Cambodian boys' transitions into young adulthood: exploring the influence of societal and masculinity norms on young men's health

Taking Stock: An Adaptable Research and Partnership Model for Developing Puberty Education in 10 Countries

There is a growing global interest in puberty and early adolescence and the importance of ensuring young people have the information and support they need during this critical phase of transition in the life course. This article highlights an adaptable model being used to support the development of contextually appropriate puberty education, in the form of illustrated and often bilingual books, for early adolescent girls and boys in countries around the world. This youth-centered participatory research and design model, which relies on the generation of community and government partnerships, has been employed in 10 countries thus far. Valuable learning has been documented from various contexts, including the approach's flexibility in adapting to the inputs of government and community members, incorporating local buy-in as a key ingredient for sustainability, using in-country experts for social and cultural appropriateness of illustrations and translations, and ensuring that the authentic youth voices captured through the participatory data collection and field-testing shape the educational content. The continuous integration of insights and perceptions of adults who influence young people's lives into the development process is also essential to enabling the uptake of puberty content in each new country. Parents, educators, youth service providers, and government officials are often the gatekeepers to young adolescents receiving puberty content and are thus critical to the process. This review of more than a decade of experience using this model underscores the essentiality of 2 key components-local partnership and participatory data collection-and highlights the importance of flexible approaches that are adapted to the unique sociocultural and environmental conditions in each country context.

"When I woke up I was so worried and ashamed, I thought it was a disease": Adolescent boys' transitions through puberty in Kenya

Growing evidence suggests a need for more focused attention on boys' experiences of puberty in sub-Saharan Africa to assure healthy transitions into young adulthood. Existing research remains limited on the masculinity norms shaping boys' maturation experiences in Kenya. To help fill this gap, we conducted a comparative case study using qualitative methodologies with 16-19-year-old male youth in rural and urban Kenya, and with adults interacting in boys' daily lives. Findings suggest that Kenyan boys experience shame, confusion and silence around changes happening in their bodies; face pressures from new societal expectations as they become young men; and have adolescent lives shaped by minimal supervision, increased peer pressures and engagement in more risky health behaviors. Additional research and targeted interventions on boys transitioning through puberty and early adolescence are needed to better understand their vulnerabilities and prevent or reduce their engagement in unsafe behaviors.

Why do young people engage in dating relationships during early adolescence? An inter-generational qualitative analysis from Blantyre, Malawi

Engagement in dating relationships plays an important role in the health trajectories of young people, particularly during the early adolescent period between ages 10-14. Yet little is known about such relationships among youth in low resource contexts. This study sought to contribute to the literature on this topic by exploring reasons why school-going young people aged 12-14 years engage in dating relationships in Blantyre, Malawi. A thematic analysis was used to code and analyse in-depth interview data from 23 young people and 19 caregivers. Against the backdrop of growing sexual desires and feelings of attraction, participants stressed harassment from boys and coercion from older men, peer pressure, social status attainment, financial deprivation and encouragement during initiation ceremonies as reasons for engaging in dating relationships. Girls were found to be subject to multiple power dynamics-including gender power relations, as well as power dynamics within same-gender peer groups-that influenced their sex and relationship involvement. These findings carry implications for the design and timing of sexual and reproductive health youth programmes in Sub-Saharan Africa and emphasise the need for multi-level interventions to address the multiple influences in young people's dating lives.

Seeking menstrual products: a qualitative exploration of the unmet menstrual needs of individuals experiencing homelessness in New York City

BACKGROUND

There has been increasing recognition that certain vulnerable populations in the United States of America struggle to meet their menstruation-related needs, including people experiencing homelessness. Media and policy attention on this subject has focused on the provision of free menstrual products to vulnerable populations, including a New York City legislative bill, which guarantees access to menstrual products for Department of Homeless Services shelter residents (Intros 1123-A).

METHODS

This qualitative study explored the challenges people experiencing homelessness in New York City face in accessing menstrual products. Data collection was conducted from June to August 2019 and included: Semi-structured key informant interviews with staff from relevant government agencies and homeless service providers (n = 15), and semi-structured in-depth interviews with individuals with experience living on the street and in shelters (n = 22). Data were analysed using thematic analysis.

RESULTS

Key themes that emerged included: (1) insufficient and inconsistent access to menstrual products; (2) systemic challenges to providing menstrual products; and (3) creative solutions to promote access to menstrual products. Both shelter- and street-living individuals reported significant barriers to accessing menstrual products. While both populations struggle, those in shelters were more likely to be able to purchase menstrual products or access free products at their shelter, while those living on the streets were more likely to have to resort to panhandling, theft, or using makeshift materials in place of menstrual products. Across both populations, individuals described barriers to accessing free products at shelters and service providers, primarily due to distribution systems that rely on gatekeepers to provide a few pads or tampons at a time, sometimes of inadequate quality and only upon request. Shelters and service providers also described challenges providing these products, including inconsistent supply.

CONCLUSION

These findings highlight the critical importance of expanding and improving initiatives seeking to provide access to menstrual products for vulnerable populations. Despite policy level efforts to support menstrual product access, individuals experiencing homelessness in New York City, whether living in shelters or on the street, are often not able to access the menstrual products that they need to manage their monthly menstrual flow.

Hearing the unheard voice-puberty experiences of young Pakistani men: A qualitative study

INTRODUCTION

Puberty experiences of male adolescents can have significant impacts on physical and psychological health outcomes. This qualitative study explored the puberty experiences of young males in Pakistan, as there are limited accounts of what shapes these puberty experiences, especially for adolescent males living in a restrictive culture.

METHODS

Twenty-two young Pakistani men (aged 18-21 years) from two urban sites in Karachi participated in individual face-to-face (n=19) and Skype (n=3) interviews. Qualitative thematic analysis was conducted using an inductive approach to identity and examine the patterns emerging from the data.

RESULTS

Participants described puberty as a challenging phase for which they were unprepared with a combination of various socio-cultural factors exposing them to negative impacts. As a result, young men expressed feelings of anxiety, embarrassment and isolation. Societal and gender norms around masculinity, sexuality and the roles and responsibilities of young men had a significant impact on how participants experienced puberty. While negative reactions towards puberty were dominant, participants described adopting coping strategies (e.g. social support) to help them deal with negative experiences.

CONCLUSIONS

Findings highlight the significance of culturally appropriate puberty education and various facilitating factors that may improve the puberty experiences for future young men. While extending current literature, this study also identifies key factors that could inform the development of health promotion programmes, which may aid adolescent males' puberty transition and positively influence their long-term health, well-being and identity.

Social and structural determinants of youth alcohol use in Tanzania: The role of gender, social vulnerability and stigma

Adolescent alcohol use remains an under-addressed population health issue across Africa. Although the literature explores the intersection of alcohol use and vulnerability to HIV and AIDS, there is limited evidence on the gendered uptake and use of alcohol among adolescents. Capturing adolescents' voiced experiences about the societal influences shaping their alcohol usage is essential for identifying contextually relevant interventions to reduce their vulnerability to alcohol and related risky behaviours, such as unsafe sex. We conducted qualitative research in urban Tanzania, including key informant interviews, systematic mapping of alcohol availability, in-depth interviews with adolescents in and out of school and adults, and participatory methodologies with adolescents ages 15-19. The findings described here were drawn from the participatory methodologies (n = 177); and in-depth interviews with adolescents (n = 24) and adults (n = 24). Three key themes emerged: (1) boys' increased social vulnerability to alcohol consumption; (2) the ways in which stigma shapes girls' alcohol usage; and (3) how gendered perceptions of alcohol use reinforce societal inequalities. There exists an urgent need to address the social and gendered vulnerabilities of youth in Africa to the uptake and use of alcohol, and identify interventions that reshape notions of masculinity increasing boy's vulnerability to use.

Young rural women's perceptions of sexual infidelity among men in Cambodia

Marriage poses a high risk of HIV infection among Cambodian women due to the country's double standards regarding extramarital sexual behaviour. Married men are much more likely than married women to engage in extramarital sex, and, among men, such activity is often socially and culturally condoned. Understanding the sexual beliefs young people possess is important as these beliefs may affect their future sexual behaviour and HIV-related risk. This study explored how young women in rural Cambodia conceptualise men's extramarital affairs. Semi-structured, in-depth interviews were conducted in the Khmer language with 43 female high school students in three rural provinces. Thematic analysis was used to identify themes and sub-categories from the participants' responses. Many participants accepted men's infidelity and verbally supported traditional cultural beliefs and practices regarding male dominance within sex and relationships. They attributed their future husbands' infidelity to their own behaviour and/or justified the act as a consequence of work-related mobility. Findings point to the need for new interventions as part of future HIV prevention programmes to increase their effectiveness among young Cambodian adults.

'Yeah, I've grown; I can't go out anymore': differences in perceived risks between girls and boys entering adolescence

This analysis is based on data from the Global Early Adolescent Study, which aims to understand the factors that predispose young people aged 10-14 years to positive or negative health trajectories. Specifically, interview transcripts from 202 adolescents and 191 parents across six diverse urban sites (Baltimore, Ghent, Nairobi, Ile Ife, Assuit and Shanghai) were analysed to compare the perceived risks associated with entering adolescence and how these risks differed by gender. Findings reveal that in all sites except Ghent, both young people and their parents perceived that girls face greater risks related to their sexual and reproductive health, and because of their sexual development, were perceived to require more protection. In contrast, when boys grow up, they and their parents recognised that their independence broadened, and parents felt that boys were strong enough to protect themselves. This has negative consequences as well, as boys were perceived to be more prone to risks associated with street violence and peer pressure. These differences in perceptions of vulnerability and related mobility are markers of a gender system that separates young women and men's roles, responsibilities and behaviours in ways that widen gender power imbalance with lifelong social and health consequences for people of both sexes.