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Glasser NJ, Jameson JC, Tung EL, Lindau ST, Pollack HA. Associations of Adolescent School Social Networks, Gender Norms, and Adolescent-to-Young Adult Changes in Male Gender Expression With Young Adult Substance Use. J Adolesc Health 2024; 74:755-763. [PMID: 38206221 PMCID: PMC11174146 DOI: 10.1016/j.jadohealth.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Male gender expression (MGE), which is shaped by sociocultural pressures around masculinity, has been previously associated with health. This study examines associations of adolescent social network variables and school gender norms with MGE changes from adolescence to young adulthood, and associations of these changes with young adult substance use. METHODS Analyzing data from Waves I (1994-95, adolescents, aged 12-18) and IV (2008-09, young adults, 24-32) of a nationally representative longitudinal cohort study, male participants' MGE was assessed in each wave using a validated, empirically derived measure. Linear regression was used to evaluate associations of adolescent-to-young adult MGE changes between waves with adolescent social network characteristics and school gender norms. Logistic regression was used to examine associations between adolescent-to-young adult MGE changes and young adult substance uses (cigarette, marijuana, heavy alcohol, and recreational drug use, and prescription drug misuse). RESULTS Among 4,776 male participants, adolescent-to-young adult MGE changes were significantly associated with school gender norms such that adolescents whose MGE markedly departed from their schools' average exhibited greater MGE changes in the direction of their schools' average (β = -0.83, p < .01) relative to those who were more similar to school means. Adolescent-to-young adult increases in MGE were significantly associated with greater odds of all young adult substance use behaviors except prescription drug misuse. DISCUSSION Adolescents' MGE relative to other males at their school was associated with MGE changes toward school norms, with implications for young adult substance use. Adolescent gender norms may be an underexplored strategy for interventions to reduce substance misuse.
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Affiliation(s)
- Nathaniel J Glasser
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois.
| | - Jacob C Jameson
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth L Tung
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine - Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, Illinois; Department of Public Health Sciences, University of Chicago, Chicago, Illinois; Urban Health Lab, University of Chicago, Chicago, Illinois
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Gayles J, Yahner M, Barker KM, Moreau C, Li M, Koenig L, Mafuta E, Mbela P, Lundgren R. Balancing Quality, Intensity and Scalability: Results of a Multi-level Sexual and Reproductive Health Intervention for Very Young Adolescents in Kinshasa. J Adolesc Health 2023; 73:S33-S42. [PMID: 37330819 DOI: 10.1016/j.jadohealth.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 01/09/2023] [Accepted: 02/03/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE In addition to the rapid physical and cognitive transformations very young adolescents (VYAs) experience between ages 10-14, gender and social norms internalized during this period have long-term implications as adolescents become sexually active. This age presents critical opportunities for early intervention to promote gender-equitable attitudes and norms for improved adolescent health. METHODS In Kinshasa, DRC, Growing Up GREAT! implemented a scalable approach to engage in- and out-of-school VYAs, caregivers, schools, and communities. A quasi-experimental study evaluated the outcomes of sexual and reproductive health (SRH) knowledge, assets and agency, and gender-equitable attitudes and behaviors among VYA participants. Ongoing monitoring and qualitative studies provided insights into implementation challenges and contextual factors. RESULTS Results show significant improvement in SRH knowledge and assets such as caregiver connectedness, communication, and body satisfaction among the intervention group. The intervention was also associated with significant improvements in gender-equitable attitudes related to adolescents' household responsibilities and decreased teasing and bullying. Intervention effects on awareness of SRH services, body satisfaction, chore-sharing, and bullying were stronger for out-of-school and younger VYAs, suggesting the intervention's potential to increase positive outcomes among vulnerable adolescents. The intervention did not shift key gender norm perceptions assessed. Implementation research suggests design decisions made to increase the intervention's scalability necessitated reductions in training and program dosing that may have affected results. DISCUSSION Results affirm the potential of early intervention to increase SRH knowledge, assets and gender-equitable behaviors. They also highlight the need for more evidence on effective program approaches and segmentation for shifting VYA and SRH norms.
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Affiliation(s)
- Jennifer Gayles
- Department of Global Health, Save the Children Federation, Washington, D.C..
| | - Melanie Yahner
- Department of Global Health, Save the Children Federation, Washington, D.C
| | - Kathryn M Barker
- Center for Gender Equity and Health, University of California San Diego, San Diego, California
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Mengmeng Li
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leah Koenig
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric Mafuta
- Department of Health Systems Management and Policy, School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pierrot Mbela
- Save the Children International, Democratic Republic of the Congo Country Office, Kinshasa, Democratic Republic of the Congo
| | - Rebecka Lundgren
- Center for Gender Equity and Health, University of California San Diego, San Diego, California
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Beckwith S, Li M, Barker KM, Gayles J, Kågesten AE, Lundgren R, Villalobos Dintrans P, Wilopo SA, Moreau C. The Impacts of Two Gender-Transformative Interventions on Early Adolescent Gender Norms Perceptions: A Difference-in-Difference Analysis. J Adolesc Health 2023; 73:S55-S64. [PMID: 37330822 DOI: 10.1016/j.jadohealth.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 06/19/2023]
Abstract
PURPOSE Inequitable gender norms are widespread and can be harmful to the wellbeing of adolescents. This study estimates the effects of two gender-transformative interventions, Semangat Dunia Remaja or Teen Aspirations (SETARA) and Growing Up Great! (GUG!), on gender norms perceptions and attitudes among very young adolescents in poor urban settings in Bandar Lampung, Semarang, Denpasar (Indonesia), and Kinshasa (Democratic Republic of the Congo). METHODS The study draws from the longitudinal Global Early Adolescent Study, using a quasi-experimental design to evaluate the interventions. Data collection took place between 2017 and 2020. Our analytical samples included 2,159 adolescents in Kinshasa and 3,335 in Indonesia. We conducted a difference-in-difference analysis using generalized estimation equations and generalized linear models, after stratification by site and sex. RESULTS The interventions shifted a range of gender perceptions, although effects varied by program, city, and sex. SETARA shifted gender-normative perceptions related to traits, roles, and relations, while GUG! effects were more concentrated on attitudes toward chore sharing. SETARA was most effective in Semarang and Denpasar, but not in Bandar Lampung. In addition, both interventions were more consistently effective for girls than boys. DISCUSSION Gender-transformative interventions can effectively promote gender equality in early adolescence, but effects are program-specific and context-specific. Our findings emphasize the importance of defined theories of change and consistent implementation in gender-transformative intervention.
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Affiliation(s)
- Sam Beckwith
- Department of Population and Family Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
| | - Mengmeng Li
- Department of Population and Family Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathryn M Barker
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California
| | - Jennifer Gayles
- Department of Global Health, Save the Children Federation, Washington, D.C
| | - Anna E Kågesten
- Global and Sexual Health Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Lundgren
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California
| | - Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Estación Central, Región Metropolitana, Chile
| | - Siswanto Agus Wilopo
- Faculty of Medicine, Public Health and Nursing, Center for Reproductive Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Caroline Moreau
- Department of Population and Family Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Pérez-Martínez V, Marcos-Marcos J, Cerdán-Torregrosa A, Briones-Vozmediano E, Sanz-Barbero B, Davó-Blanes MC, Daoud N, Edwards C, Salazar M, La Parra-Casado D, Vives-Cases C. Positive Masculinities and Gender-Based Violence Educational Interventions Among Young People: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:468-486. [PMID: 34282677 DOI: 10.1177/15248380211030242] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Hegemonic masculinity has been recognized as contributing to the perpetration of different forms of gender-based violence (GBV). Abandoning hegemonic masculinities and promoting positive masculinities are both strategies used by interventions that foreground a "gender-transformative approach." Preventing GBV among young people could be strengthened by engaging young men. In this article, we aim to systematically review the primary characteristics, methodological quality, and results of published evaluation studies of educational interventions that aim to prevent different forms of GBV through addressing hegemonic masculinities among young people. MAIN BODY We conducted a systematic review of available literature (2008-2019) using Medline (PubMed), Scopus, Web of Science, PsycInfo, the CINAHL Complete Database, and ERIC as well as Google scholar. The Template for Intervention Description and Replication was used for data extraction, and the quality of the selected studies was analyzed using the Mixed Method Appraisal Tool. More than half of the studies were conducted in Africa (n = 10/15) and many were randomized controlled trials (n = 8/15). Most of the studies with quantitative and qualitative methodologies (n = 12/15) reported a decrease in physical GBV and/or sexual violence perpetration/victimization (n = 6/15). Longitudinal studies reported consistent results over time. CONCLUSIONS Our results highlight the importance of using a gender-transformative approach in educational interventions to engage young people in critical thinking about hegemonic masculinity and to prevent GBV.
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Affiliation(s)
- Vanesa Pérez-Martínez
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Jorge Marcos-Marcos
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Ariadna Cerdán-Torregrosa
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | | | - Belen Sanz-Barbero
- Epidemiology and Statistics Department, National School of Health Carlos III, Madrid, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - MCarmen Davó-Blanes
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
| | - Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, 26732Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Clarie Edwards
- School of Applied Social Studies, 8795University College Cork, Ireland
| | - Mariano Salazar
- Department of Global Public Health, GloSH research group, Karolinska Institutet, Stockholm, Sweden
| | | | - Carmen Vives-Cases
- Community Nursing, Preventive Medicine and Public Health and History of Science Department, 16718University of Alicante, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
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Bhatia K, Rath S, Pradhan H, Samal S, Copas A, Gagrai S, Rath S, Gope RK, Nair N, Tripathy P, Rose-Clarke K, Prost A. Effects of community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India (JIAH trial): A cluster-randomised controlled trial. SSM Popul Health 2022; 21:101330. [PMID: 36618545 PMCID: PMC9811248 DOI: 10.1016/j.ssmph.2022.101330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Objectives To evaluate whether and how community youth teams facilitating participatory adolescent groups, youth leadership and livelihood promotion improved school attendance, dietary diversity, and mental health among adolescent girls in rural India. Design A parallel group, two-arm, superiority, cluster-randomised controlled trial with an embedded process evaluation. Setting intervention and participants 38 clusters (19 intervention, 19 control) in West Singhbhum district in Jharkhand, India. The intervention included participatory adolescent groups and youth leadership for boys and girls aged 10-19 (intervention clusters only), and family-based livelihood promotion (intervention and control clusters) between June 2017 and March 2020. We surveyed 3324 adolescent girls aged 10-19 in 38 clusters at baseline, and 1478 in 29 clusters at endline. Four intervention and five control clusters were lost to follow up when the trial was suspended due to the COVID-19 pandemic. Adolescent boys were included in the process evaluation only. Primary and secondary outcome measures Primary: school attendance, dietary diversity, and mental health; 12 secondary outcomes related to education, empowerment, experiences of violence, and sexual and reproductive health. Results In intervention vs control clusters, mean dietary diversity score was 4·0 (SD 1·5) vs 3·6 (SD 1·2) (adjDiff 0·34; 95%CI -0·23, 0·93, p = 0·242); mean Brief Problem Monitor-Youth (mental health) score was 12·5 (SD 6·0) vs 11·9 (SD 5·9) (adjDiff 0·02, 95%CI -0·06, 0·13, p = 0·610); and school enrolment rates were 70% vs 63% (adjOR 1·39, 95%CI 0·89, 2·16, p = 0·142). Uptake of school-based entitlements was higher in intervention clusters (adjOR 2·01; 95%CI 1·11, 3·64, p = 0·020). Qualitative data showed that the community youth team had helped adolescents and their parents navigate school bureaucracy, facilitated re-enrolments, and supported access to entitlements. Overall intervention delivery was feasible, but positive impacts were likely undermined by household poverty. Conclusions Participatory adolescent groups, leadership training and livelihood promotion delivered by a community youth team did not improve adolescent girls' mental health, dietary diversity, or school attendance in rural India, but may have increased uptake of education-related entitlements. Trial registration ISRCTN17206016.
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Affiliation(s)
- Komal Bhatia
- Institute for Global Health, University College London, London, UK,Corresponding author. Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | | | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
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Hill AL, Miller E, Switzer GE, Abebe KZ, Chang JC, Pulerwitz J, Brush LD, Hill AV. Gender Equitable Attitudes Among Adolescents: A Validation Study and Associations with Sexual Health Behaviors. ADOLESCENT RESEARCH REVIEW 2022; 7:523-536. [PMID: 38895164 PMCID: PMC11185410 DOI: 10.1007/s40894-021-00171-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/27/2021] [Indexed: 06/21/2024]
Abstract
Gender inequitable attitudes are associated with violence perpetration and poor sexual health. There is limited diversity in U.S. samples used to validate gender attitudes measurements. This study assessed a 13-item gender equitable attitudes scale's validity among a sample of predominantly Black adolescent boys (n = 866; mean age = 15.5, range = 13-19 years) and examined associations with sexual health behaviors. Exploratory and confirmatory factor analyses tested construct validity. Logistic mixed-effects models were used to explore associations between gender equitable attitudes, adolescent relationship abuse, pornography use, and condom use behaviors; linear mixed-effects models explored associations between gender equitable attitudes and condom negotiation self-efficacy. By pooling data from two other gender transformative programs, Sisterhood 2.0 (n = 246, 13-19-year-old females (mean age = 15.2), 73.6% Black/African American) and Coaching Boys into Men Middle School (n = 958, 11-14-year-old males-6th grade: 10.4%, 7th grade: 36.5%, 8th grade: 53.1-56.6% white), measurement invariance was assessed across Black (n = 400) and white (n = 298) race and male (n = 429) and female (n = 246) gender. A three-factor 11-item scale showed construct validity among a sample of Black adolescent boys, weak factorial invariance across Black and white race, and configural invariance across male and female gender. Gender equitable attitudes were associated with less adolescent relationship abuse, higher condom negotiation self-efficacy, and less pornography use. These findings demonstrate some variability in measurements of gender equitable attitudes by race and gender. Targeting harmful gender norms may help prevent adolescent relationship abuse and improve sexual health behaviors.
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Affiliation(s)
- Amber L. Hill
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA 15213, USA
- Department of Pediatrics, Michigan Medicine, 1522 Simpson Road East, Ann Arbor, MI 48109, USA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA 15213, USA
| | - Galen E. Switzer
- Department of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, 151C University Drive, Pittsburgh, PA 15240, USA
| | - Kaleab Z. Abebe
- Department of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - Judy C. Chang
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Department of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15213, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, 300 Halket St, Pittsburgh, PA 15213, USA
| | - Julie Pulerwitz
- Population Council, 4301 Connecticut Ave NW #280, Washington, DC 20008, USA
| | - Lisa D. Brush
- Department of Sociology, University of Pittsburgh, 230 S Bouquet St, Pittsburgh, PA 15213, USA
| | - Ashley V. Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA 15213, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA 15261, USA
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Santhya KG, Francis Zavier AJ. Long-Term Impact of Exposure to a Gender-Transformative Program Among Young Men: Findings From a Longitudinal Study in Bihar, India. J Adolesc Health 2022; 70:634-642. [PMID: 34952780 DOI: 10.1016/j.jadohealth.2021.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gender-transformative programs with men and boys are recognized as a promising strategy for reducing violence against women and girls (VAWG). Reviews of such programs have underscored the need for investments in high-quality studies that measure effects on bio-behavioral outcomes and downstream effects. This article extends the limited evidence on long-term effects of gender-transformative programs with men and boys in India. METHODS We used data from a cluster randomized trial of a gender-transformative life-skills education cum sports coaching program that sought to promote gender egalitarian attitudes and rejection of VAWG among boys and men aged 13-21 and a follow-up study. Young men were interviewed thrice-before the launch, after the completion, and 5 years after the completion of the trial (N = 853). We used generalized estimating equations models to estimate the short- and long-term effects of the intervention and effect modification by participation level and intervention exposure in early/late adolescence. RESULTS The intervention succeeded in promoting gender equitable attitudes and notions of positive masculinity (β = 0.319; p = .012), and attitudes rejecting men's controlling behaviors (β = 0.428; p = .068) and VAWG (β = 0.673; p = .051) among young men in the long- erm. It reduced their perpetration of intimate partner violence (odds ratio 0.639; p = .062). The long-term positive effects were observed for regular participants only, and greater effects were observed among those exposed to the intervention in early than late adolescence. DISCUSSION Exposing boys to gender-transformative programs early on and ensuring their regular intervention participation can have sustained impact on promoting gender egalitarian attitudes and reducing their perpetration of VAWG.
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Affiliation(s)
- K G Santhya
- Population Council, Poverty, Gender and Youth, New Delhi, India.
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Cherewick M, Lebu S, Su C, Richards L, Njau PF, Dahl RE. Promoting gender equity in very young adolescents: targeting a window of opportunity for social emotional learning and identity development. BMC Public Health 2021; 21:2299. [PMID: 34923962 PMCID: PMC8684613 DOI: 10.1186/s12889-021-12278-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background The transition from childhood to adolescence is a uniquely sensitive period for social and emotional learning in the trajectory of human development. This transition is characterized by rapid physical growth, sexual maturation, cognitive and behavioral changes and dynamic changes in social relationships. This pivotal transition provides a window of opportunity for social emotional learning that can shape early adolescent identity formation and gender norms, beliefs and behaviors. The objective of this study is to evaluate the potential of a social emotional learning intervention for very young adolescents (VYAs) to improve social emotional mindsets and skills. Methods Discover Learning is a social emotional learning intervention designed for VYAs (10-11 years of age) to support development of social emotional mindsets and skills from four primary schools in Dar es Salaam, Tanzania. The intervention delivered three different packages of learning experiences to three arms of the study. 528 VYAs were randomized to each of the three study arms (A-Content learning, B-Content learning and reflection, and C-Content learning, reflection and experiential practice). A quantitative survey was administered to all participants before and after the intervention to capture changes in social emotional mindsets and skills. A discrete choice experiment measured changes in gender norms, beliefs and behaviors. Results 528 VYAs were included in the analysis. Participants in all three arms of the study demonstrated significant improvements in social emotional mindsets and skills outcomes (generosity, curiosity, growth mindset, persistence, purpose and teamwork). However, Group C (who received experiential social learning opportunities in small, mixed-gender groups and a parent and community learning components demonstrated larger treatment effects on key outcomes in comparison to Groups A and B. Results indicate Group C participants had greater change in gender equity outcomes (OR = 1.69, p = <0.001) compared to Group A (OR = 1.30, p = <0.001) and Group B (OR = 1.23, p = 0.004). Conclusion These findings provide evidence that social emotional learning interventions targeting VYAs can improve social emotional mindsets and skills and gender equity outcomes. The findings indicate the importance of experiential learning activities in mixed-gender groups during the unique developmental window of early adolescence. The study also provides support for the inclusion of parental/caregiver and community engagement in programs designed for VYAs. Trial registration Retrospectively registered on July 7th, 2020. NCT0445807 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12278-3.
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Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, 13001 E 17th Pl, Room B119, Aurora, CO, 80045, USA.
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
| | - Christine Su
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
| | - Lisa Richards
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Prosper F Njau
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Ronald E Dahl
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
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Opening closed doors: using machine learning to explore factors associated with marital sexual violence in a cross-sectional study from India. BMJ Open 2021. [PMCID: PMC8718485 DOI: 10.1136/bmjopen-2021-053603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Sexual violence against women is pervasive in India. Most of this violence is experienced in the context of marriage, and rates of marital sexual violence (MSV) have been relatively stagnant over the past decade. This paper machine learning algorithms paired with qualitative thematic analysis to identify new and potentially modifiable factors influencing MSV in India. Design, setting and participants This cross-sectional analysis of secondary data used data from in-person interviews with ever-married women aged 15–49 who responded to gender-based violence questions in the nationally representative 2015–2016 National Family Health Survey (N=66 013), collected between 20 January 2015 and 4 December 2016. Analyses included iterative thematic analysis (L-1 regularised regression followed by iterative qualitative thematic coding of L-2 regularised regression results) and neural network modelling. Outcome measure Participants reported their experiences of sexual violence perpetrated by their current (or most recent) husband in the previous 12 months. These responses were aggregated into any vs no recent MSV. Results Nearly 7% of women experienced MSV in the past 12 months. Major themes associated with MSV through iterative thematic analysis included experiences of/exposure to violence, sexual behaviour, decision making and freedom of movement, sociodemographics, access to media, health knowledge, health system interaction, partner control, economic agency, reproductive and maternal history, and health status. A neural network model identified variables that largely corresponded to these themes. Conclusions This analysis identified several themes that may be promising avenues to identify and support women experiencing MSV, and to mitigate these traumatic experiences. In particular, amplifying screening activities at health encounters, especially among women who appear to have compromised health or restricted agency, may enable a greater number of women access to essential physical and emotional support services, and merits further consideration.
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Chzhen Y, Prencipe L, Eetaama F, Luchemba P, Lukongo TM, Palermo T. Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents. J Adolesc Health 2021; 68:899-905. [PMID: 32843241 DOI: 10.1016/j.jadohealth.2020.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Inequitable attitudes toward men's and women's roles, rights, and responsibilities are associated with poor health-related outcomes, particularly for girls and women. Yet, we know relatively little about what interventions work to improve gender-equitable attitudes among adolescents in low-income countries. This study examines the impact of a government-implemented "cash plus" intervention on gender-equitable attitudes among adolescents in Tanzania. The intervention includes discussions and activities related to gender norms, embedded in broader life skills, livelihoods, and health training. METHODS The study utilizes a cluster randomized design, using data from 1,933 males and females aged 14-19 years at baseline who took part in the baseline (2017), midline (2018), and endline (2019) surveys. Gender attitudes were measured using 24 items from the Gender-Equitable Men (GEM) Scale. We estimate intent-to-treat impacts on the GEM scale and four subscales (violence, sexual relationships, reproductive health, and domestic chores). RESULTS The "cash plus" intervention had a significant impact on the overall GEM scale at midline. The intervention increased gender-equitable attitudes on the domestic chores subscale at both midline and endline. The intervention improved gender-equitable attitudes among males on the overall GEM scale and three subscales at midline and on two subscales at endline, but it had no impacts among females. CONCLUSIONS Gender transformative social protection is currently being advocated as a way to address the gendered nature of poverty and its consequences. Initiatives such as the one studied here, which address the multifaceted drivers of gender inequities, could be a promising way forward.
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Affiliation(s)
| | - Leah Prencipe
- Department of Public Health, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Frank Eetaama
- Children and AIDS Section, UNICEF Tanzania, Dar es Salaam, Tanzania
| | - Paul Luchemba
- Tanzania Social Action Fund, United Republic of Tanzania, Dodoma, Tanzania
| | | | - Tia Palermo
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, New York
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Corley A, Glass N, Remy MM, Perrin N. A Latent Class Analysis of Gender Attitudes and Their Associations with Intimate Partner Violence and Mental Health in the Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084063. [PMID: 33921491 PMCID: PMC8068999 DOI: 10.3390/ijerph18084063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022]
Abstract
Gender role attitudes, views held by individuals regarding the roles men and women should play in society, are a powerful social determinant of health. However, work remains in elucidating the associations between gender attitudes and intimate partner violence (IPV) perpetration or victimization and mental health problems. We used latent class analysis to classify patterns of responses on survey items on gender attitudes by male and female adults in households that participated in an economic empowerment intervention and evaluation in rural villages in the Democratic Republic of Congo. Attitudes about IPV and gender equality were two subdomains to emerge from analysis and a 3-class model solution was found to best fit response patterns. Results indicated that, as compared to the least gender equitable class, individuals in the moderately gender equitable and fully gender equitable classes had lower odds of having experienced or perpetrated psychological abuse. Individuals within the moderately gender equitable class were at lower odds of having experienced or perpetrated physical or sexual violence. Further, individuals in the moderately gender equitable and fully gender equitable classes had significantly lower mean scores on symptoms associated with PTSD than individuals in the least gender equitable class. Future research should explore the relationships between gender attitudes, partner violence and mental health to build resilient families.
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Affiliation(s)
- Andrew Corley
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
- Correspondence:
| | - Nancy Glass
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
| | - Mitima Mpanano Remy
- Programme d’Appui aux Initiatives de Développement Economique au Kivu (PAIDEK), Bukavu, Democratic Republic of Congo;
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
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12
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Patel SK, Santhya KG, Haberland N. What shapes gender attitudes among adolescent girls and boys? Evidence from the UDAYA Longitudinal Study in India. PLoS One 2021; 16:e0248766. [PMID: 33735285 PMCID: PMC7971892 DOI: 10.1371/journal.pone.0248766] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The role of gender norms in shaping education and work opportunities, distribution of power and resources, and health and wellbeing is well recognised. However, rigorous studies in low- and middle-income countries on when and how norms change over time and what factors shape adolescents’ and young adult’s gender attitudes are limited. This paper explores the factors that determine adolescents’ gender attitudes, as well as patterns in gender attitude shifts over time among younger and older adolescent boys and girls in India. Data and methods Data presented in this paper were drawn from a unique longitudinal study of adolescents aged 10–19 (Understanding the lives of adolescent and young adults–UDAYA study) in the states of Bihar and Uttar Pradesh in India, conducted during 2015–2016 (wave 1) and 2018–2019 (wave 2). The analysis presented in this paper drew on data from 4,428 boys and 7,607 girls who were aged 10–19 and unmarried at wave 1 and interviewed at both rounds of the survey. We used univariate and bivariate analyses to examine changes in adolescents’ gender role attitudes over time and the association between explanatory variables and gender role attitudes. We also used linear fixed effects regression models to identify factors that shape adolescents’ gender role attitudes. Results Gender role attitudes became more egalitarian over time among boys and girls, except among the older cohort of boys in our study. Among both younger and older cohorts, girls/young women held more egalitarian views than boys/young men and this pattern held over time for both cohorts. Factors that influenced gender role attitudes differed for younger and older adolescents, particularly among boys. While some predictors differed for boys and girls, there were substantial similarities as well. Gender attitudes were affected by factors at the individual, family, peer, and societal levels, as well as by community engagement. Conclusions Our findings show that it is possible to shift gender attitudes toward greater equity and, in so doing, contribute to improved health and rights.
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Cherewick M, Lebu S, Su C, Richards L, Njau PF, Dahl RE. Adolescent, caregiver and community experiences with a gender transformative, social emotional learning intervention. Int J Equity Health 2021; 20:55. [PMID: 33536044 PMCID: PMC7860221 DOI: 10.1186/s12939-021-01395-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Inequitable gender norms, beliefs and behaviors, are shaped by learning experiences during key developmental stages in an individual's life course, and can have negative impacts on health and well-being outcomes. Very early adolescence represents one stage when formative learning experiences about gender inequity can have the potential to support or hinder more equitable gender norms, beliefs and behaviors. The aim of this qualitative study was to evaluate the effect of a gender transformative, social emotional learning intervention for very young adolescents (VYAs) that included experiential learning with peers, parents/caregivers and community members. METHODS This study examined the effects of an intervention designed to provide social emotional learning opportunities for adolescents ages 10-11 in Dar es Salaam, Tanzania. The qualitative sample included 279 participants. Qualitative methods included 102 in-depth interviews with VYAs, 22 focus groups with 117 VYAs, 60 in-depth interviews with parents/caregivers and 54 participant observations. A grounded theory approach was used to identify emergent themes. RESULTS Participants reported growth in targeted areas of social emotional mindsets and skills, including a shift in gender norms, beliefs and behaviors. VYAs reported that experiential learning in mixed gender teams provided opportunities to actively practice and reflect on gender norms, beliefs and behaviors. VYAs also reported active practice of social emotional mindsets and skills with peers, parents/caregivers and the community. Parents/caregivers reported changes in VYAs' social emotional mindsets and skills within the home, with the community and with siblings and peers. Both adolescents and parent/caregivers reported positive change towards more equitable gender norms, beliefs and behaviors through participation in experiential learning activities and reflective discussions. CONCLUSIONS These findings suggest that an intervention providing social and emotional experiential learning opportunities during the developmental window of very young adolescence can be effective in transforming gender norms, beliefs and behaviors. Involvement of peers, parents/caregivers and community members was effective at supporting learning social emotional mindsets and skills in VYAs. Findings encourage local and global adolescent programming to include gender transformative content paired with social emotional experiential learning with peers, family and the community and can stimulate positive change in gender norms, beliefs and behaviors to promote gender equity.
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Affiliation(s)
- Megan Cherewick
- Department of Health Sciences, California State University East Bay, 25800 Carlos Bee Blvd, Hayward, CA 94542 USA
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720 USA
| | - Christine Su
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720 USA
| | - Lisa Richards
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Prosper F. Njau
- Health for a Prosperous Nation, P.O. Box 13650, Dar es Salaam, Tanzania
| | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA 94720 USA
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Blum RW. Gender Norm Transformative Programing: Where Are We Now? Where Do We Need to Be? J Adolesc Health 2020; 66:135-136. [PMID: 31952565 DOI: 10.1016/j.jadohealth.2019.11.299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Robert W Blum
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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