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Seff I, Deitch J, Harker Roa A, Rodriguez C, Andia T, Ariza Pena T, Stark L. Sibling-Support for Adolescent Girls (SSAGE): A study protocol for a pilot randomized-controlled trial of a whole-family, gender transformative approach to preventing mental illness among forcibly displaced adolescent girls. PLoS One 2024; 19:e0303588. [PMID: 38820363 PMCID: PMC11142595 DOI: 10.1371/journal.pone.0303588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Forcibly displaced adolescents face increased risks for mental illness and distress, with adolescent girls disproportionately affected in part due to heightened gender inequity. Although the family unit has the potential to promote healthy development in adolescents, few family interventions have employed a gender transformative approach or included male siblings to maximize benefits for adolescent girls. METHODS This study will assess a whole-family and gender transformative intervention-Sibling Support for Adolescent Girls in Emergencies (SSAGE)-to prevent mental health disorders among adolescent girls in Colombia who were recently and forcibly displaced from Venezuela. The study will employ a hybrid type 1 effectiveness-implementation pilot randomized control trial (RCT) to test the program's effectiveness to explore determinants of implementation to establish the feasibility, acceptability, and fidelity of SSAGE. To address these aims, we will enroll 180 recently arrived, forcibly displaced adolescent girls in an RCT and examine the program's effectiveness in the prevention of mental illness (through reduction in anxiety, depression, interpersonal sensitivity, and somatization symptoms) one-month post-intervention. We will use contextually adapted to collect data on the hypothesized mechanistic pathways, including family attachment, gender-equitable family functioning, self-esteem, and coping strategies. The implementation evaluation will employ mixed methods to assess the program's feasibility, acceptability, fidelity, and barriers and facilitators to successful implementation. DISCUSSION Findings can support humanitarian program implementation, as well as inform policy to support adolescent girls' mental health and to prevent the myriad disorders that can arise as a result of exposure to displacement, conflict, and inequitable gender norms.
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Affiliation(s)
- Ilana Seff
- Brown School at Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Julianne Deitch
- Women’s Refugee Commission, New York, New York, United States of America
| | | | | | | | | | - Lindsay Stark
- Brown School at Washington University in St. Louis, St. Louis, Missouri, United States of America
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Zhang LL, Dou JH, Sun L, Lu GH. Impact of Gender-Role Attitudes and Mental Health on Hostile Sexism and Acceptance of Cosmetic Surgery. Aesthetic Plast Surg 2024:10.1007/s00266-024-04028-8. [PMID: 38740626 DOI: 10.1007/s00266-024-04028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/26/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Each year, tens of thousands of people worldwide choose to undergo cosmetic surgery in order to alter their appearance. In recent years, young people have gradually emerged to comprise the main driving force behind the increasing demand for cosmetic surgery. Previous studies have found that sexism may motivate young people to undergo such surgeries. However, few studies have been conducted to determine if this psychological mechanism influences the acceptance of cosmetic surgery among Chinese university students. METHODS A total of 579 Chinese university students (280 girls and 299 boys, 17-20 years) volunteered to participate in the online survey. They completed a questionnaire containing the Ambivalent Sexism Inventory, the 12-item General Health Questionnaire, the Gender-Role Attitudes Questionnaire and the Acceptance of Cosmetic Surgery Scale. We firstly evaluated the underlying factor structure of the Acceptance of Cosmetic Surgery Scale using exploratory and confirmatory factor analyses, and exploring pattern of associations between the constructs was analyzed via path analysis. RESULTS According to the findings, hostile sexism was associated with greater levels of acceptance toward cosmetic surgery. Moreover, gender-role attitudes mediated the link between hostile sexism and the acceptance of cosmetic surgery, and this mediation was positively influenced by general mental health. CONCLUSION Our study contributes to a deeper understanding of Chinese university students' attitudes toward cosmetic surgery, hostile sexism may contribute to normalizing traditional gender stereotypes and encourage cosmetic surgery acceptability among Chinese university students. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Lu-Lin Zhang
- School of Psychology, Shandong Second Medical University, Weifang, China
| | - Jin-Hua Dou
- Office of Student Affairs, Shandong Second Medical University, Weifang, China
| | - Lin Sun
- School of Psychology, Shandong Second Medical University, Weifang, China.
- Department of Neurosurgery, Shan-ting District People's Hospital, Zao-Zhuang, China.
- Management Committee of Shan-ting Economic Development Zone, Zao-Zhuang, China.
| | - Guo-Hua Lu
- School of Psychology, Shandong Second Medical University, Weifang, China.
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Kanamori M, Stickley A, Takemura K, Kobayashi Y, Oka M, Ojima T, Kondo K, Kondo N. Community gender norms, mental health, and suicide ideation and attempts among older Japanese adults: a cross-sectional study. Int Psychogeriatr 2024; 36:385-395. [PMID: 37927096 DOI: 10.1017/s104161022300087x] [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] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults' perceptions of community gender norms and mental health and suicide-related outcomes. DESIGN Cross-sectional. SETTING This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study. PARTICIPANTS In total, 25,937 participants aged 65 years or older in 61 municipalities. MEASUREMENTS Perceptions of community gender norms were assessed by the respondents' perceptions of the gender-differentiating language used by those around them such as "You should/should not do XXX, because you are a man/woman." RESULTS The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes. CONCLUSIONS Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health.
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Affiliation(s)
- Mariko Kanamori
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Institute for the Future of Human Society, Kyoto University, Kyoto, Japan
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
- Department of Health and Social Behavior, Faculty of Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Andrew Stickley
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Yumiko Kobayashi
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
- Department of Health and Social Behavior, Faculty of Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Mayumi Oka
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Moriokacho, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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Aguirre E, Benzeval M, Murray A. Parental gender attitudes and children's mental health: Evidence from the UK household longitudinal study. Soc Sci Med 2024; 344:116632. [PMID: 38316081 DOI: 10.1016/j.socscimed.2024.116632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
Gender role attitudes have been found to be associated with the mental health of adults and adolescents, but little is known about whether parents' gender attitudes are associated with their children's mental health. Using data from Understanding Society, the UK Household Longitudinal Study (UKHLS), a large-population representative sample, we examine the links between parental gender role attitudes and child mental health outcomes as measured by the total and five components of the strengths and difficulties questionnaire (SDQ). We construct structural equation models, separately for mothers and for fathers and for children aged 5 and 8, and adjust for key sociodemographic variables. We find that children aged 5 years exhibit fewer emotional and peer relationship problems and are more prosocial when their mothers have more egalitarian (compared to traditionalist) gender role attitudes. We also find that children are more prosocial at age 8 when their mothers have more egalitarian gender role attitudes. No statistically significant mediation effect is observed via maternal parenting behaviour. Fathers' more egalitarian gender role attitudes were associated with higher hyperactivity at age 5 and more prosocial behaviour at age 8. Further, engaging in less negative parenting behaviour completely mediates the association of fathers' more egalitarian gender attitudes with children's mental health across the majority of the SDQ scales. This suggests that parental gender attitudes may be a possible target for the prevention of mental health difficulties among children; however, future research will be required to examine the extent to which the associations we identified reflect causality.
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Affiliation(s)
- Edith Aguirre
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, C04 3SQ, United Kingdom.
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, C04 3SQ, United Kingdom
| | - Aja Murray
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, United Kingdom
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Abdi S, Akinsulure-Smith AM, Sarkadi A, Fazel M, Ellis BH, Gillespie S, Juang LP, Betancourt TS. Promoting positive development among refugee adolescents. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:1064-1084. [PMID: 37807940 DOI: 10.1111/jora.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suárez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.
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Affiliation(s)
- Saida Abdi
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | | | | | | | - Sarah Gillespie
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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Martino RM, Weissman DG, McLaughlin KA, Hatzenbuehler ML. Associations Between Structural Stigma and Psychopathology Among Early Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-11. [PMID: 37916808 PMCID: PMC11063121 DOI: 10.1080/15374416.2023.2272936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Ample evidence demonstrates that structural stigma - defined as societal-level conditions, cultural norms, and institutional policies and practices that constrain opportunities, resources, and well-being of stigmatized populations - is associated with psychopathology in adults from marginalized groups. Yet there is limited research on whether structural stigma is similarly associated with internalizing and externalizing symptoms among youth. METHOD Structural stigma related to sex, sexual orientation, race, and Latinx ethnicity was measured using indicators of state-level policy and aggregated attitudes. Using data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,414; M age = 12 years, SD = 0.66; 48% female, 6.8% lesbian, gay, and bisexual (LGB), 13.4% Black, 20% Latinx), we examined associations of structural stigma with internalizing and externalizing symptoms among female, LGB, Black, and Latinx youth. RESULTS LGB youth living in higher (vs. lower) structural stigma states had elevated levels of internalizing and externalizing symptoms. In lower structural stigma states, there were no differences in externalizing symptoms between LGB and heterosexual youth. Similarly, Latinx youth and females living in higher (vs. lower) structural stigma states had elevated levels of externalizing symptoms. In lower structural stigma states, there were no differences in externalizing symptoms between Latinx youth and non-Latinx White youth. Structural stigma related to race was unrelated to internalizing or externalizing symptoms for Black youth. CONCLUSIONS This study provides novel evidence that macro-level social environments, in the form of structural stigma, contribute to adverse mental health outcomes for marginalized youth and partly explain disparities in externalizing symptoms.
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Gulema H, Demissie M, Worku A, Assebe Yadeta T, Berhane Y. Influence of engaging female caregivers in households with adolescent girls on adopting equitable family eating practices: a quasi-experimental study. PeerJ 2023; 11:e16099. [PMID: 37750079 PMCID: PMC10518164 DOI: 10.7717/peerj.16099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Background In patriarchal societies, female caregivers decide on food allocation within a family based on prevailing gender and age norms, which may lead to inequality that does not favor young adolescent girls. This study evaluated the effect of a community-based social norm intervention involving female caregivers in West Hararghe, Ethiopia. The intervention was engaging female caregivers along with other adult influential community members to deliberate and act on food allocation social norms in a process referred to as Social Analysis and Action (SAA). Method We used data from a large quasi-experimental study to compare family eating practices between those who participated in the Social Analyses and Action intervention and those who did not. The respondents were female caregivers in households with young adolescent girls (ages 13 and 14 years). The study's outcome was the practice of family eating together from the same dish. The difference in difference (DID) analysis with the mixed effect logistic regression model was used to examine the effect of the intervention. Result The results showed improved family eating practices in both groups, but the improvement was greater in the intervention group. The DID analysis showed an 11.99 percentage points greater improvement in the intervention arm than in the control arm. The mixed-effect regression produced an adjusted odds ratio of 2.08 (95% CI [1.06-4.09]) after controlling selected covariates, p-value 0.033. Conclusions The involvement of influential adult community members significantly improves the family practice of eating together in households where adolescent girls are present in our study. The intervention has great potential to minimize household food allocation inequalities and thus improve the nutritional status of young adolescents. Further studies are necessary to evaluate the effectiveness of the intervention in different social norm contexts to formulate policy and guidelines for scale-up.
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Affiliation(s)
- Hanna Gulema
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Nilles H, El-Awad U, Kerkhoff D, Braig J, Schmees P, Kilinc Y, Rueth JE, Eschenbeck H, Lohaus A. Gender role attitudes and well-being of German and refugee adolescents-same or different? BMC Psychiatry 2023; 23:663. [PMID: 37684604 PMCID: PMC10492273 DOI: 10.1186/s12888-023-05100-4] [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: 10/06/2022] [Accepted: 08/09/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Assumed differences in gender role attitudes (GRAs) of German adolescents and refugee adolescents from the Middle East are often discussed, but rarely investigated. Presumed differences in GRAs across cultures and genders are assumed to be involved in emerging gender differences in well-being and mental health symptoms. Overall, appropriate measurements for investigating GRAs of adolescents with different cultural backgrounds are scarce. METHODS Hence, the present study exemplarily investigates (1) the measurement invariance (MI) of a German translation of the Social Role Questionnaire (SRQ) for German (n = 114) and German-speaking Middle Eastern refugee adolescents from Syria, Afghanistan, or Iraq (n = 115), using a Multiple Indicator Multiple Cause (MIMIC) model to account for age and gender. Moreover, (2) differences between GRAs of both groups, (3) relationships of GRAs with different facets of affective well-being, as well as (4) differences in these relationships between German and refugee adolescents are examined by extending the MIMIC-model to a full structural equation model (SEM). RESULTS Results indicate (1) that scalar MI for the SRQ can be assumed. Furthermore, (2) German adolescents show less traditional gender-linked GRAs than refugee adolescents, but no further differences in GRAs. Furthermore, no differences between the relationships of GRAs with well-being and mental health symptoms were found between the groups (4). Also, (3) GRAs showed no relation with any of the outcomes, but gender and age predicted mental health symptoms. CONCLUSION The findings show that the SRQ is a useful measurement for investigating the GRAs of adolescents living in Germany and could be used in further cross-cultural research.
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Affiliation(s)
- Hannah Nilles
- Department of Developmental Psychology, Bielefeld University, Bielefeld, Germany.
- Department of Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany.
| | - Usama El-Awad
- Department of Developmental Psychology, Bielefeld University, Bielefeld, Germany
| | - Denny Kerkhoff
- Department of Developmental Psychology, Bielefeld University, Bielefeld, Germany
| | - Johanna Braig
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Pia Schmees
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Yasemin Kilinc
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Jana-Elisa Rueth
- Department of Developmental Psychology, Bielefeld University, Bielefeld, Germany
| | - Heike Eschenbeck
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Arnold Lohaus
- Department of Developmental Psychology, Bielefeld University, Bielefeld, Germany
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Sedlander E, Dahal M, Bingenheimer JB, Puri MC, Rimal RN, Granovsky R, Diamond-Smith NG. Adapting and Validating the G-NORM (Gender Norms Scale) in Nepal: An Examination of How Gender Norms Are Associated with Agency and Reproductive Health Outcomes. Stud Fam Plann 2023; 54:181-200. [PMID: 36715570 DOI: 10.1111/sifp.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Research calls for the sexual and reproductive rights field to prioritize gender norms to ensure that women can act on their reproductive rights. However, there is a gap in accepted measures. We addressed this by including important theoretical components of gender norms: differentiating between descriptive and injunctive norms and adding a referent group. Our team originally developed and validated the G-NORM, a gender norms scale, in India. In this paper, we describe how we subsequently adapted and validated it in Nepal. We administered items to women of reproductive age, conducted exploratory and confirmatory factor analysis, and examined associations between the subscales and reproductive health outcomes. Like the original G-NORM, our factor analyses showed that descriptive norms and injunctive norms comprise two distinct scales which fit the data well and had Cronbach alphas of 0.92 and 0.89. More equitable descriptive gender norms were associated with higher decision-making scores, increased odds of intending to use family planning, disagreeing that it is wrong to use family planning, and older ideal age at marriage. Injunctive gender norms were only associated with disagreeing that it is wrong to use family planning. Findings offer an improved measure of gender norms in Nepal and provide evidence that gender norms are critical for agency and reproductive health outcomes.
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Affiliation(s)
- Erica Sedlander
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Minakshi Dahal
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | | | - Mahesh C Puri
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Granovsky
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nadia G Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Corley A, Perrin N, Geiger K, Remy MM, Glass N. Exploring caregivers' gender attitudes' influence on adolescent health in the eastern Democratic Republic of Congo: A mixed methods study. Glob Public Health 2022; 17:3700-3720. [PMID: 35442156 DOI: 10.1080/17441692.2022.2049848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adolescence is a developmentally important phase in one's life. However, restrictive gender attitudes that gain increased importance during adolescence prevent many from reaching their health and development potential. The objective of this study is to explore associations between caregiver gender attitudes and adolescent psychosocial health, school attendance, and food security in a sample living in the eastern Democratic Republic of Congo, a region that has experienced persistent poverty and nearly thirty years of insecurity. A mixed methods design was selected for this research. Quantitative results were combined with qualitative focus group discussion results to provide new insight into how caregiver gender attitudes might influence adolescent health and development. Findings from the research suggest that more gender equitable caregiver attitudes are associated with fewer reports of internalising behaviour and greater food security in adolescent girls. No significant associations were found between caregiver gender equality attitudes and adolescent prosocial behaviour or school attendance. Focus group discussions supported some quantitative findings while refuting others. Participants suggested that adolescent girls with caregivers who endorse more equitable gender attitudes experience less psychological control and witness less conflict and violence between caregivers in their home.
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Affiliation(s)
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Keri Geiger
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Mitima Mpanano Remy
- Programme d'Appui aux Initiatives de Développement Economique au Kivu (PAIDEK), Bukavu, Democratic Republic of Congo
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Seff I, Koris A, Giuffrida M, Ibala R, Anderson K, Shalouf H, Deitch J, Stark L. Exploring the Impact of a Family-Focused, Gender-Transformative Intervention on Adolescent Girls' Well-Being in a Humanitarian Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15357. [PMID: 36430075 PMCID: PMC9690627 DOI: 10.3390/ijerph192215357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
While family functioning interventions show promise for improving adolescent girls' well-being in humanitarian contexts, few programs employ a gender-transformative approach to maximize benefits for adolescent girls. This paper presents findings from a mixed-methods pilot evaluation of a whole-family, gender-transformative intervention conducted with Syrian refugee families in Jordan. The Siblings Support of Adolescent Girls in Emergencies program was implemented with 60 Syrian refugee households in Azraq and Za'atari camps in Jordan. A quantitative survey was administered to 18 households at baseline and endline, and researchers conducted qualitative interviews and focus group discussions with caregivers, paired interviews and participatory discussions with adolescents, and key informant interviews with program mentors. Paired t-tests revealed statistically significant improvements in mental distress, resilience, and gender equitable attitudes in the full sample and for girls only and marginally significant improvements in family functioning. Qualitative findings revealed improvements in four domains of girls' well-being-self-efficacy, self-confidence, pro-social behavior, and mental health-through three primary pathways: family members' increased gender equitable attitudes, healthier intrahousehold communication, and greater affective involvement. Findings from this mixed-methods evaluation point to the potential value in merging gender-transformative and whole-family approaches in humanitarian programming to maximize positive impacts for adolescent girls.
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Affiliation(s)
- Ilana Seff
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Andrea Koris
- Independent Researcher, Capetown 8001, South Africa
| | | | - Reine Ibala
- Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Hana Shalouf
- Mercy Corps Jordan, Building No. 8, Tabasheer 3 Street, 7th Circle, Amman, Jordan
| | | | - Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA
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Sedlander E, Bingenheimer JB, Long MW, Swain M, Rimal RN. The G-NORM Scale: Development and Validation of a Theory-Based Gender Norms Scale. SEX ROLES 2022; 87:350-363. [PMID: 36168556 PMCID: PMC9508194 DOI: 10.1007/s11199-022-01319-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
Gender norms are increasingly recognized as important modifiers of health. Despite growing awareness of how gender norms affect health behavior, current gender norms scales are often missing two important theoretical components: differentiating between descriptive and injunctive norms and adding a referent group. We used a mixed-methods approach to develop and validate a novel gender norms scale that includes both theoretical components. Based on qualitative data, the theory of normative social behavior, and the theory of gender and power, we generated a pool of 28 items. We included the items in a baseline questionnaire among 3,110 women in Odisha, India as part of a cluster randomized controlled trial. We then ran exploratory factor analysis which resulted in 18 items. Using a second wave of data with the same sample, we evaluated psychometric properties using confirmatory factor analysis and structural equation modeling. The analysis resulted in two subscales with nine items each, “descriptive gender norms” and “injunctive gender norms.” Both subscales represent high internal validity with Cronbach’s alpha values of 0.81 and 0.84 and the combined scale has an alpha of 0.87. The G-NORM, gender norms scale, improves on existing measures by providing distinct descriptive and injunctive norms subscales and moving beyond individual attitudes by assessing women’s perceptions of community-level gender norms.
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Affiliation(s)
- Erica Sedlander
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, California, San Francisco, United States
| | - Jeffrey B. Bingenheimer
- Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, Washington D.C., United States
| | - Michael W. Long
- Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, Washington D.C., United States
| | | | - Rajiv N. Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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Misunas C, Amin S. Identifying latent classes of empowerment among early adolescent girls and the factors that cultivate them: Evidence from a community‐based skills training program. J Adolesc 2022; 94:148-165. [DOI: 10.1002/jad.12014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Sajeda Amin
- GIRL Center, Population Council New York City New York USA
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Blum RW, Li M, Choiriyyah I, Barnette Q, Michielson K, Mmari K. Body Satisfaction in Early Adolescence: A Multisite Comparison. J Adolesc Health 2021; 69:S39-S46. [PMID: 34217458 DOI: 10.1016/j.jadohealth.2021.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 01/25/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This study assesses the relationship between unequal gender perceptions, socioecological factors, and body satisfaction among early adolescents in six urban poor settings in four countries. METHODS A cross-sectional study, part of the Global Early Adolescent Study, was conducted in Shanghai, China; Cuenca, Ecuador; Kinshasa, DRC; and three cities in Indonesia: Denpasar, Semarang, and Bandar Lampung. Bivariate and multiple linear regressions were conducted to assess the relationships between body satisfaction, perceptions of gender norms, and socioecological factors. A final sample of 7840 respondents aged between 10 and 14 years were included in the analysis. RESULTS Adolescents who endorsed more traditional sex roles and traits were more likely to be satisfied with their bodies in Kinshasa and Indonesia, while only endorsement of GST was associated with body satisfaction in Shanghai. Individual factors related to body satisfaction varied by site and included perceived health status, perception of body weight, height, and growth rate. Family and neighborhood factors related to increased body satisfaction varied by site and sex and included closeness to parents, parental communication, discussing bodily changes with anyone, parental awareness, and perception of neighborhood. CONCLUSION The results highlight the association between gender norms and social factors at individual, family, and neighborhood levels with body satisfaction. While associations differ significantly by site and sex, namely in perception of body weight and height, there exists commonalities that suggest body satisfaction, gender norms, and social context are intertwined.
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Affiliation(s)
- Robert Wm Blum
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland.
| | - Mengmeng Li
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland
| | - Ifta Choiriyyah
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Quinn Barnette
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland
| | - Kristien Michielson
- International Centre for Reproductive Health, University of Ghent, Ghent, Belgium
| | - Kristin Mmari
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland
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15
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Cislaghi B, Bhatia A, Li M, Lian Q, Baird S, Kayembe P, Chipeta E, Moreau C. Changes in the Sexual Double Standard Associated With Sociodevelopmental Factors Among Young Adolescents in Kinshasa. J Adolesc Health 2021; 69:S23-S30. [PMID: 34217455 DOI: 10.1016/j.jadohealth.2020.07.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to describe the changes in adolescents' perceptions of a sexual double standard (SDS) over time and to examine the developmental and social factors associated with these changing perceptions. METHODS The sample includes 2,163 10- to 14-year-old adolescents from Kinshasa, interviewed at two time points (T0 and T1), 1 year apart. We examined associations between SDS and pubertal onset, family interactions, peer interactions, and media exposure. We conducted sex-stratified generalized estimation equation models to test associations between changes in SDS and sociodevelopmental factors at T0 as well as with changes in sociodevelopmental factors between T0 and T1. RESULTS At T0, the SDS score was 4.15/5 among boys and 4.43/5 among girls, signaling highly gender unequal perceptions. SDS scores increased over time, shifting toward greater inequality. Adolescents who were prepubertal at T0 experienced greater increases in SDS scores than those who were pubertal at T0. The greatest increase in SDS scores was observed among girls who transitioned through puberty between T0 and T1. High parental monitoring of boys mitigated the increase in SDS as did boys' increased exposure to social media between T0 and T1. Girls who had mixed-sex friendships also experienced less change in SDS perceptions compared with those who socialized in same-sex groups. CONCLUSIONS Puberty was associated with changes in SDS perceptions for all adolescents, whereas family interactions and media exposure affected changes in SDS perceptions for boys and peer interactions affected changes in SDS perceptions for girls.
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Affiliation(s)
- Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Mengmeng Li
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Qiguo Lian
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, People's Republic of China
| | - Sarah Baird
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Effie Chipeta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Reproductive Health (CRH), University of Malawi, College of Medicine, Blantyre, Malawi
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Soins Primaires et Prévention, Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Paris, France
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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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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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Murphy M, Jones N, Yadete W, Baird S. Gender-norms, violence and adolescence: Exploring how gender norms are associated with experiences of childhood violence among young adolescents in Ethiopia. Glob Public Health 2020; 16:842-855. [PMID: 32758016 DOI: 10.1080/17441692.2020.1801788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Adolescence is a time of particular risk for violence perpetrated by parents, teachers, peers and intimate partners. Social norms that condone violent discipline, promote masculinities focused on violence, and support gender inequality play an important role in perpetuating violence. However, little is known about the relationship between inequitable gender norms and children's experiences of violence from parents or other adults in the household. Utilising data from the Gender and Adolescence: Global Evidence (GAGE) study, this paper explores how adolescent and household attitudes and community-level gender norms influence experiences of violence among young adolescents (aged 10-12) in Ethiopia. Our results show that community norms, rather than adolescent and household attitudes, are significantly associated with experiences of household violence. This result holds for boys and girls, and in rural areas. In urban areas, however, adolescent attitudes were more influential than community norms, perhaps indicating less cohesive communities. Overall, these findings suggest that violence prevention programming should prioritise shifting community norms, particularly in rural areas, in order to promote adolescent girls' and boys' right to bodily integrity.
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Affiliation(s)
- Maureen Murphy
- The Global Women's Institute, George Washington University, Washington, DC, USA
| | | | - Workneh Yadete
- Gender and Adolescence: Global Evidence (GAGE), Addis Ababa, Ethiopia
| | - Sarah Baird
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Intersecting inequalities, gender and adolescent health in Ethiopia. Int J Equity Health 2020; 19:97. [PMID: 32539778 PMCID: PMC7296636 DOI: 10.1186/s12939-020-01214-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/04/2020] [Indexed: 01/22/2023] Open
Abstract
Background Until recently, global public health initiatives have tended to overlook the ways that social factors shape adolescent health, and particularly how these dynamics affect the specific needs of adolescents in relation to information about puberty, menstruation and sexual health. This article draws on mixed methods data from rural and urban areas of Ethiopia to explore how access to health information and resources - and subsequently health outcomes - for adolescents are mediated by gender and age norms, living in different geographical locations, poverty, disability and migration. Methods Data was collected in 2017–2018 for the Gender and Adolescence: Global Evidence (GAGE) mixed-methods longitudinal research baseline in three regions of Ethiopia (Afar, Amhara and Oromia). Quantitative data was collected from over 6800 adolescents and their caregivers, with qualitative data obtained from a sub-sample of 220 adolescents, their families and communities. Adolescent participants shared their experiences of health, illness and nutrition over the previous year; their knowledge and sources of information about sexual and reproductive health and puberty; and their attitudes toward sexual and reproductive health. Regression analysis was used to explore differences by gender, age, rural/urban residence, and disability status, across a set of adolescents’ health knowledge and other outcomes in the quantitative data. Intersectional analysis was used in analysing the qualitative data. Results Analysis suggested that gender inequality intersects with age, disability and rural/urban differences to shape young people’s access to information about puberty, with knowledge about this topic particularly lacking amongst younger adolescents in rural areas. Drought and lack of access to clean water exacerbates health challenges for adolescents in rural areas, where a lack of information and absence of access to preventive healthcare services can lead to permanent disability. The research also found that gaps in both school-based and alternative sources of education about puberty and menstruation reinforce stigma and misinformation, especially in rural areas where adolescents have higher school attrition rates. Gendered cultural norms that place high value on marriage and motherhood generate barriers to contraceptive use, particularly in certain rural communities. Conclusions As they progress through adolescence, young people’s overall health and access to information about their changing bodies is heavily shaped by intersecting social identities. Structural disadvantages such as poverty, distress migration and differential access to healthcare intersect with gender norms to generate further inequalities in adolescent girls’ and boys’ health outcomes.
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