Understanding Factors that Shape Gender Attitudes in Early Adolescence Globally: A Mixed-Methods Systematic Review

Any better? A follow-up content analysis of adolescent sexual and reproductive health inclusion in Global Financing Facility country planning documents

BACKGROUND

The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries.

OBJECTIVES

This paper furthers that analysis for 16 GFF partner countries as part of a Special Series.

METHODS

Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator.

RESULTS

Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities.

CONCLUSION

Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.

The sociocultural context of adolescent pain: portrayals of pain in popular adolescent media

ABSTRACT

Research has consistently suggested that media consumption plays a vital role in children's socialization, including the socialization of painful experiences. Past research examining young children's popular media revealed worrisome trends in media depictions of pain; it consisted of narrow depictions of pain, gender stereotypes, and an overwhelming lack of empathy from observers, which could contribute to pain-related stigma. Research has not yet examined how pain is portrayed in adolescent media, despite adolescence being the developmental period when chronic pain often emerges. The current study extracted a cross-section of popular adolescent media selected based on popularity, including 10 movies and the first seasons of 6 TV shows. Pain instances were coded using 2 established observational coding schemes assessing sufferer pain characteristics and observer responses. Across 616 instances of pain, there was a preponderance of violence and injuries, whereas everyday, chronic-type, and medical/procedural pains were seldom represented. Individuals from marginalized (ie, gender diverse, girls) and minoritized groups (individuals with racialized identities) were underrepresented in pain instances. Furthermore, regardless of observed gender or "race," observers displayed a lack of empathy for sufferers and rarely engaged in prosocial behaviors. Popular media may serve as an agent of socialization in adolescence; thus, pain depictions may be a powerful force in propagating pain-related stigma and inequities. An opportunity exists to harness popular media to adaptively and accurately portray pain to adolescents.

Intimate partner violence against adolescent girls: regional and national prevalence estimates and associated country-level factors

BACKGROUND

Intimate partner violence is a serious public health problem and negatively affects short-term and long-term health, development, and wellbeing of adolescent girls. Global estimates from WHO have shown that adolescent girls aged 15-19 years experience high rates of intimate partner violence. We aimed to estimate the lifetime and past-year prevalence and patterns of physical or sexual intimate partner violence against adolescent girls by male partners across 161 countries and areas, and to examine the country-level factors, including the prevalence of child marriage, associated with the lifetime and past-year prevalence of intimate partner violence in this age group.

METHODS

These analyses used the 2018 global, regional, and country estimates on intimate partner violence published by WHO and economic, social, and political metadata from subject-specific databases. Drawing on data from the WHO Global Database on Prevalence of Violence Against Women, we used hierarchical Bayesian modelling techniques to estimate lifetime and past-year prevalence of physical or sexual (or both) intimate partner violence against adolescent girls aged 15-19 years by country. Linear regression methods were used to examine contextual social, economic, and political factors associated with intimate partner violence against adolescent girls in the 101 countries (lifetime prevalence) and 105 countries (past-year prevalence) for which these metadata were available.

FINDINGS

The estimated global prevalence of physical or sexual intimate partner violence against ever-partnered adolescent girls aged 15-19 years was 24% (95% uncertainty interval 21-28) in their lifetime and 16% (14-19) in the past year. Prevalence varied greatly across countries and regions, with lifetime prevalence ranging from 6% (3-11) in Georgia to 49% (35-64) in Papua New Guinea. Overall, the prevalence of both lifetime (154 countries) and past-year (157 countries) intimate partner violence against adolescent girls was higher in low-income and lower-middle-income countries and regions than in high-income countries and regions. Countries with higher rates of female secondary school enrolment and those with inheritance laws that are more gender-equal had lower prevalence of intimate partner violence against adolescent girls. Lower-income countries and societies with a high prevalence of child marriage had higher prevalence of physical or sexual intimate partner violence against adolescent girls.

INTERPRETATION

Our findings highlight the widespread prevalence of intimate partner violence against adolescent girls across the globe and its relationship with country-level contextual factors. They emphasise the need for promoting and ensuring policies and programmes that increase and ensure gender equality. Countries should strive to provide secondary education for all girls, ensure equal property rights for women, eliminate discriminatory gender norms, and address harmful practices such as child marriage.

FUNDING

UN Women-WHO Joint Programme on Strengthening Violence Against Women Data funded by the UK Foreign and Commonwealth Development Office and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction.

Watching Televised Counter-Stereotypes Alone or with Mom: Studying the Effects on Preadolescents' Gender Attitudes and Beliefs

Despite the dominant presence of traditional gender portrayals on television, there is a growing effort to incorporate more diverse gender representations, including in youth television series. The impact of such counter-stereotypical portrayals on preadolescents' gender attitudes and beliefs remains largely unexplored. This mixed-design experimental study among 75 mother-child dyads (Mage child = 10.69, SD = 1.37) examined the effects of watching an episode of an entertainment television program that positively portrays a transgender character, either alone or with the mother. The findings indicated that watching the episode lowered preadolescents' gender essentialism, but did not increase acceptability of and willingness to befriend gender-nonconforming peers. Maternal presence did not further impact the findings. Perceived similarity to and liking of the transgender character did not act as moderators, but had a direct impact on preadolescents' gender attitudes and beliefs. In conclusion, the results suggest that exposure to counter-stereotypes in entertainment television can influence components of preadolescents' gender attitudes and beliefs. Gender-diverse television characters who are perceived as highly similar and likeable appear to be particularly influential.

The predictors of objectified body consciousness among adolescents: Socıal appearance anxiety and social media use

OBJECTIVE

The purpose of this study was to determine the predictors of social appearance anxiety and social media addiction on objectified body consciousness among adolescents.

METHOD

This descriptive and cross-sectional study included 502 adolescents. The Child and Family Information Form, Social Appearance Anxiety Scale, Objectified Body Consciousness Scale-Youth Form, and Social Media Addiction Scale for Adolescents were used to collect data. Mann-Whitney U test, Kruskal Wallis H test and regression analysis were used.

RESULTS

In the study, being female, being pleased with one's weight, and following and being influenced by influencers all increase levels of self-objectification. It was found that social media addiction, social appearance anxiety, and self-objectification all have an effect on one another.

CONCLUSION

It was concluded that social media usage characteristics, social media addiction, social appearance anxiety affect self-objectification.

A systematic review of economic evaluations conducted on gender-transformative interventions aimed at preventing unintended pregnancy and promoting sexual health in adolescents

AIMS

We synthesised the best-available evidence on economic evaluations of gender-transformative interventions that prevent unintended pregnancy and promote sexual-health in adolescents. We also assessed the methodological quality of the economic-evaluation studies and identified gaps in the economic-evaluation evidence.

DESIGN

A systematic review (SR) of economic evaluations reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2020.

DATA SOURCES

We searched the following bibliographic databases for economic evaluations that met our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We also conducted a grey literature search. We included articles published from January 1, 1990 to December 31, 2021, in English, including adolescents aged 10-19. Two independent reviewers conducted the title and full-text screening.

DATA EXTRACTION AND SYNTHESIS

One reviewer conducted data extraction and quality assessment, which a second reviewer checked. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and Consensus on Health Economic Criteria (CHEC) checklist to measure the reporting and methodological quality. Synthesis was done narratively and using summary tables.

RESULTS

Twenty-two studies were included, with 16 full and six partial economic evaluations. The quality of studies was moderate to high for most. The most reported outcomes were incremental cost-effectiveness ratio, costs per averted sexually transmitted infection, quality-adjusted life years saved per averted infection and costs per averted pregnancy. Most studies were cost-effective or cost-saving.

CONCLUSIONS

Most of the economic evaluations are cost-effective. There is a scarcity of available economic evaluations for most existing gender-transformative interventions, with most included studies originating from high-income countries (HICs). There is a need to develop guidance specific to economic evaluations of gender-transformative interventions.

Intersectionality, gender norms, and young adolescents in context: a review of longitudinal multicountry research programmes to shape future action

Discriminatory gender norms can intersect and interact with other dimensions of discrimination-such as age, race, ethnicity, disability, education status, and sexual orientation-to shape individuals' experiences and impact their health and wellbeing. This interaction is referred to as intersectionality. Although the theory has been in circulation since the late 1980s, only recently has it gained traction in low-income and middle-income settings, and it has yet to fully penetrate global research on adolescence. The social and structural intersectional drivers of adolescent health and wellbeing, particularly during early adolescence (age 10-14 years), are poorly understood. The evidence base for designing effective interventions for this formative period of life is therefore relatively small. In this Review, we examine how gender intersects with other forms of disadvantage in the early stages of adolescence. Analysing data from hybrid observation-intervention longitudinal studies with young adolescents in 16 countries, our aim is to inform the health and wellbeing of girls and boys from a range of social contexts, including in conflict settings. Adolescents' perceptions about gender norms vary by context, depend on individual opinion, and are shaped by socioecological drivers of gender inequalities in health. Shifting those perceptions is therefore challenging. We argue for the importance of applying an intersectionality lens to improve health and wellbeing outcomes for young adolescents and conclude with five practical recommendations for programme design and research.

Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data

BACKGROUND

Addressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) and Agenda 2030. We aimed to develop a comprehensive index to measure attitudinal support for SRHR, expanding opportunities for global trend analyses and tailored interventions.

METHODS

We designed a new module capturing attitudes towards different dimensions of SRHR, collected via the nationally representative World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020-2021 (n = 3,711). We used exploratory factor analysis of 58 items to identify sub-scales and an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex.

RESULTS

A 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive "SRHR Support Index", standardized on a 1-100 scale (mean = 39.19, SD = 15.27, Cronbach's alpha = 0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD = 16.78) followed by Ethiopia (40.2, SD = 13.63), and lowest in Zimbabwe (32.65, SD = 13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urban residence correlated with more support among males only.

CONCLUSION

The SRHR Support Index has the potential to broaden SRHR attitude research from a comprehensive perspective - addressing the need for a common measure to track progress over time.

Disclosure of Sexually Transmitted Infections to Sexual Partners: A Systematic Critical Literature Review

The purpose of this review was to systematically and critically evaluate the STI disclosure literature (excluding HIV disclosure literature), summarize limitations and omissions, and identify opportunities for future research. We used the Health Disclosure Decision-Making Model (DD-MM) as a guiding theoretical framework. Following PRISMA guidelines, database searches using key terms identified 387 possible articles, 32 of which ultimately met inclusion criteria for this review. Findings indicated that individuals with STIs experience a variety of negative feelings and emotions related to the prospect of disclosure. Reasons for disclosure included moral obligation, love for partner, and desire for support, whereas reasons to not disclose included fears about partner's reaction and response, fears of being rejected or broken up with, and beliefs about the lack of obligation. Disclosers used a variety of disclosure strategies, including priming messages, framing, and direct disclosure. Non-disclosers used strategies to pass as uninfected (i.e. passing), withdraw from relationships, and using outbreaks to time sexual activity. Among studies that examined disclosure timing, around half or fewer individuals disclosed or believed they should disclose prior to engaging in sexual activity. The findings indicated that relationship-related factors such as greater levels of commitment, relationship quality, length together, and feelings of closeness were important predictors of disclosure. Finally, some individuals experienced negative partner responses, whereas others experienced positive responses and relationship outcomes. Our review revealed that the experiences of receivers of STI disclosures are not well-represented in the literature. Implications for future research, education, and intervention are specified.

Self-Rated Masculinity and Femininity and Reported Number of Lifetime Sexual Partners Among Cisgender Heterosexual and LGBQ Men and Women

Prior research has quantitatively examined why heterosexual men and women report different numbers of lifetime different-sex sexual partners, whereas qualitative work has analyzed how men's masculinity-and to a lesser extent, women's femininity-is tied to gender norms about sexual activity. Less research, however, has quantitatively examined the associations between self-rated masculinity and femininity and reported number of lifetime sexual partners. This brief report uses a large sample of Canadians (n = 2117) to examine how self-rated masculinity and femininity relate to reported numbers of sexual partners among four groups of cisgender people: (1) heterosexual men (n = 972), (2) heterosexual women (n = 979), (3) gay and bisexual/pansexual men (n = 99), and (4) lesbian and bisexual/pansexual women (n = 67). Results demonstrate that self-rated femininity was negatively, and masculinity positively, associated with reported numbers of lifetime different-sex sexual partners among heterosexual women. No significant associations emerged for other groups. The lack of significant associations among heterosexual men may be attributable to the fact that most rated themselves as very masculine and not very feminine, whereas there was more variation among heterosexual women. In contrast, the non-significance among LGBQ women and men could reflect that subcultural norms and practices more strongly shape the number of sexual partners individuals report having in these communities. These results demonstrate that it would be beneficial for researchers to measure self-rated masculinity and femininity in future studies about sexual partnering practices, especially among heterosexual cisgender women.

South Asian Young Adults and Gender Roles: Expectations, Expressions, and Intimate Partner Violence Prevention

The goals of the researchers who conducted this study were to explore South Asian young adults' (N = 30) perceptions of gender roles and intimate partner violence (IPV) prevention in South Asian communities in the United States. Three distinct themes (a) gender role socialization and expectations, (b) gender role expression/negotiation within own intimate relationship, family, and own community, and (c) IPV prevention were identified. Important implications include how socialization and acculturation processes, immigration, and other factors influence South Asian young adults' perceptions of IPV in the community.

Boys' perspectives on girls' marriage and school dropout: a qualitative study revisiting a structural intervention in Southern India

Girls' education has for many decades been central to the global development agenda, due to its positive impact on girls' health and wellbeing. In this paper, the authors revisit boys' attitudes, behaviours and norms related to girls' education, following the Samata intervention to prevent girls' school dropouts in Northern-Karnataka, South India. Data were collected from 20 boys in intervention villages before and after the intervention, and analysis was undertaken using a thematic-framework approach. Findings suggest that while boys did hold some attitudes and beliefs that supported girls' education and delayed-marriage, these remained within the framework of gender-inequitable norms concerning girls' marriageability, respectability/family-honour. Participants criticised peers who sought to jeopardise girls' respectability by teasing and community gossip about girls-boys' communication in public. Boys who rejected prevailing norms of masculinity were subjected to gossip, ridicule and violence by the community. Boys' attitudes and beliefs supported girls' education but were conditional on the maintenance of gendered hierarchies at household and interpersonal levels. Social norms concerning girls' honour, respectability and the role of boys as protectors/aggressors appeared to influence boys' response to girls' school dropouts. Future interventions aiming to address girls' education and marriage must invest time and resources to ensure that intervention components targeting boys are relevant, appropriate and effective.

Endorsing Precarious Manhood Beliefs Is Associated With Sexual Harassment Myths Acceptance in Italian Men and Women

The present study aimed to expand the understanding of the correlates of sexual harassment myths, a set of beliefs that serve to justify male perpetrators. Data collected among Italian adults (N = 407; 59.5% women) showed that individual levels of precarious manhood beliefs-according to which manhood is a social status that must be proven via public action-were related to greater sexual harassment myths acceptance in male and female respondents. Such associations were mediated by hostile sexism and benevolence toward men. Findings suggest that interventions to reduce tolerance of sexual harassment of women should target cultural views of manhood and counteract rigid models of masculinity and femininity.

Associations of Adolescent School Social Networks, Gender Norms, and Adolescent-to-Young Adult Changes in Male Gender Expression With Young Adult Substance Use

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.

A Semantic Approach to Describe Social and Economic Characteristics That Impact Health Outcomes (Social Determinants of Health): Ontology Development Study

BACKGROUND

Social determinants of health (SDoH) have been described by the World Health Organization as the conditions in which individuals are born, live, work, and age. These conditions can be grouped into 3 interrelated levels known as macrolevel (societal), mesolevel (community), and microlevel (individual) determinants. The scope of SDoH expands beyond the biomedical level, and there remains a need to connect other areas such as economics, public policy, and social factors.

OBJECTIVE

Providing a computable artifact that can link health data to concepts involving the different levels of determinants may improve our understanding of the impact SDoH have on human populations. Modeling SDoH may help to reduce existing gaps in the literature through explicit links between the determinants and biological factors. This in turn can allow researchers and clinicians to make better sense of data and discover new knowledge through the use of semantic links.

METHODS

An experimental ontology was developed to represent knowledge of the social and economic characteristics of SDoH. Information from 27 literature sources was analyzed to gather concepts and encoded using Web Ontology Language, version 2 (OWL2) and Protégé. Four evaluators independently reviewed the ontology axioms using natural language translation. The analyses from the evaluations and selected terminologies from the Basic Formal Ontology were used to create a revised ontology with a broad spectrum of knowledge concepts ranging from the macrolevel to the microlevel determinants.

RESULTS

The literature search identified several topics of discussion for each determinant level. Publications for the macrolevel determinants centered around health policy, income inequality, welfare, and the environment. Articles relating to the mesolevel determinants discussed work, work conditions, psychosocial factors, socioeconomic position, outcomes, food, poverty, housing, and crime. Finally, sources found for the microlevel determinants examined gender, ethnicity, race, and behavior. Concepts were gathered from the literature and used to produce an ontology consisting of 383 classes, 109 object properties, and 748 logical axioms. A reasoning test revealed no inconsistent axioms.

CONCLUSIONS

This ontology models heterogeneous social and economic concepts to represent aspects of SDoH. The scope of SDoH is expansive, and although the ontology is broad, it is still in its early stages. To our current understanding, this ontology represents the first attempt to concentrate on knowledge concepts that are currently not covered by existing ontologies. Future direction will include further expanding the ontology to link with other biomedical ontologies, including alignment for granular semantics.

Assessing Survey Items on Social Norms Relating to Dating and Relationship Violence and to Gender: Cognitive Interviews with Young People in England

Widespread among adolescents in England, dating and relationship violence (DRV) is associated with subsequent injuries and serious mental health problems. While DRV prevention interventions often aim to shift harmful social norms, no established measures exist to assess relevant norms and their role in mediating DRV outcomes. We conducted cognitive interviews exploring the understandability and answerability of candidate measures of social norms relating to DRV and gender roles, informing measure refinement. In all, 11 participants aged 13 to 15 from one school in England participated. Cognitive interviews tested two items assessing descriptive norms (beliefs about what behaviors are typical), three assessing injunctive norms (beliefs about what is socially acceptable), and (for comparison) one assessing personal attitudes. Findings were summarized by drawing on interview notes. Summaries and interview notes were subjected to thematic analysis. For some participants, injunctive norms items required further explanation to clarify that items asked about others' views, not their own. Lack of certainty about, and perceived heterogeneity of, behaviors and views among a broad reference group detracted from answerability. Participants were better able to answer items for which they could draw on concrete experiences of observing or discussing relevant behaviors or social sanctions. Data suggest that a narrowed reference group could improve answerability for items assessing salient norms. Findings informed refinements to social norms measures. It is possible to develop social norms measures that are understandable and answerable for adolescents in England. Measures should assess norms that are salient and publicly manifest among a cohesive and influential reference group.

Evaluation of ambivalent sexism in Colombia and validation of the ASI and AMI brief scales

Sexism has implications for people's physical and mental health. Thus, understanding sexism and its prevalence is key to understanding the phenomenon. In the current study, 717 Colombian men and women completed the brief scales of Ambivalent Sexism toward women and men and the Gender Identity Scale. The assessment was conducted using a web-based method. Both scales, as expected, were two-dimensional. Reliability ranged from .83 to .88. Moderate and high correlations were observed with the Gender Identity Scale. Men showed higher levels of hostile and benevolent sexism toward women and benevolent sexism toward men. It was also found that the higher the level of education, the lower the rates of sexism toward men and women. The brief scales were valid and reliable for measuring hostile and benevolent sexism in Colombia.

Misperception of peer beliefs reinforces inequitable gender norms among Tanzanian men

Gender role ideology, i.e. beliefs about how genders should behave, is shaped by social learning. Accordingly, if perceptions about the beliefs of others are inaccurate this may impact trajectories of cultural change. Consistent with this premise, recent studies report evidence of a tendency to overestimate peer support for inequitable gender norms, especially among men, and that correcting apparent 'norm misperception' promotes transitions to relatively egalitarian beliefs. However, supporting evidence largely relies on self-report measures vulnerable to social desirability bias. Consequently, observed patterns may reflect researcher measurement error rather than participant misperception. Addressing this shortcoming, we examine men's gender role ideology using both conventional self-reported and a novel wife-reported measure of men's beliefs in an urbanising community in Tanzania. We confirm that participants overestimate peer support for gender inequity. However, the latter measure, which we argue more accurately captures men's true beliefs, implies that this tendency is relatively modest in magnitude and scope. Overestimation was most pronounced among men holding relatively inequitable beliefs, consistent with misperception of peer beliefs reinforcing inequitable norms. Furthermore, older and poorly educated men overestimated peer support for gender inequity the most, suggesting that outdated and limited social information contribute to norm misperception in this context.

Role of Gender perceptions in shaping gender-based discrimination and gender equality among school-going adolescents, Telangana: A cross-sectional community-based study

Background

Adolescence is a unique phase of life, facilitates the transition of a child to an adult, and thus is characterized with distinctive challenges as well as potentialities. Gender socialization during adolescence is shaped by the family, culture, and social construct results to development of attitudes, with more consistent and organized vision toward self and the society.

Aim

The present study aims to identify the gender attitudes, perceived gender role, and gender discrimination among adolescents.

Materials and Methods

Cross-sectional descriptive design adopted to study the gender perceptions among adolescents (N = 200) between 8th and 12th standards and meeting the inclusive criteria. Data were collected on gender attributes, attitudes, and perceived discrimination based on gender. Gender equality scores measured among students were categorized between high and low.

Results

Findings reveal the persistence of gendered attitudes, roles, and relationships based on gender; 54% girls and 58% boys reported that boys/men are expected to be tough and less emotional and (37.5% girls; 46% boys) agreed that men were decision makers in the financial and family matters and women were felt as lesser role players. Overall, 46% were with gender-biased perceptions. Girls (18%) and boys (5%) reported sexual abuse; however, for any gender abuse, only 16% preferred to seek help from the family members.

Conclusion

Findings of the present study highlight the need for gender sensitization in education and schools to transform gender-balanced attitudes and behaviors from young age which greatly affect the inter-personal relationships, affecting behaviors and relationships in families and societies in adulthood.

Time use patterns and household adversities: A lens to understand the construction of gender privilege among children and adolescents in India

We investigate gender differences in time-use patterns in 1891 children and assess how time is reallocated in response to challenges faced by households in India. We use adaptations made within a household during adversities to understand how gender inequality in time use is produced and reinforced. Using three waves of the Young Lives Panel Survey (2009, 2013, and 2016), we find that boys spend significantly more time on school and leisure than girls. Girls spend more time on household chores, care work, and studying at home than boys while spending fewer hours on school and leisure. Girls perform paid work during household adversities besides carrying out additional care work and household chores. Boys are more likely to engage in unpaid work than girls but are similarly affected in other domains. However, their time for education and leisure is often protected. Thus, girls labor more than boys daily and respond in equal measure during adversities, demonstrating that gender inequality in time use emerges at an early age.

Determinants of women's agency in accessing and utilising reproductive healthcare services; a systematic review

Women's agency is vital to access and use reproductive healthcare services, particularly in contexts where patriarchal beliefs and cultural norms limit women's desire to act on their goals or affect their access to essential resources. However, less is known about what resources enable women to exercise agency to access these services. A comprehensive systematic review was conducted to summarise existing evidence on the determinants of women's agency in accessing and using reproductive healthcare services. Various determinants were identified, including individual characteristics; household structure; reproductive health-related determinants; social relations; and economic factors. These determinants of women's agency in accessing reproductive healthcare services were strongly associated with social norms and cultural beliefs. Several gaps in the literature included inconsistent definitions and measurement of women's agency; lack of considering cultural sensitivities and socially acceptable practices in the conceptualisation and measurement of women's agency; a narrow focus on services related predominantly to pregnancy and birth, with other aspects of services including sexual health and safe abortion being largely unreported. The literature focused on developing countries in Africa and Asia, leaving a significant gap in knowledge about women's agency to access services in other geographical areas or among immigrant or refugee populations living in developed countries.

Interpersonal Violence and Gender Inequality in Adolescents: A Systematic Analysis of Global Burden of Disease Data From 1990 to 2019

PURPOSE

Interpersonal violence is a leading cause of adolescent deaths and disability. This study investigates sex differences in burden of interpersonal violence for adolescents and explores associations with gender inequality.

METHOD

Using data from the 2019 Global Burden of Disease study, we report numbers, proportions, rates of interpersonal violence deaths and disability adjusted life years (DALYs) for all ages, and rate of change (from 1990 to 2019) in adolescents aged 10-24 years disaggregated by sex and geography. We explored associations with gender inequality using gender inequality index.

RESULTS

One in four (24.8%) all-age interpersonal violence deaths are in adolescents. In 2019, the rate of deaths in adolescent males was almost six times higher than females (9.3 vs. 1.6 per 100,000); and since 1990, the rate of decline in DALYs for females was double than that for males (-28.9% vs. -12.7%). By contrast, the burden of sexual violence is disproportionately borne by adolescent females, with over double the rate than males (DALYs: 42.8 vs. 17.5 per 100,000). In countries with greater gender inequality, the male-to-female ratio (deaths and DALYs) was increased among older adolescents, pointing to benefits for males in more gender equal settings.

DISCUSSION

Social identities, relationships, and attitudes to violence are established in adolescence, which is an inflection point marking the emergence of disproportionate burdens of interpersonal violence. Our findings affirm that global agendas must be expanded to address interrelated factors driving multiple forms of interpersonal violence experienced by adolescents and reverberating to the next generation.

Effets identitaires de la socialisation différentielle de genre sur les aspirations au premier enfant et au mariage des jeunes adolescent(e)s à Ouagadougou: une étude mixte

Studies show that gender socialisation shapes differently the gendered identity, self-esteem, and sexual behaviours of girls and boys. While pre-adolescence is viewed as a pivotal period for gendered socialisation, few studies in francophone Africa investigate the role of gender identity effects on aspirations and sexual and reproductive behaviours at this life stage. This article explores how the internalisation of gender stereotypes during socialisation is linked to the aspirations of girls and boys for certain life events, such as having their first child or getting married. A survey was conducted in 10 primary schools in Ouagadougou, among pupils aged between 9 and 16 years, as well as seven focus group discussions with their parents. The findings indicate a gender-based variation in the effects of adherence to unequal gender norms among young adolescents. As a result, girls tend to have earlier aspirations towards marriage and later aspirations for childbearing, while boys show earlier aspirations for childbearing and later ones for marriage. These effects may expose both girls and boys to risks of poor sexual and reproductive health. Interventions promoting egalitarian gender norms could boost girls' self-esteem as well as mutual respect among young adolescents of both genders, aiming to improve their sexual and reproductive health during adolescence and into adulthood.

Social Norms About Dating and Relationship Violence and Gender Among Adolescents: Systematic Review of Measures Used in Dating and Relationship Violence Research

Adolescent dating and relationship violence (DRV) is widespread and associated with increased risk of subsequent poor mental health outcomes and partner violence. Shifting social norms (i.e., descriptive norms of perceived behavior and injunctive norms of acceptable behavior among a reference group of important others) may be important for reducing DRV. However, few DRV studies assess norms, measurement varies, and evidence on measure quality is diffuse. We aimed to map and assess how studies examining DRV measured social norms concerning DRV and gender. We conducted a systematic review of DRV literature reporting on the use and validity of such measures among participants aged 10-18 years. Searches included English peer-reviewed and grey literature identified via nine databases; Google Scholar; organization websites; reference checking; known studies; and expert requests. We identified 24 eligible studies from the Americas (N = 15), Africa (N = 4), and Europe (N = 5) using 40 eligible measures of DRV norms (descriptive: N = 19; injunctive: N = 14) and gender norms (descriptive: N = 1; injunctive: N = 6). No measure was shared across studies. Most measures were significantly associated with DRV outcomes and most had a defined reference group. Other evidence of quality was mixed. DRV norms measures sometimes specified heterosexual relationships but rarely separated norms governing DRV perpetrated by girls and boys. None specified sexual-minority relationships. Gender norms measures tended to focus on violence, but missed broader gendered expectations underpinning DRV. Future research should develop valid, reliable DRV norms and gender norms measures, and assess whether interventions' impact on norms mediates impact on DRV.

Empowering hearts and shaping destinies: unveiling the profound influence of education on women's mate selection in Pakistan - a comprehensive mixed-methods study

This study investigates the impact of education on women's empowerment in the realm of mate selection within Malakand Division, Khyber Pakhtunkhwa, Pakistan. Employing a mixed-method research approach, the study conducted 30 semi-structured interviews with educated women and distributed a Likert Scale questionnaire to 500 women. The qualitative findings reveals that education significantly influences women's perspectives, guiding their priorities, and instilling a desire for compatibility and shared values in their relationships. Educated women also display resilience, confidence, and a readiness to challenge prevailing societal norms and gender stereotypes when selecting a life partner. Quantitative analysis establishes a statistically significant positive correlation between education and women's empowerment in mate selection. These findings underscore the pivotal role of education in enhancing women's agency and autonomy in a critical aspect of their lives. The study's implications extend to policy recommendations advocating for increased access to quality education and the implementation of gender-sensitive curricula in Malakand Division and analogous regions. Recognizing education's potential to empower women in mate selection is vital for fostering a more equitable and inclusive society.

Patterns of participation in summer programming among United States' elementary children from low-income urban households: Results from the project SWEAT study

Food insecurity increases among marginalized children during the summer when school is out of session. Summer programming that offers access to healthy meals and snacks may reduce the risk. There is a national call in the US for more research to assure equitable access to summer programming. The objective of this prospective observational study was to characterize patterns of participation in summer programming among elementary children from low-income urban neighborhoods of metropolitan[Blinded]. Summer programming was broadly defined (e.g., church, school, recreation center, community center). Caregivers(n = 100) received weekly text messages via TextIt during the summer (Jun-Aug 2017). They were asked: "How many days this week did [ChildName] attend a summer program? Please respond with a number from 0 to 5, where 0 - no days, 2 - 2 days, etc." Weekly counts were summed. Stepwise logistic and linear regression models were conducted to examine differences in patterns of attendance according to key sociodemographic characteristics. Mean age was 7.03 ± 0.23. 52 % identified as female, 70 % were low-income, and 80.0 % identified as Black. 51 % attended summer programming at least once; 49 % never attended. Those who attended at least once vs. not at all were more likely to be male(p < 0.01); 62.75 % males vs. 37.25 % females attended summer programming at least once, whereas 67.35 % females compared to 32.65 % males never attended. Overall mean attendance was 10.40 ± 1.43 days(out of 50). Mean + SE attendance was lower for females (7.52 + 1.76) vs. males (13.52 + 2.21)(p < 0.05), and non-Black (4.30 + 1.97) vs. Black (11.93 + 1.67)(p = 0.01) children. Future research is needed to understand barriers to participation in summer programming.

The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study

PLAIN LANGUAGE STATEMENT

Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.

Gender ideologies across the transition to adulthood in Germany: How early romantic relationships slow down the egalitarian trend

This study explores the development of gender ideologies across adolescence and the transition to adulthood in Germany and investigates the relevance of first romantic relationship experiences in shaping gender beliefs. Integrating the life course perspective with the theoretical framework of gender as a social structure and psychological theories, we extend the literature by following adolescents from age 15 to about age 20 across the transition to adulthood and by differentiating between young women and men from different immigrant and non-immigrant backgrounds, who may be affected differently by gender-related expectations. Using the representative and ethnically diverse German sample of the Children of Immigrants Longitudinal Survey in Four European Countries, we conducted fixed-effects regression analyses (n = 1474). First, our findings show that young people become increasingly egalitarian during adolescence, irrespective of gender and immigrant origin. Second, for young women, romantic relationship experiences of moderate and longer durations are significantly associated with slower increases in egalitarianism. For most young men, romantic relationship experiences do not affect their gender ideologies. One exception is the group of Turkish-origin men, who change their gender ideologies less towards egalitarianism with increasing relationship durations than other groups of young men. The findings suggest that, especially for young women, early romantic relationships may be crucial in shaping their gender beliefs, which subsequently predict important educational, occupational, and family choices.

Maternal childhood adversity and adolescent marijuana use at age 17 years: The role of parental mental health and parenting behaviors

INTRODUCTION

Children's risk for marijuana use may be linked to their parents' history of childhood adversity, yet little is known about the mechanisms underlying this link. This study examined whether maternal parenting behavior and mental health serve as mechanisms linking maternal childhood adversity to their children's marijuana use at age 17 years, by gender.

METHODS

Data were from the Young Women and Child Development Study (59% male), a longitudinal panel study, which began in 1988 and followed mother-child dyads for 17 years (n = 240). Participants were recruited from health and social services agencies located in a metropolitan region of Washington State. Hypotheses were tested using Structural Equation Modeling in Mplus. Multiple-group analysis was conducted to evaluate potential gender differences.

RESULTS

Results showed that maternal childhood adversity was associated with their mental health outcomes (β = .32, p < .001), which in turn was predictive of mothers' harsh parenting (β = .27, p < .01). Maternal harsh parenting behavior was then associated with their children's marijuana use at age 17 years (β = .34, p < .001). Multiple group analyses revealed that the path from harsh parenting to adolescent marijuana use differed across genders being only significant for boys (β = .42, p < .001).

CONCLUSIONS

The intergenerational impact of childhood adversity highlights the need for interventions that target both parents and children. This would support teen mothers with a history of childhood adversity to acquire skills and knowledge to help mitigate its impact on their parenting behaviors and offset risks for their children.

The Association between Intrahousehold Food Allocation Social Norms and Thinness among Young Adolescent Girls: A Community-Based Study

Background

Inequalities in food allocation related to social norms among household members significantly affect the nutritional status and well-being of the vulnerable members of the household, such as adolescent girls. This study assesses the association between social norms related to intrahousehold food allocation and young adolescent girls' thinness.

Materials and Methods

The study involved 1,083 pairs of mothers/caregivers and young adolescent girls. Data were collected using a structured and pretested questionnaire. Multilevel mixed-effect logistic regression analysis was employed to examine associations using STATA/SE V.14 statistical software. In addition, a stratified analysis was done to investigate the effect of social norms on thinness in food-secure and food-insecure households.

Result

The overall prevalence of young adolescent girls' thinness was 15.70% (95% CI 13.52-17.86%). Young adolescent girls' thinness was associated with mothers'/caregivers' conformity to inequitable intrahousehold food allocation social norms in food-secure households [Adjusted odds ratio (AOR): 1.43, 95% CI: 1.14-1.80] but not in food-insecure households.

Conclusion

Nearly 16% of adolescent girls were thin. Mothers/female caregivers conforming to inequitable intrahousehold food allocation social norms compromise the nutritional status of adolescent girls, particularly in food-secure households. The lack of statistically significant association in food-insecure households hints at the need to address inequality in food-secure households while addressing food shortage to improve the nutritional status of adolescents in low-income countries. We also recommend more studies in different sociocultural contexts to fully gather the evidence for adopting appropriate policies and practices.

Methodological and Ethical Implications of Using Remote Data Collection Tools to Measure Sexual and Reproductive Health and Gender-Based Violence Outcomes among Women and Girls in Humanitarian and Fragile Settings: A Mixed Methods Systematic Review of Peer-Reviewed Research

Purpose: This systematic review investigates the methodological and ethical implications of using remote data collection tools to measure sexual/reproductive health (SRH) and gender-based violence (GBV) outcomes among women and girls in humanitarian and fragile settings. Methods: We included empirical studies of all design types that collected any self-reported primary data related to SRH/GBV using information and communication technology, in the absence of in-person interactions, from women and girls in humanitarian and fragile settings. The search was run in March 2021 without filters or limits in Ovid Medline, Embase, Web of Science, Clinicaltrials.gov, and Scopus. Quality was assessed using an adapted version of the MMAT tool. Two reviewers independently determined whether each full text source met the eligibility criteria, and conflicts were resolved through consensus. A-priori extraction fields concerned methodological rigor and ethical considerations. Results: 21 total studies were included. The majority of studies were quantitative descriptive, aiming to ascertain prevalence. Telephone interviews, online surveys, and mobile applications, SMS surveys, and online discussion forums were used as remote data collection tools. Key methodological considerations included the overuse of non-probability samples, lack of a defined sampling frame, the introduction of bias by making eligibility contingent on owning/accessing technology, and the lack of qualitative probing. Ethical consideration pertained to including persons with low literacy, participant safety, use of referral services, and the gender digital divide. Conclusion: Findings are intended to guide SRH/GBV researchers and academics in critically assessing methodological and ethical implications of using remote data collection tools to measure SRH and GBV in humanitarian and fragile settings.

Boys and girls differ in their rationale behind eating: a systematic review of intrinsic and extrinsic motivations in dietary habits across countries

Background

Boys' and girls' food habits diverge in adolescence (13-18 years). This contributes to unequal risks of adverse health outcomes based on sex and gender in adulthood (e.g., heart diseases in men vs. disorder eating in women). Though multi-factorial, why these dietary differences occur is unclear.

Purpose

To identify the reasons why adolescents' motivation behind dietary habits differs among genders.

Methods

Four databases were searched following PRISMA guidelines. Eligible studies had to use qualitative methodology and report at least one gender unique theme. Reported themes were thematically analyzed, with a sub-analysis by country where the studies were conducted. Quality appraisals were assessed using the Critical Appraisal Skills Programme checklist.

Results

In the 34 eligible articles (n = 1,694 returned) two overarching themes emerged that dictated dietary habits in adolescents: Self-motivators and Uncontrollable factors. Gender differences arose whereby girls highlighted more external motivators (e.g., eat healthier, change dietary habits around boys and be thin to fit traditional norms) over their dietary habits. In contrast, boys focused on more internal motivators (e.g., gain autonomy, eat for enjoyment and pursue gains in physical performance). This suggests that motivation underlying how boys and girls eat differs. These trends were largely consistent across countries.

Conclusion

Boys' and girls' food habits are not motivated by the same factors. To create more effective dietary interventions targeting health promotion, unique motivations behind food habits need to be understood and incorporated.

Systematic review registration

Identifier: CRD42022298077.

Gender role attitudes and well-being of German and refugee adolescents-same or different?

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.

Gender stereotypes and their correlates: the moderating role of voluntary sports club membership

Introduction

This study examined the correlates of gender stereotypes and the moderating role of membership in a voluntary sports club. Drawing on the contact hypothesis, this study argues that gender stereotypes are lower when individuals regularly have the opportunity to meet and play sport with such people, for example in a voluntary sports club.

Methods

Survey data from the European Values Study are used for the analysis (n = 36,185; 30 countries). Gender stereotypes are measured with statements on gender role attributes.

Results

Regression results show that membership in a voluntary sports club, being a student, income, and living in a more gender equal country significantly reduce gender stereotypes. On the contrary, male gender, living in a partnership, having children, lower and medium education, part-time employment, self-employment, unemployment, being a home maker, and living in a small town are correlates of higher gender stereotypes. Interacting the latter correlates with sports club membership support its moderating effect in the sense that most correlates turn insignificant or have smaller coefficients. The only variables retaining their coefficient size are self-employment and living in a small town.

Discussion

The findings support the contact hypothesis and suggest that sports clubs are places that lessen gender stereotypes.

Attitudes to adolescent pregnancy among families in the Dominican Republic and El Salvador: insights from a longitudinal study

Over the past few decades growing attention has focused on the perceived challenge of adolescent pregnancy and the need for girls to make 'smart choices'. This has generated considerable debate particularly because of the failure of many programmes and interventions to consider the structural constraints faced by young women in accessing sexual and reproductive health and rights (SRHR). Yet limited attention has been given to the views and experiences of girls' parents and caregivers, many of whom were often adolescent parents themselves. We use data from the Real Choices, Real Lives longitudinal study conducted by Plan International to consider how the experiences of girls' families shape their attitudes to teenage pregnancy in the Dominican Republic and El Salvador. Many families believe girls need to practise abstinence and avoid men and boys but given the lack of provision for SRHR faced by young women this response is not unexpected.

A Student-Centric Evaluation of a Program Addressing Prevention of Gender-Based Violence in Three African Countries

Studies investigating the effectiveness of school-related gender-based violence prevention programs seldom report on the extent to which students themselves value and recommend such programs. Yet, along with evidence about effectiveness in relation to shifts in knowledge, attitudes, or intentions, student-valuing is a significant indicator that the programs can make a positive contribution to students' lives. This mixed-method study analyses survey and focus group data collected from ninety-two schools in three African countries (Tanzania, Zambia, and Eswatini). Students found the program contributed to improved peer relationships and identified the five most useful components as learning about gender equality and human rights, learning how to obtain help for those affected by violence, understanding and communicating about their emotions, strategies to avoid joining in with bullying and harassment, and understanding the effects of gender-based violence.

A Time of Great Change: How Parents, Friends, and Classmates Shape Adolescents' Attitudes towards the Gender Division of Labor

Parents are crucial in the construction of their children's attitudes towards the gender division of labor. However, little is known about the extent to which parents' influences on their children's attitudes weaken in favor of peers during adolescence. This study explores how gender beliefs of parents, friends, and classmates shape adolescents' attitudes towards the gender division of labor in Sweden, Germany, England, and the Netherlands. It extends previous research which predominantly examined parent-child transmission. The analysis draws on 4645 children (at wave 1: M_age = 14.9, SD_age = 0.67, females = 50%) of the Children of Immigrants Longitudinal Survey in Four European Countries. Regression analyses of within-person changes in attitudes show that adolescents on average become more egalitarian from age 15 to 16 and significantly adapt their own beliefs to those of their parents, friends, and classmates. In cases of opposing beliefs, adolescents tended to adapt more strongly to whoever held more egalitarian views, possibly aligning with more widespread norms of egalitarianism. The findings show great similarity in adaptation processes across countries and align well with a multi-layered conceptualization of gender as a social structure that shapes gender attitudes.

The Impacts of Two Gender-Transformative Interventions on Early Adolescent Gender Norms Perceptions: A Difference-in-Difference Analysis

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.

Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review

Background

In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap.

Methods

This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review.

Results

From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents.

Conclusion

This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.

Social, Emotional, and Behavioral Skills: Age and Gender Differences at 12 to 19 Years Old

Individuals use social, emotional, and behavioral (SEB) skills to build and maintain social relationships, regulate emotions, and manage goal-directed behaviors. A promising integrative framework of SEB skills was recently proposed, showing that they matter for positive outcomes during adolescence. Nothing is known about how and whether they differ between 12 and 19 years old and whether such differences depend on gender (males or females). Uncovering their age trajectories is fundamental because SEB skills are highly needed during this period of life. Educators, psychologists, and policymakers need to understand when, why, and how interventions concerning SEB skills should be proposed, potentially considering male and female profiles. To cover this gap, we cross-sectionally analyzed data from 4106 participants (2215 females, 12-19 years old). We highlighted age and gender differences in the five domains of SEB skills (self-management, innovation, cooperation, social engagement, and emotional resilience). Our results show that each SEB skill follows a specific age trend: emotional resilience and cooperation skills increase naturally between 12 and 19 years old, while innovation, social engagement, and self-management skills decline, especially between 12 and 16 years old, and grow later. The trajectories of self-management, social engagement, and emotional resilience skills also differ between males and females. Importantly, we detected declines in SEB skills (especially for social engagement and innovation skills) that can inform policies and interventions to sustain SEB skills in youths to favor their well-being and success in this crucial period.

The stronger and the weaker sex - gender differences in the perception of individuals who experienced physical and sexual violence in childhood. A scoping review

BACKGROUND

Violence against children is an issue of serious concern. Stigma impacts coping with childhood trauma. A central aspect regarding disclosing trauma and seeking help is the social perception of the victim and survivor's gender.

OBJECTIVE

This review aims to synthesize qualitative and quantitative research about the impact of the victim and survivor gender on the societal perceptions of individuals who have experienced sexual and/or physical violence in childhood.

PARTICIPANTS AND SETTING

This review considered both society's and victims and survivors' perspectives on gender-linked perceptions concerning individuals with childhood trauma.

METHODS

The initial search was conducted in November 2021 and involved the databases Web of Science, PubMed, and PsychInfo. All studies, published in English or German, that reported study design, sample characteristics, and gender-linked perceptions of individuals with a history of sexual and/or physical violence in childhood were included.

RESULTS

A total of 10,373 studies were identified, of which 20 studies were eligible for review. Six studies reported no significant victim gender effect. However, when significant victim gender effects were present, males were characterized with considerably more stigmatizing attributes regarding the blame category while females were exposed to considerably more stigmatizing attributes regarding the harm category.

CONCLUSIONS

Females and males experience stigmatization reflecting typical stereotypes of femininity and masculinity. Thus, females are perceived as more vulnerable, more burdened, and with a higher need for security than males. Males are seen as more blameworthy and less trustworthy than females due to their presumed capability to physically resist or escape abuse.

Women who use drugs: engagement in practices of harm reduction care

BACKGROUND

Harm reduction services that employ or are operated by people who use drugs are an effective means of mitigating overdose risks and other drug-related harms. However, stereotypes portraying people who use criminalized drugs as incapable caregivers persist. This is especially true for women who use drugs, and to a greater extent racialized women, who are characterized as having diverged from traditional ideals of womanhood as a result of drug-user stigma and the intersections of gender- and class-based and racist stereotypes. In an effort to identify and understand how women who use drugs practise care through harm reduction, we explored the experiences of women accessing a low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive) in Vancouver, Canada.

METHODS

Data were drawn from research conducted from May 2017 to June 2018 exploring women's experiences accessing the supervised consumption site during an overdose crisis. Data included forty-five semistructured interviews with women recruited from the site, analysed thematically to explore practices of care through harm reduction.

FINDINGS

Participants reported engaging in both formal and informal care. Acts of care included interventions that both aligned with and deviated from conventional understandings of care practices, including overdose reversal and education, overdose supervision/care, and assisted injection.

CONCLUSION

The boundary between formal and informal harm reduction care is fluid. Women who use drugs engage in harm reduction across these borders with acts of care that align with or fill the gaps in current harm reduction services in order to meet the needs of drug-using communities, challenging negative stereotypes of women who use drugs. However, these caregiving practices can increase risks to care providers' physical, mental, and emotional health and wellness. Increased financial, social, and institutional supports, including safer supply, assisted injection, and community resources, are needed to better support women as they continue to engage in harm reduction care.

Burden and contributing factors to overweight and obesity in young adolescents in Addis Ababa, Ethiopia

The prevalence of overweight/obesity in adolescents has increased globally, including in low- and middle-income countries. Early adolescence provides an opportunity to develop and encourage positive health and behavioural practices, yet it is an understudied age group with limited information to guide and inform appropriate interventions. This study aims to determine the prevalence of overweight/obesity in young adolescents, aged between 10 and 14 years attending public schools in Addis Ababa, Ethiopia, and to explore the contributing factors. A cross-sectional school-based study was conducted. Adolescents completed individual questionnaires. Weight (kg) and height (m) measurements were converted to BMI-for-age and gender z-scores. Multivariate regression analysis was conducted to determine the associated factors. The overall prevalence of overweight/obesity was 8% among adolescents aged 10-14 years and it was significantly higher in females (13%) than males (2%). The diet quality for the majority of the adolescents was inadequate, putting them at risk for poor health outcomes. The contributors to overweight/obesity were different between males and females. Age and no access to a flush toilet were negatively associated with overweight/obesity in males and access to a computer, laptop or tablet was positively associated. In females, menarche was positively associated with overweight/obesity. Living with only their mother or another female adult and an increase in physical activity were negatively associated with overweight/obesity. There is a need to improve the diet quality of young adolescents in Ethiopia and understand the reasons why females are less physically active to limit the risk of poor diet-related health outcomes.

Adolescent Girls and Their Family Members' Attitudes Around Gendered Power Inequity and Associations with Future Aspirations in Karnataka, India

Intergenerational differences in inequitable gender attitudes may influence developmental outcomes, including education. In rural Karnataka, India, we examined the extent of intergenerational (adolescent girls [AGs] vs. older generation family members) dis/agreement to attitudes around gendered power inequities, including gender roles and violence against women (VAW). Unadjusted and adjusted logistic regression examined associations between intergenerational dis/agreement to attitude statements and AGs' future educational and career aspirations. Of 2,457 AGs, 90.9% had a matched family member (55% mothers). While traditional gender roles were promoted intergenerationally, more AGs supported VAW than family members. In adjusted models, discordant promotion of traditional gender roles and concordant disapproval of VAW were associated with greater aspirations. Results highlight the need for family-level programming promoting positive modeling of gender-equitable attitudes.

What shapes attitudes on gender roles among adolescents in Bangladesh

Background

In Bangladesh, large gender differentials exist in outcomes in almost all spheres of life, stemming from conservative norms and attitudes around gender. Adolescence is a crucial period for social-emotional learning that can shape gender norms and attitudes.

Objective

The aim of the paper is to investigate the extent to which adolescents hold egalitarian attitudes toward gender roles, and to examine the factors that influence egalitarian gender attitudes.

Methods

The paper uses data from a nationally representative sample survey of 7,800 unmarried girls and 5,523 unmarried boys ages 15–19 years. Adolescents were considered to have egalitarian attitudes on gender role if they disagreed with all the following four unequal gender role statements with regards to socio-economic participation, while respondents who agreed with any one of the four statements were considered to have non-egalitarian attitudes: (1) It is important that sons have more education than daughters, (2) Outdoor games are only for boys, not girls, (3) Household chores are for women only, not for men, even if the woman works outside the home, and (4) Women should not be allowed to work outside the home. Multivariable linear probability regression analysis was implemented to identify the factors shaping attitudes on gender roles.

Results

Unmarried girls and boys differ hugely in their views on gender roles regarding socio economic participation-girls were much more egalitarian than boys (58 vs. 19%). The multivariate linear probability model results show girls and boys who completed at least grade 10 were 31% points and 15% points more likely to have egalitarian views on gender roles respectively, compared to girls and boys with primary or less education. Having strong connection with parents is associated with having egalitarian views on gender roles among girls but not boys. Adolescents' individual attitude on gender role is highly associated with the views of their community peers for both girls and boys. Girls and boys who had participated in adolescent programs were 6–7% points more likely to have egalitarian attitude than those who were not exposed to these programs. Egalitarian views were also significantly higher, by 5% points among girls and 6% points among boys, who were members of social organizations compared to those who were not. Watching television had positive influence on egalitarian attitudes among girls but not among boys. To create a more egalitarian society, both men and women need to hold progressive attitudes toward gender roles. The interventions must be multilevel, influencing adolescents at the personal, interpersonal, communal, and societal levels.

Prevalence, Trends, and Factors Associated with Teen Motherhood in Nigeria: An Analysis of the 2008-2018 Nigeria Demographic and Health Surveys

Background: Teen pregnancy and childbearing are common in Nigeria, and understanding the complexities, such as sociodemographics and economic factors including sexual and reproductive health knowledge and awareness among adolescents over time can trigger innovative approaches and interventions. This study intends to capture the patterns and associated factors of teen motherhood among sexually active adolescents (15-19 years) between 2008 and 2018. Methods: The study data was extracted from 2008, 2013, and 2018 Nigeria Demographic and Health Surveys. Descriptive analysis was presented using frequencies and percentages; multivariable analysis was conducted using log-binomial logistic regression at a p-value <0.05. All analyses were performed using Stata 15.0, weighted and adjusted for the complex survey design and population size. Results: The prevalence of teen motherhood increased between the three successive survey waves (50.9% vs. 52.4% vs. 55.2%) from 2008, 2013, and 2018. Although, the pooled adjusted analysis revealed no significant change over the 10-year period. Knowledge of modern contraceptive methods, primary education, non-Catholic Christians, residing in the South-South region, and those currently or formerly married were associated with increased risk of teen motherhood. There was an inverse relationship between teen motherhood and wealth status; lower wealth status was associated with high adolescent pregnancy and childbearing. Conclusion: This study revealed an increase in the proportion of teen pregnancy and childbearing in Nigeria. Notably, there exist variations across age groups, geographic location, educational level, religious belief, marital and economic status. Interventions that ensure comprehensive sexuality education, girl child education, and economic empowerment especially for school dropouts are advocated to reduce teen motherhood.

Effectiveness of an educational intervention targeting homophobic language use by young male athletes: a cluster randomised controlled trial

OBJECTIVE

Homophobic language is common in male sport and associated with negative physical and mental health outcomes for all sport participants, but particularly for gay or bisexual youth populations. Evidence-based interventions are needed to reduce such language and mitigate harm. This study evaluated the effectiveness of a short social-cognitive educational intervention delivered by professional rugby union players in youth sport.

METHODS

In a two-arm, cluster randomised controlled trial, 13 Australian youth rugby teams from 9 clubs (N=167, ages 16-20, mean 17.9) were randomised into intervention or control groups. Professional rugby players delivered the intervention in-person. Frequency of homophobic language use was measured 2 weeks before and 2 weeks after the intervention. Hypothesised factors underpinning homophobic language were also measured, including descriptive (other people use), prescriptive and proscriptive injunctive norms (approval/disapproval by others), and attitudes towards the acceptability of homophobic language.

RESULTS

At baseline, 49.1% of participants self-reported using homophobic language in the past 2 weeks and 72.7% reported teammates using homophobic language. Significant relationships were found between this behaviour and the hypothesised factors targeted by the intervention. However, generalised estimating equations found the intervention did not significantly reduce homophobic language, or alter the associated norms and attitudes, relative to controls.

CONCLUSION

Use of professional rugby athletes to deliver education on homophobic language was not effective. Other approaches to reduce homophobic language (and other forms of discrimination) such as peer-to-peer education, and enforcement of policies prohibiting specific language by coaches, should be explored.

Soccer clubs as avenues for gender transformative socialization of adolescent boys in Cape Town and Mthatha, South Africa: A qualitative study

In this paper, we explore the gender socialization of adolescent boys in soccer clubs, and ask whether there are opportunities for integrating gender transformative elements into that socialization. This qualitative study involved 11 in-depth interviews and informal conversations with male soccer coaches from Gugulethu township and Mthatha town in the Western Cape and Eastern Cape provinces of South Africa, respectively. Data were analyzed using a thematic analysis approach. We found that the coaches felt that the adolescent boys in their soccer clubs faced serious social and emotional challenges, with the boys' poor socio-economic backgrounds and fragmented family structures being major contributors to these challenges. Most coaches also gave themselves the responsibility to try to address some of the challenges faced by their club members. To do this, they employed specific strategies, including creating an alliance with parents and professionals. In the process, the coaches engaged the boys on topics around respect, sexual and reproductive health, and avoiding alcohol, drugs, and involvement in criminal gangs. Some coaches also played a social fathering role to club members as a way of helping them to think differently about their lives, redirect risky practices, and reduce the chance for poor health outcomes. These findings highlight the role of soccer clubs and coaches as potential avenues for health- and equity-promoting gender socialization of adolescent boys.