent or adult women was positively associated with high cholesterol and blood pressure (both adult gender expression only), depression, migraines (adult gender expression only), and physical limitations (ie, health problems that limited their daily activities). However, higher femininity in adolescence was negatively associated with self-rated good health in adulthood. Although feminine gender expression in adolescents was predictive of adult recreational and prescription drug and marijuana use and experience of sexual violence, feminine gender expression in adulthood was negatively associated with adult substance use and experience of sexual violence, suggesting that expressions of femininity typical of adolescents impart risks that expression of femininity as an adult does not. Individuals who are highly masculine or feminine seem to be at greatest risk of adverse health outcomes and behaviours. INTERPRETATION We found compelling evidence that adolescent gender expression is correlated with health in adulthood independently of gender expression as an adult. Although more research is needed to identify causal mechanisms, our results suggest that those designing health behaviour interventions should carefully consider integrating gender transformative components into interventions. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, Gender Equality, Integrated Delivery, HIV, Nutrition, Family Planning, and Water Sanitation and Hygiene Program Strategy Teams (Bill and Melinda Gates Foundation).
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Affiliation(s)
- Holly B Shakya
- Center on Gender Equity and Health, Division of Infectious Disease and Global Public Health, University of California San Diego, San Diego, CA, USA.
| | - Ben Domingue
- Department of Education, Stanford University, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ann Weber
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
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175
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Blum RW, Sheehy G, Li M, Basu S, El Gibaly O, Kayembe P, Zuo X, Ortiz J, Chan KS, Moreau C. Measuring young adolescent perceptions of relationships: A vignette-based approach to exploring gender equality. PLoS One 2019; 14:e0218863. [PMID: 31247045 PMCID: PMC6597075 DOI: 10.1371/journal.pone.0218863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
This paper reports the development and baseline data of a vignettes-based measure of gender equality. METHODS Vignettes were developed through 3-day long focus groups. After piloting in 13 sites and repiloting a revised version in 6 countries, responses were categorized by the construct tapped and a scoring system developed. Finalized vignettes were then tested in DR Congo, Ecuador and China. RESULTS Young adolescents can successfully respond to vignettes; and can differentiate self from hypothetical protagonists of same and opposite sex. Response differences by sex of respondent and protagonist were statistically significant across a range of scenarios and settings. CONCLUSION This is the first vignettes-based measure for young adolescents assessing young adolescent perceptions of relationships differentiated by sex of the protagonist.
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Affiliation(s)
- Robert W. Blum
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Grace Sheehy
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mengmeng Li
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sharmistha Basu
- Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ), New Delhi, India
| | | | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Xiayun Zuo
- Shanghai Institute of Planned Parenthood Research, Shanghai, China
| | - Jose Ortiz
- Faculty of Medical Sciences of the University of Cuenca-Ecuador, Cuenca, Ecuador
| | - Kitty S. Chan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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176
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Weber AM, Cislaghi B, Meausoone V, Abdalla S, Mejía-Guevara I, Loftus P, Hallgren E, Seff I, Stark L, Victora CG, Buffarini R, Barros AJD, Domingue BW, Bhushan D, Gupta R, Nagata JM, Shakya HB, Richter LM, Norris SA, Ngo TD, Chae S, Haberland N, McCarthy K, Cullen MR, Darmstadt GL. Gender norms and health: insights from global survey data. Lancet 2019; 393:2455-2468. [PMID: 31155273 DOI: 10.1016/s0140-6736(19)30765-2] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
Abstract
Despite global commitments to achieving gender equality and improving health and wellbeing for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and subnational data provide some key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies showed that: (1) gender norms are complex and can intersect with other social factors to impact health over the life course; (2) early gender-normative influences by parents and peers can have multiple and differing health consequences for girls and boys; (3) non-conformity with, and transgression of, gender norms can be harmful to health, particularly when they trigger negative sanctions; and (4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programmes. Limitations of survey-based data are described that resulted in missed opportunities for investigating certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.
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Affiliation(s)
- Ann M Weber
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
| | | | - Valerie Meausoone
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Iván Mejía-Guevara
- Department of Biology, Stanford University, Stanford, CA, USA; Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Pooja Loftus
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Emma Hallgren
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ilana Seff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lindsay Stark
- Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Cesar G Victora
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Romina Buffarini
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Aluísio J D Barros
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | | | - Devika Bhushan
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Ribhav Gupta
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Jason M Nagata
- University of California San Francisco, Department of Pediatrics, San Francisco, CA, USA
| | - Holly B Shakya
- Department of Medicine, Center on Gender Equity and Health, University of California San Diego, La Jolla, CA, USA
| | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- Department of Paediatrics, SAMRC Developmental Pathways for Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Thoai D Ngo
- GIRL Center, Population Council, New York, NY, USA
| | - Sophia Chae
- GIRL Center, Population Council, New York, NY, USA
| | | | | | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, Zewdie D. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 393:2440-2454. [PMID: 31155275 DOI: 10.1016/s0140-6736(19)30652-x] [Citation(s) in RCA: 463] [Impact Index Per Article: 92.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
Abstract
Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.
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Affiliation(s)
- Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | | | - Neisha Opper
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Maria Stavropoulou
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Caroline Harper
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Marcos Nascimento
- Programa de Posgraduação em Saúde da Criança e da Mulher, Instituto Fernandes Figueira-Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Debrework Zewdie
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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178
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Wright PJ, Štulhofer A. Adolescent pornography use and the dynamics of perceived pornography realism: Does seeing more make it more realistic? COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2019.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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179
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Thapa R, Yang Y, Nget M. Perceptions of Sexual Infidelity in Rural Cambodia: A Qualitative Study of Adolescent Men. Am J Mens Health 2019; 13:1557988319848576. [PMID: 31055984 PMCID: PMC6505243 DOI: 10.1177/1557988319848576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
Sexual infidelity plays a significant role in the high rate of spousal transmission of HIV in Cambodia. The sexual beliefs and attitudes of a person begin in childhood and are developed through multiple chains in early adolescence, affecting his or her future sexual behavior and future incidence of HIV. A deeper understanding of the perspectives of adolescents regarding infidelity is critical to effective HIV prevention efforts during adulthood. Using a descriptive qualitative approach, this study explored the perceptions of male adolescents regarding male infidelity. Through the thematic analysis method, themes and subcategories were developed from the responses of 48 male high school students from three provinces. Majority of the participants ( n = 33) were found to have liberal attitudes not only toward male infidelity but also toward the high possibility of their own future infidelity ( n = 14). Almost 45% ( n = 21) of the participants explained that men would fulfill their sexual desires outside, such as in karaoke, when their wives are unable to have sex with them. Participants believed it annoying for men to disclose their extramarital activities to their wives. The study concluded that the participants hold accepting perceptions about infidelity; they are part of the HIV problem and must be part of the solution. Educators and counselors need to deliver age-appropriate, scientifically correct, and culturally relevant messages about sexual health and HIV prevention to growing adolescents.
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Affiliation(s)
- Roshna Thapa
- School of Nursing, Research Institute of
Nursing Science, Chonbuk National University, Jeonju, Baekje-daero, Republic of
Korea
| | - Youngran Yang
- School of Nursing, Research Institute of
Nursing Science, Chonbuk National University, Jeonju, Baekje-daero, Republic of
Korea
| | - Manndy Nget
- School of Nursing, Thammasat University,
Bangkok, Thailand
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180
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Wamoyi J, Heise L, Meiksin R, Kyegombe N, Nyato D, Buller AM. Is transactional sex exploitative? A social norms perspective, with implications for interventions with adolescent girls and young women in Tanzania. PLoS One 2019; 14:e0214366. [PMID: 30939145 PMCID: PMC6445416 DOI: 10.1371/journal.pone.0214366] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 03/12/2019] [Indexed: 11/18/2022] Open
Abstract
Although transactional sex is common in many sexual relationships, there has been little research into the degree to which the practice is considered exploitative in the settings in which it is practiced. We describe the social norms that influence transactional sex in two sites in Mwanza, Tanzania, and explore local understandings of whether and under what conditions it is considered exploitative. We then compare these "emic" understandings of exploitation to international definitions and norms around sexual exploitation. This study employed a qualitative research design involving 18 focus group discussions and 43 in-depth interviews with young people aged 14-24 years and parents with children aged 14-24 years in a rural area and an urban center within Mwanza, Tanzania. Thematic analysis was conducted with the aid of NVivo 10. The social norms influencing the practice of transactional sex included: reciprocity as a core cultural value that permeates the way exchange in sexual relationships is judged; gendered expectations that men should provide for women's material needs in sexual relationships and that women should reciprocate by means of sex; and peer pressure to be perceived as "fashionable". Adolescent girls and young women (AGYW) are under strong peer pressure to conform to a "modern lifestyle" as reflected in stylish clothing and other items of modernity such as cellphones. The emic conceptualization of exploitation is defined by circumstances surrounding the relationship or a sexual encounter. Important factors that characterize local notions of when transactional relationships are considered exploitative include: when the encounter or relationship involves an imbalance of power (based on age, male economic power and social status); when a man fails to reciprocate; and when sex is coerced. According to community perspectives, young women's behavior should be considered exploitative of men when they take gifts or money yet refuse sex or when they demand large sums of money. Interventions aimed at reducing AGYW's exploitation through transactional sex need to be cognizant of the variations in the understanding of what constitutes sexual exploitation as well as the social and gender norms influencing the practice of transactional sex. Interventions need to involve communities and families in critical thinking that helps them identify positive alternatives to current gendered social norms that shape the involvement of AGYW and men in transactional sex.
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Affiliation(s)
- Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Rebecca Meiksin
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Ana Maria Buller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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181
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Landry M, Vyas A, Malhotra G, Nagaraj N. Adolescents’ development of gender equity attitudes in India. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2019. [DOI: 10.1080/02673843.2019.1590852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Megan Landry
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
| | - Amita Vyas
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
| | - Gayatri Malhotra
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
| | - Nitasha Nagaraj
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health , Washington, DC, USA
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182
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Lundgren R, Burgess S, Chantelois H, Oregede S, Kerner B, Kågesten AE. Processing gender: lived experiences of reproducing and transforming gender norms over the life course of young people in Northern Uganda. CULTURE, HEALTH & SEXUALITY 2019; 21:387-403. [PMID: 29882476 DOI: 10.1080/13691058.2018.1471160] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
The years between 10-19 represent a critical stage of human development during which boys and girls learn and embody socially constructed gender norms, with long-term implications for their sexual and reproductive health. This ethnographic cohort study sought to understand how gendered norms and practices develop during the transition from child to young adult in post-conflict northern Uganda. A total of 60 girls and boys aged 10-19 were selected using purposive sampling for in-depth interviews over a three-year period; 47 individuals completed all four interviews. Drawing on feminist theory and an ecological perspective, findings were used to create a conceptual framework displaying the experiences of young people navigating patriarchal and alternative norms, emphasising their lived processes of performing and negotiating norms within six key domains (work, puberty, family planning, intimate partner relations, child discipline and alcohol). The framework identifies: (1) personal factors (knowledge, agency and aspirations); (2) social factors (socialisation processes, capital, costs and consequences); and (3) structural factors (health/educational systems, religious institutions, government policies) which may encourage young people towards one norm or another as they age. These findings can inform policies and programmes to transform gender norms and promote equitable, healthy relationships.
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Affiliation(s)
- Rebecka Lundgren
- a Institute for Reproductive Health , Georgetown University , Washington , USA
| | - Sarah Burgess
- a Institute for Reproductive Health , Georgetown University , Washington , USA
- d Camber Collective , San Francisco , USA
| | - Heather Chantelois
- a Institute for Reproductive Health , Georgetown University , Washington , USA
| | - Susan Oregede
- b Pathfinder International , Kampala , Uganda
- e UN Women Uganda , Kampala , Uganda
| | | | - Anna E Kågesten
- a Institute for Reproductive Health , Georgetown University , Washington , USA
- f Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
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183
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Taylor AY, Murphy-Graham E, Van Horn J, Vaitla B, Del Valle Á, Cislaghi B. Child Marriages and Unions in Latin America: Understanding the Roles of Agency and Social Norms. J Adolesc Health 2019; 64:S45-S51. [PMID: 30914168 PMCID: PMC6426822 DOI: 10.1016/j.jadohealth.2018.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/30/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Child marriages and unions can infringe upon adolescent and youth sexual and reproductive health (AYSRH). Interventions increasingly promote strategies to transform social norms or foster the agency of adolescent girls. Recent empirical studies call for further understanding of how social norms and agency interact in ways that influence these practices, especially in contexts where girls' agency is central. METHODS A secondary cross-case analysis of three qualitative studies (in Brazil, Guatemala, Honduras) was conducted to inform the investigation of how norms and agency may relate in sustaining or mitigating child marriage. RESULTS Social norms dictating how girls/young women and how men should act indirectly led to child marriages and unions. The data showed that (1) social norms regulated girls' acceptable actions and contributed to their exercise of "oppositional" agency; (2) social norms promoted girls' "accommodating" agency; and (3) girls exercised "transformative" agency to resist harmful social norms. CONCLUSIONS Research should advance frameworks to conceptualize how social norms interact with agency in nuanced and context-specific ways. Practitioners should encourage equitable decision-making; offer confidential, adolescent-friendly AYSRH services; and address the social norms of parents, men and boys, and community members.
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Affiliation(s)
- Alice Y Taylor
- University of California, Berkeley Graduate School of Education, Berkeley, California.
| | - Erin Murphy-Graham
- University of California, Berkeley Graduate School of Education, Berkeley, California
| | | | - Bapu Vaitla
- Harvard University TH Chan School of Public Health, Cambridge, Massachusetts
| | | | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London United Kingdom
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Reynes E, Dumoulin C, Robert B, Berthouze SE. Why aren’t they involved in physical activities? The hypothesis of negative self-perception due to past physical activity experiences. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1570691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Eric Reynes
- Laboratoire sur les Vulnérabilités et l’Innovation dans le Sport (L-ViS, EA 7428), Confédération Recherches Interdisciplinaires en Sport (CRIS, FED 4272), Univ Lyon, Université Claude Bernard Lyon 1, Lyon F-69622, France
| | - Coralie Dumoulin
- Laboratoire Interuniversitaire de Biologie de la motricité (LIBM, EA 7424), Confédération Recherches Interdisciplinaires en Sport (CRIS, FED 4272), Univ Lyon, Université Claude Bernard Lyon 1, Lyon F-69622, France
| | - Bernard Robert
- Université de Bordeaux, EA 4136 HACS Handicap cognition activité santé, UFR STAPS, Pessac, 33600, France
| | - Sophie E. Berthouze
- Laboratoire Interuniversitaire de Biologie de la motricité (LIBM, EA 7424), Confédération Recherches Interdisciplinaires en Sport (CRIS, FED 4272), Univ Lyon, Université Claude Bernard Lyon 1, Lyon F-69622, France
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185
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Mistrale Hendrickson Z, Byrne M, Sawadogo N, Mafuta E, Bazié F, Moreau C. Santé des adolescents de 10 à 14 ans à Kinshasa et Ouagadougou : risques et opportunités. SANTE PUBLIQUE 2019; 31:845-853. [DOI: 10.3917/spub.196.0845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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186
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Buller AM, Schulte MC. Aligning human rights and social norms for adolescent sexual and reproductive health and rights. REPRODUCTIVE HEALTH MATTERS 2018. [DOI: 10.1080/09688080.2018.1542914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ana Maria Buller
- Assistant Professor, Deputy Director Gender Violence and Health Centre, Social Sciences, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Celine Schulte
- Research Fellow, Gender, Violence and Health Centre, Social Sciences, London School of Hygiene and Tropical Medicine, London, UK
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187
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Ramanaik S, Collumbien M, Prakash R, Howard-Merrill L, Thalinja R, Javalkar P, Murthy S, Cislaghi B, Beattie T, Isac S, Moses S, Heise L, Bhattacharjee P. Education, poverty and "purity" in the context of adolescent girls' secondary school retention and dropout: A qualitative study from Karnataka, southern India. PLoS One 2018; 13:e0202470. [PMID: 30183747 PMCID: PMC6124724 DOI: 10.1371/journal.pone.0202470] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gender-related norms and poverty remain important structural barriers to secondary school attendance among adolescent girls in southern India. We analyse how gender norms interact with family deprivation and dynamics to result in girls dropping out of school; we identify the main facilitators of school retention and changes to gender socialisation. METHODS Longitudinal qualitative case studies with 36 girls were nested within a cluster randomized trial to evaluate the Samata intervention targeting adolescent girls in Bagalkote and Vijayapura districts in northern Karnataka. We used two rounds of in-depth interviews, conducted in 2014 at a time when respondents were in 8th standard at the age of 13 to 14 and sixteen months later. We combined thematic and narrative analyses. RESULTS Our study found that poverty and socioeconomic realities at the household level strongly affect conformity with discriminatory gender practices such as restricting girls' mobility. The value placed on education by parents clearly differentiates the regular school goers from those frequently absent and others who dropped out. With active encouragement of the girls' educational and career aspirations, parents engendered the girl's agency to communicate openly both at home and at school, allowing subtle changes to gender performance while resisting the pressure of social sanctions. In contrast, where educational aspirations were weak, parents invested more intensely in enforcing correct performance of gender, prioritising her well-being by aiming to secure her future in a good marriage. Among poorer families, girls' domestic duties came at the cost of schooling with concerns about protecting her sexual purity predominating. CONCLUSIONS In contexts where a strong gender ideology of virginity before marriage rules, subtle shifts in harmful gender practices are possible. Interventions aiming to improve education need to target the most deprived families, focussing on trust building through open communication.
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Affiliation(s)
| | - Martine Collumbien
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Lottie Howard-Merrill
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | | | - Prakash Javalkar
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Srikanta Murthy
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
| | - Ben Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | - Tara Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, London, United Kingdom
| | - Shajy Isac
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Parinita Bhattacharjee
- Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar, Bangalore, India
- Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
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188
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Ruane-McAteer E, Hanratty J, Lynn F, Reid E, Khosla R, Amin A, Lohan M. Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-24. [PMID: 37131371 PMCID: PMC8428064 DOI: 10.1002/cl2.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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189
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Ike CG, Anderson N. A proposal for teaching bioethics in high schools using appropriate visual education tools. Philos Ethics Humanit Med 2018; 13:11. [PMID: 30029667 PMCID: PMC6053790 DOI: 10.1186/s13010-018-0064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023] Open
Abstract
Teaching bioethics with visual education tools, such as movies and comics, is a unique way of explaining the history and progress of human research and the art and science of medicine to high school students. For more than a decade, bioethical concepts have appeared in movies, and these films are useful for teaching medical and research ethics in high schools. Using visual tools to teach bioethics can have both interpretational and transformational effects on learners that will enhance their overall understanding of complex moral and legal issues in medicine and research.High school students are uniquely suited to learn bioethics because they will soon become legal adults. As adults, they will make moral decisions that may affect their health and wellbeing as well as that of their communities and societies.However, not all visual education tools are appropriate for bioethics pedagogy in high school. Bioethics film and comic producers must consider the specifics of student age, race, gender, belief, level of education, and sexual orientation. Such tools must not be dominated by either dystopic or utopic genres, must aim for objectivity, and must consider the complexity of ethical decision making. It is critical that the teacher, who is the final arbiter regarding the use of visual tools in the classroom, determines that the visual learning tool is acceptable for students in any particular education context. In addition, during the conceptualization and creation of these tools, bioethics film and comic producers must work harder to ensure that these visual tools are devoid of any form of stereotyping.
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Affiliation(s)
- Chiedozie G. Ike
- Department of Public Health, Irrua Specialist Teaching Hospital, Irrua, Edo State Nigeria
| | - Nancy Anderson
- Department of Midwifery, Bastyr University, Kenmore, Washington USA
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190
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Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, Coll-Seck AM, Grover A, Laski L, Roa M, Sathar ZA, Say L, Serour GI, Singh S, Stenberg K, Temmerman M, Biddlecom A, Popinchalk A, Summers C, Ashford LS. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet 2018; 391:2642-2692. [PMID: 29753597 DOI: 10.1016/s0140-6736(18)30293-9] [Citation(s) in RCA: 480] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | - Alex C Ezeh
- African Population and Health Research Center, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Center for Global Development, Washington, DC, USA
| | | | - Alaka Basu
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Robert Blum
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Monica Roa
- Independent Consultant, Islamabad, Pakistan
| | | | - Lale Say
- World Health Organization, Geneva, Switzerland
| | - Gamal I Serour
- International Islamic Center For Population Studies And Research, Al Azhar University, Cairo, Egypt
| | | | | | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
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191
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AlMenhali EA, Khalid K, Iyanna S. Testing the psychometric properties of the Environmental Attitudes Inventory on undergraduate students in the Arab context: A test-retest approach. PLoS One 2018; 13:e0195250. [PMID: 29758021 PMCID: PMC5951589 DOI: 10.1371/journal.pone.0195250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 03/19/2018] [Indexed: 11/18/2022] Open
Abstract
The Environmental Attitudes Inventory (EAI) was developed to evaluate the multidimensional nature of environmental attitudes; however, it is based on a dataset from outside the Arab context. This study reinvestigated the construct validity of the EAI with a new dataset and confirmed the feasibility of applying it in the Arab context. One hundred and forty-eight subjects in Study 1 and 130 in Study 2 provided valid responses. An exploratory factor analysis (EFA) was used to extract a new factor structure in Study 1, and confirmatory factor analysis (CFA) was performed in Study 2. Both studies generated a seven-factor model, and the model fit was discussed for both the studies. Study 2 exhibited satisfactory model fit indices compared to Study 1. Factor loading values of a few items in Study 1 affected the reliability values and average variance extracted values, which demonstrated low discriminant validity. Based on the results of the EFA and CFA, this study showed sufficient model fit and suggested the feasibility of applying the EAI in the Arab context with a good construct validity and internal consistency.
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Affiliation(s)
| | - Khalizani Khalid
- Department of Management, College of Business Administration, Abu Dhabi University, Abu Dhabi, UAE
- * E-mail:
| | - Shilpa Iyanna
- Department of Marketing, College of Business Administration, Abu Dhabi University, Abu Dhabi, UAE
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192
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Lundgren R, Gibbs S, Kerner B. Does it take a village? Fostering gender equity among early adolescents in Nepal. Int J Adolesc Med Health 2018; 32:/j/ijamh.ahead-of-print/ijamh-2017-0164/ijamh-2017-0164.xml. [PMID: 29708882 DOI: 10.1515/ijamh-2017-0164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/10/2017] [Indexed: 06/08/2023]
Abstract
Background Gender inequity contributes to a range of poor health outcomes. Early adolescence presents a window of opportunity for gender transformative interventions to shift inequitable gender norms, attitudes and behaviors. Objective The objective of this study is to evaluate a set of individual, family and community interventions to increase gender equity among very young adolescents (VYAs) in rural Nepal. Methods Two communities received the individual-level Choices intervention as well the family and community Voices and Promises interventions (CVP). Two comparison communities received only Choices. Samples of 1200 VYAs and 600 parents were interviewed at baseline before implementation and at end line 1 year later. Results In both CVP and Choices only areas most measures of gender norms, attitudes, and behaviors improved, suggesting a positive effect of the individual-level intervention. Increases in norms, attitudes, and behaviors reported by VYAs were generally greater in CVP areas compared to Choices areas, suggesting an added benefit from the family and community interventions. Parent-reported measures did not demonstrate an intervention effect of the family and community interventions. Uneven evaluation results, particularly among parents, may reflect implementation challenges such as the compressed 3-month intervention period due to the 2015 earthquakes and subsequent political unrest. Conclusion Overall findings are encouraging and suggest that adding family and community interventions may improve gender equity.
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Affiliation(s)
- Rebecka Lundgren
- Institute for Reproductive Health, Georgetown University, 1825 Connecticut Ave Suite, Suite 699, Washington DC 20009, USA, Phone: +12026877969
| | - Susannah Gibbs
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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193
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Rousseau A, Rodgers RF, Eggermont S. A Short-Term Longitudinal Exploration of the Impact of TV Exposure on Objectifying Attitudes Toward Women in Early Adolescent Boys. SEX ROLES 2018. [DOI: 10.1007/s11199-018-0925-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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194
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Hayden MH, Barrett E, Bernard G, Toko EN, Agawo M, Okello AM, Gunn JKL, Ernst KC. Barriers and Opportunities to Advancing Women in Leadership Roles in Vector Control: Perspectives from a Stakeholder Survey. Am J Trop Med Hyg 2018; 98:1224-1227. [PMID: 29557326 PMCID: PMC5953369 DOI: 10.4269/ajtmh.17-0693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Increasing the active participation of professional women in vector control (VC) activities may help promote greater gender equity in the workplace and reduce the burden of vector-borne diseases. This stakeholder survey examined the current roles and perspective of professionals employed in the VC sector in Kenya, Indonesia, India, and other countries. The largest barriers that women face in pursuing leadership roles in the VC sector include lack of awareness of career opportunities, limitations based on cultural norms, and the belief that VC is men’s work. These barriers could be addressed through improving education and recruitment campaigns, as well as supporting higher education and mentoring programs. Females were almost six times more likely to be encouraged to pursue leadership positions in their organization compared with male respondents (odds ratio = 5.9, P > 0.03, 95% confidence interval: 1.19, 29.42). These findings suggest that once women are recruited into the VC workforce, they face minimal discrimination and have increased leadership opportunities.
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Affiliation(s)
- Mary H Hayden
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado
| | - Erika Barrett
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Guyah Bernard
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Nyanza, Kenya
| | - Eunice N Toko
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Nyanza, Kenya
| | - Maurice Agawo
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Nyanza, Kenya
| | - Amanda M Okello
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Jayleen K L Gunn
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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195
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Amin A, Kågesten A, Adebayo E, Chandra-Mouli V. Addressing Gender Socialization and Masculinity Norms Among Adolescent Boys: Policy and Programmatic Implications. J Adolesc Health 2018; 62:S3-S5. [PMID: 29455715 PMCID: PMC5817048 DOI: 10.1016/j.jadohealth.2017.06.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/20/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Avni Amin
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
| | - Anna Kågesten
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel Adebayo
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland,Adolescent Health Unit, Institute of Child Health, University of Ibadan, Ibadan, Nigeria
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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196
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Patton GC, Darmstadt GL, Petroni S, Sawyer SM. A Gender Lens on the Health and Well-being of Young Males. J Adolesc Health 2018; 62:S6-S8. [PMID: 29455720 DOI: 10.1016/j.jadohealth.2017.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- George C Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Susan M Sawyer
- Centre for Adolescent Health, Murdoch Childrens Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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197
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Schlecht J, Lee C, Kerner B, Greeley M, Robinson C. Prioritizing programming to address the needs and risks of very young adolescents: a summary of findings across three humanitarian settings. Confl Health 2017. [PMCID: PMC5688487 DOI: 10.1186/s13031-017-0126-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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198
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Chandra-Mouli V, Plesons M, Adebayo E, Amin A, Avni M, Kraft JM, Lane C, Brundage CL, Kreinin T, Bosworth E, Garcia-Moreno C, Malarcher S. Implications of the Global Early Adolescent Study's Formative Research Findings for Action and for Research. J Adolesc Health 2017; 61:S5-S9. [PMID: 28915994 PMCID: PMC5612022 DOI: 10.1016/j.jadohealth.2017.07.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Marina Plesons
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Emmanuel Adebayo
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Avni Amin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Michal Avni
- United States Agency for International Development, Washington, D.C
| | - Joan Marie Kraft
- United States Agency for International Development, Washington, D.C
| | - Catherine Lane
- United States Agency for International Development, Washington, D.C
| | | | - Tamara Kreinin
- David and Lucile Packard Foundation, Los Altos, California
| | - Emily Bosworth
- David and Lucile Packard Foundation, Los Altos, California
| | - Claudia Garcia-Moreno
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shawn Malarcher
- United States Agency for International Development, Washington, D.C
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199
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Al-Attar G, De Meyer S, El-Gibaly O, Michielsen K, Animosa LH, Mmari K. "A Boy Would Be Friends With Boys … and a Girl … With Girls": Gender Norms in Early Adolescent Friendships in Egypt and Belgium. J Adolesc Health 2017; 61:S30-S34. [PMID: 28915990 DOI: 10.1016/j.jadohealth.2017.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/15/2017] [Accepted: 03/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE A gender analysis was conducted to illuminate the key elements of friendships highlighted by early adolescent girls and boys in two sites for the purpose of better understanding the impact of gender norms on adolescent friendships in different contexts. METHODS Narrative interviews with early adolescents were conducted in two sites: Assiut, Egypt (n = 37) and Ghent, Belgium (n = 30). The interviews were recorded, transcribed, translated into English, and coded using Atlas.ti for analysis. RESULTS In both Assiut and Ghent, early adolescents reported some similarities in defining key characteristics of their same-sex friends as well as in the activities they share. However, differences were noticed among boys and girls within each site. In addition, the scope of shared activity was broader in Ghent than in Assiut. In both sites, few opposite-sex friendships were reported. Gender norms influenced choice of friends as well as the type and place of shared activities. CONCLUSIONS Building on knowledge that adolescent friendships guide and reinforce attitudes, beliefs, and behaviors that impact immediate and long-term health, our findings indicate that gender norms inform early adolescent friendships, which may impact healthy development.
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Affiliation(s)
- Ghada Al-Attar
- Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Sara De Meyer
- International Centre for Reproductive Health (ICRH), Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Omaima El-Gibaly
- Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Kristien Michielsen
- International Centre for Reproductive Health (ICRH), Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lydia H Animosa
- Population, Family & Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kristin Mmari
- Population, Family & Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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200
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Yu C, Zuo X, Blum RW, Tolman DL, Kågesten A, Mmari K, De Meyer S, Michielsen K, Basu S, Acharya R, Lian Q, Lou C. Marching to a Different Drummer: A Cross-Cultural Comparison of Young Adolescents Who Challenge Gender Norms. J Adolesc Health 2017; 61:S48-S54. [PMID: 28915993 DOI: 10.1016/j.jadohealth.2017.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/19/2017] [Accepted: 07/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Little is known about how gender norms regulate adolescents' lives across different cultural settings. This study aims to illustrate what is considered as violating gender norms for boys and girls in four urban poor sites as well as the consequences that follow the challenging of gender norms. METHODS Data were collected as part of the Global Early Adolescent Study, a 15-country collaboration to explore gender norms and health in early adolescence. The current study analyzed narrative and in-depth interviews conducted in urban poor sites in two middle-income (Shanghai, China; and New Delhi, India) and two high-income countries (Baltimore, U.S.; and Ghent, Belgium). A total of 238 participants, 59 boys and 70 girls aged 11-13 years old and 109 of their parents/guardians (28 male adults and 81 female adults), were interviewed. A thematic analysis was conducted across sites using Atlas.Ti 7.5 software. RESULTS Findings revealed that although most perceptions and expressions about gender were regulated by stereotypical norms, there was a growing acceptability for girls to wear boyish clothes and engage in stereotypical masculine activities such as playing soccer/football. However, there was no comparable acceptance of boys engaging in traditional feminine behaviors. Across all sites, challenging gender norms was often found to lead to verbal, physical, and/or psychological retribution. CONCLUSIONS While it is sometimes acceptable for young adolescents to cross gender boundaries, once it becomes clear that a behavior is socially defined as typical for the other sex, and the adolescent will face more resistance. Researchers, programmers, and clinicians working in the field of adolescent health need not only attend to those who are facing the consequences of challenging prevailing gender norms, but also to address the environment that fosters exclusion and underscores differences.
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Affiliation(s)
- Chunyan Yu
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, P.R. China; School of Public Health, Fudan University, Shanghai, P.R. China
| | - Xiayun Zuo
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, P.R. China
| | - Robert W Blum
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deborah L Tolman
- Hunter College and The Graduate Center, City University of New York, New York, New York
| | - Anna Kågesten
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kristin Mmari
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sara De Meyer
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Kristien Michielsen
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | | | | | - Qiguo Lian
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, P.R. China; School of Public Health, Fudan University, Shanghai, P.R. China
| | - Chaohua Lou
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, P.R. China.
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