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Marching to a Different Drummer: A Cross-Cultural Comparison of Young Adolescents Who Challenge Gender Norms

      Abstract

      Purpose

      Little is known about how gender norms regulate adolescents' lives across different cultural settings. This study aims to illustrate what is considered as violating gender norms for boys and girls in four urban poor sites as well as the consequences that follow the challenging of gender norms.

      Methods

      Data were collected as part of the Global Early Adolescent Study, a 15-country collaboration to explore gender norms and health in early adolescence. The current study analyzed narrative and in-depth interviews conducted in urban poor sites in two middle-income (Shanghai, China; and New Delhi, India) and two high-income countries (Baltimore, U.S.; and Ghent, Belgium). A total of 238 participants, 59 boys and 70 girls aged 11–13 years old and 109 of their parents/guardians (28 male adults and 81 female adults), were interviewed. A thematic analysis was conducted across sites using Atlas.Ti 7.5 software.

      Results

      Findings revealed that although most perceptions and expressions about gender were regulated by stereotypical norms, there was a growing acceptability for girls to wear boyish clothes and engage in stereotypical masculine activities such as playing soccer/football. However, there was no comparable acceptance of boys engaging in traditional feminine behaviors. Across all sites, challenging gender norms was often found to lead to verbal, physical, and/or psychological retribution.

      Conclusions

      While it is sometimes acceptable for young adolescents to cross gender boundaries, once it becomes clear that a behavior is socially defined as typical for the other sex, and the adolescent will face more resistance. Researchers, programmers, and clinicians working in the field of adolescent health need not only attend to those who are facing the consequences of challenging prevailing gender norms, but also to address the environment that fosters exclusion and underscores differences.

      Keywords

      Implications and Contribution
      The current study uniquely illustrates how young adolescents across different cultural settings challenge stereotypical gender norms through various approaches. The adverse consequences of challenging gender norms call for researchers, program implementers, and clinicians working in the field of adolescent health to create more gender inclusive environments.
      Gender norms are often defined as culturally shared expectations about the characteristics that men and women should possess and how they ought to behave [
      • Eagly A.H.
      • Wood W.
      • Diekman A.B.
      Social role theory of sex differences and similarities: A current appraisal.
      ]. These norms are among the strongest social factors influencing an individual's gender-related attitudes, beliefs, and behaviors [
      • Bussey K.
      • Bandura A.
      Social cognitive theory of gender development and differentiation.
      ].
      Feminist scholars have critiqued the view of gender as a binary construct (e.g., man/woman, masculine/feminine), pointing to the multidimensional and complex nature of gender [
      • Tolman D.L.
      • Striepe M.I.
      • Harmon T.
      Gender matters: Constructing a model of adolescent sexual health.
      ,
      • Scott J.W.
      Gender: A useful category for historical analysis.
      ,
      • Budgeon S.
      The Dynamics of gender hegemony: Femininities, masculinities and social change.
      ,
      • Hawkesworth M.
      Confounding gender.
      ]. For example, Connell [
      • Connell R.W.
      Masculinities: Knowledge, power and social change.
      ,
      • Connell R.W.
      • Messerschmidt J.W.
      Hegemonic masculinity: Rethinking the concept.
      ] described how multiple masculinities and femininities exists within any given culture and identified one dominant hegemonic masculinity characterized by sterotypically masculine men's power over women as well as over other masculinities. Schippers [
      • Schippers M.
      Recovering the feminine other: Masculinity, femininity, and gender hegemony.
      ] later elaborated a similar concept of hegemonic femininity and other more marginalized femininities to highlight devalued and complementary relationship of femininity to the dominant masculinity. This hierarchal relationship between the varieties in femininities and masculinities describes an interlocking set of social and cultural practices and norms that work in tandem to organize and regulate gender-appropriate emotional expressions, behaviors, and sexualities [
      • Tolman D.L.
      • Davis B.R.
      • Bowman C.P.
      “That’s just how it is”: A gendered analysis of masculinity and femininity Ideologies in adolescent girls’ and boys’ Heterosexual relationships.
      ].
      While the formation of individual perceptions about gender norms begin in the first decade of life [
      • Herdt G.
      • McClintock M.
      The magical age of 10.
      ], early adolescence (ages 10–14 years) is a period when such attitudes, while still malleable, become more solidified—a construct Hill and Lynch refer to as the Gender Intensification Hypothesis [
      • Galambos N.L.
      • Almeida D.M.
      • Petersen A.C.
      Masculinity, femininity, and sex role attitudes in early Adolescence: Exploring gender intensification.
      ,
      • Priess H.A.
      • Lindberg S.M.
      • Hyde J.S.
      Adolescent gender-role identity and mental health: gender intensification revisited.
      ]. During this period of time, young adolescents become increasingly aware of what is expected of them as men and women and as they face increasing pressures to conform to what are viewed as “appropriate” gender norms [
      • Hill J.P.
      • Lynch M.E.
      The intensification of gender-related role expectations during early adolescence.
      ]. Such pressures may have negative implications for young adolescents' psychological adjustment [
      • Bussey K.
      • Bandura A.
      Social cognitive theory of gender development and differentiation.
      ,
      • Egan S.K.
      • Perry D.G.
      Gender identity: A multidimensional analysis with implications for psychosocial adjustment.
      ]. However, young adolescents are not just passive recipients of pressures to conform to gender norms; rather, they are actively engaged with shaping and changing gender norms as they endorse, resist, or alter them in a variety of contexts, from interpersonal to institutional [
      • West C.
      • Zimmerman D.H.
      Doing gender.
      ,
      • Courtenay W.H.
      Constructions of masculinity and their influence on men's well-being: A theory of gender and health.
      ,
      • Boudet A.M.M.
      • Petesch P.
      • Varolyn Turk
      • et al.
      On norms and agency: Conversations about gender equality with women and men in 20 countries.
      ].
      To date, most research on gender norms in adolescence has taken place in high-income countries [
      • Connell R.W.
      • Messerschmidt J.W.
      Hegemonic masculinity: Rethinking the concept.
      ,
      • Tolman D.L.
      • Davis B.R.
      • Bowman C.P.
      “That’s just how it is”: A gendered analysis of masculinity and femininity Ideologies in adolescent girls’ and boys’ Heterosexual relationships.
      ,
      • Hill J.P.
      • Lynch M.E.
      The intensification of gender-related role expectations during early adolescence.
      ]. For example, a recent systematic review of gender attitudes in early adolescence found that 90% of all published peer-reviewed studies were conducted in the U.S., Great Britain, or other Western countries [
      • Kågesten A.
      • Gibbs S.
      • Blum R.W.
      • et al.
      Understanding factors that shape gender attitudes in early adolescence globally: A mixed-methods systematic review.
      ]. Little is known about gender attitudes among young adolescents in low- and middle-income countries.
      The present study aims to: (1) explore how young adolescent boys and girls in four different cultural settings challenge gender norms and the possible consequences of such resistances; and (2) explore cross-cultural similarities and differences in gender norm challenging and the social consequences for young adolescents.

      Methods

      Participants

      Data were collected as part of the Global Early Adolescent Study in which narrative and in-depth interviews were conducted with approximately 30 dyads of young adolescents aged between 11 and 13 years and their parent or guardian in urban poor sites across 15 different countries (see the paper by Mmari et al. in this supplement). For the current study, we used data from four of the sites in two middle-income countries (Shanghai, China; and New Delhi, India) and two high-income countries (Baltimore, U.S.; and Ghent, Belgium). A total of 129 young adolescents (59 boys and 70 girls) and 109 of their parents/guardians (28 male adults and 81 female adults, of whom 3 were guardians) were interviewed. A detailed description of the respondents is shown in Table 1.
      Table 1Description of study participants
      CharacteristicsBaltimoreGhentNew DelhiShanghai
      Adolescent sample
       Sex
      Male14121617
      Female20181517
       Ages
      111791010
      1210111015
      13710119
       Family structure
      Two parent18173129
      Single parent141103
      Other or NA22
       Education level
      Elementary or equivalent10131211
      Primary or equivalent11171923
      NA13
      Parent/guardian sample
       Age group
      ≤34310222
      35–44715120
      ≥4543012
      NA91
       Relationship to adolescent
      Mother18271418
      Father411013
      Grandparent or others1003
       Education level
      <High School1915
      Of them, 10 received no formal education.
      12
      Completed high school49710
      Trade/vocational (incl.undergrad)1903
      Associate degree3
      College or university (incl.undergrad)7119
      NA81
       Marital status
      Married16172429
      Single (incl. divorced/widowed/separated)101105
      a Of them, 10 received no formal education.

      Procedure and protocol

      All four sites used a similar approach to recruit participants and conduct activities from June to May 2015. Participants were either recruited via community-based organizations, school-related programs, or key informants working with adolescents. In Baltimore, participants were recruited through after-school program providers and churches. In Ghent, respondents were recruited through (health) organizations working with adults and adolescents in low-income neighborhoods and a school. In New Delhi, a house-listing exercise was conducted to identify adolescents aged 11–13 years from the selected neighborhood. Subsequently, trained researchers invited the parent/guardian of eligible adolescents to participate in the study. In Shanghai, participants were recruited via community-based organizations, where parent/guardian-child pairs were screened first by community informants for their eligibility to participate in the study. On participants' arrival for the interview, the study procedures were explained to them again by local researchers.
      Consent procedures were standardized across sites by obtaining written parental/guardian consent and an adolescent assent. All research protocols were approved by the World Health Organization's Ethical Review Board, the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB), and institutional approval by each site's IRB committee.
      At each site, several forms of data collection occurred [
      • Mmari K.
      • Blum R.W.
      • Atnafou R.
      • et al.
      Exploration of gender norms and socialization among early adolescents: The use of qualitative methods for the Global Early Adolescent Study.
      ]. In the current study, we used data from individual narrative interviews [
      • Tolman D.L.
      • Brydon-Miller M.
      Transforming psychology: Interpretive and participatory research methods.
      ] with young adolescents and in-depth interviews with their parent/guardian (see Mmari et al. in this supplement for detailed description of the methodology). Each interview was audio recorded, transcribed, and where needed translated into English [
      • Mmari K.
      • Blum R.W.
      • Atnafou R.
      • et al.
      Exploration of gender norms and socialization among early adolescents: The use of qualitative methods for the Global Early Adolescent Study.
      ]. All translations were spot checked by research assistants or site coordinators.

      Analytical strategy

      A thematic analysis was conducted, focusing on young adolescents' narratives about the violation and challenging of gender norms as well as parent/guardians' perceptions about how boys and girls learn what is expected of young men/women in their respective societies. In the first step of the analysis, line-by-line open coding within each site [
      • Braun V.
      • Clarke V.
      Using thematic analysis in psychology.
      ] was completed, followed by cross-site analysis to identify core categories and subcategories as well as site-specific ones. Core categories related to “rejecting norms” by either adolescents or their parents/guardians were extracted. Next, these categories were compared and contrasted across sites to generate common themes related to the expression and consequences of challenging gender norms.

      Results

      Perceptions about what it means to challenge gender norms

      Across sites, young adolescents expressed similar perceptions about gender norms and what it means to challenge such norms (Table 2).
      Table 2Characters and behaviors of boys and girls who are considered as challenging norms across site (city name is ordered by alphabet)
      BaltimoreDelhiGhentShanghai
      Boys challenging normsThose who do not play sports, do house chores (cook and wash), have bigger butt (a female character physically), liking boys, dress like girls, wear girls' stuff, wear makeups, in girls' hair, etc.Those who are looking after parents, not arguing with parents, helping mother in household chores like cooking as well as being shy.Those who do not like football, who knit or jump ropes, love Barbie dolls and love pink, wear makeups and walk like faggots.Those who wear womanish clothes or accessories; being soft, shy, or indecisive; speak in a weak voice, talk and walk like a girl, employing female gestures like orchid fingers, crying a lot and could not fight.
      Girls challenging normsThose who work outside and earn more than men, fight, beat people, do not like heels, do not wear bra, do men's labor work (hammer the nails) and play boys' sports like football and baseball.Those who do not perform household chores, do not cook, roam outside in the neighborhood, and play with boys.Those who play football, sit with legs open, dress or do their hair like boys, act sporty or tough, say dirty words, go to bars and parties.Those who never wear skirts and those of dominant masculine characteristics like active, violent, brave, naughty, funny, sunny, careless as well as playing boys' games.
      In Baltimore, Ghent, and Shanghai, challenging gender norms for boys included not liking sports, wearing girl stuff, and nail polish, while doing household chores were described as not manly in Baltimore and Delhi. Girls who participated in certain sports (e.g., soccer) were considered by some respondents to be acting like a man (Shanghai) and to be not feminine (Ghent). For girls, challenging gender norms was also characterized by dressing in boyish clothes (e.g., pants), having short hair, engaging in violence or fighting, and playing American football (in U.S., when participants refer to football, they meant American football, while in other two sites (Ghent and Shanghai), they were referring to soccer) or soccer (Baltimore, Ghent and Shanghai), and the avoidance of house chores to play with boys (New Delhi). A girl from Delhi talked about how she was treated by her mom for not doing the house chores assigned to her:[Yesterday night] I was supposed to fill water but I get very tired by filling water, but my mother says that it’s your work you should finish it and not to do useless things. I went to circus and did not complete any of my work. When I came back I was beaten badly by my mother.
      Clothing was also singled out as a marker of gender-appropriate public presentation for both boys and girls. Specifically, across sites, there were clear reflections as to what gender-appropriate clothing is, for example, that boys are supposed to wear sport clothes, while girls should wear skirts, dresses, and so.

      Challenging gender norms

      Below, we elaborate on three commonly referenced themes of challenging gender norms across sites: boys wearing nail polish, girls playing football/soccer, and gender “inappropriate” clothing. These behaviors signify violation of, respectively, proper gender behavior and proper gender comportment or “performance” [
      • Schmalz D.L.
      • Kerstetter D.L.
      Girlie girls and manly men: Children's stigma consciousness of gender in sports and physical activities.
      ,
      • Butler J.
      Undoing gender.
      ].

      Boys wearing nail polish

      In Baltimore, Ghent, and Shanghai, boys who wore nail polish were considered to challenge gender norms since this was viewed as a girl's thing. For example, an 11-year-old girl from Baltimore reported that she would never “Get my nails done… And get our hair done” with her brothers because “they are boys.” She went on to indicate that when they were children, they used to do these activities together but now that they are adolescents it is inappropriate. She further elaborated that the only condition that boys would do this is if “they are gay, and my brother is not gay.” A similar conclusion echoed from a narrative of an 11-year-old Ghent boy, who also told a story about what it meant to be a “real man”:…uh, a man can also have something feminine, but if you want to be a real man…That you have to adapt with those things, with your clothing and stuff. And also play soccer and stuff, well yeah, or not like put on make-up and like mascara and paint your nails. Then you're not a boy.
      Nail polishing was such a clear marker of femininity that violation of this norm had consequences, as one college-educated mother in Shanghai described:I have a good friend. His son is five years old. …When he saw his mother lipsticks and nail polish, he would cry for them. [laughs] Then he put nail polish on his toenails, and he came to my home to play. There were a few older boys [10– to 13 years] …and when adults were out, they were playing at home. They took off shoes, jumped in my bed. Suddenly they saw his nail polish. Then they made fun of him. My son said, you are not a boy, because you have the nail polish. Then another said, if you agree that he is not a boy, raise your hand. Then all the children raised their hands. Then he said, “Take off pants to prove that you are not a girl.” … When he [the boy who polished his toe-nails] went home he asked mom to remove all the nail polish. Then he did not touch anything that belonged to his mother. He told his mom, I am a boy, a man, and cannot touch girl's things.
      Clearly, wearing nail polish was such a threat to masculinity norms that even at the age of 5 years, peer pressure was sufficiently strong for the child to hear that if he were to be considered a boy, he should never do it again. And while for the 5-year old, it was not seen as a big deal, it clearly was for his adolescent male neighbors.

      Girls playing football/soccer

      While wearing nail polish has traditionally been viewed as an expression of femininity, playing soccer (football) has traditionally been viewed as a “boy thing.” Interestingly, however, it appears that in some cultures, this is changing. For example, in Ghent, some male participants acknowledged that norms around soccer are changing:“Girls are hundred percent [as involved as] boys in football. [Today] there are more girls playing football than boys. (13 year old boy)”
      Elsewhere soccer was seen as predominantly a male activity and comments centered on the requirements of strength, fearlessness, and indifference to pain. As an 11-year-old Chinese boy made his point of a girl being very strong and not feeling hurt when he kicked the ball on her. While in Baltimore, where American football is popular among males, a boy aged 11 years old said:[I]f you [girls] play girl football like if you play boy football, they are going to tackle you anyway, they are just going to tackle you, at my school.
      Not surprisingly, there were girls recognized as expressing both masculine and feminine characteristics across sites. In Baltimore, a mom talked about her daughter as being a tom girl [boy] as she engaged in both stereotypically feminine expressions like wearing makeup, nail polish, and doing her hair but also rejecting the stereotype: “…she just don’t want to be girly, like she is a tom girl[boy].” In Belgium, some informants noted that the fact that a girl is good at soccer “doesn’t mean she is a boy.” A similar duality was seen in Shanghai where, for example, one girl talked about liking shiny accessories and pink tops but also used the phrase tomboy referring to her participating in more stereotypical masculine behaviors like running and jumping with boys.

      Clothing

      As was true for gender norms about sports, perceptions about norms related to clothing appeared to be changing in many places, but again, these changes were more apparent among girls than boys in this study. For example, in many of the sites, stereotypically masculine clothing like pants was considered as something that can be worn by both boys and girls. However, as an 11-year-old boy from Shanghai noted girls can wear both skirts and pants, but boys can only wear pants. The same notion was heard in Baltimore from a boy about the same age who said that it did not matter so much what boys did, but they need to dress right suggesting that boys could not dress in stereotypical feminine clothing such as skirts.
      Furthermore, clothing played a clear role in marking the transitions into adolescence. In Delhi, for example, a 12-year-old female participant talked about the expectation that as they become adolescents, tank tops, short skirts, and jeans are not supposed to be worn, but rather, they should wear the salwar (traditional Indian dress):… There was a girl in our class in Mithapur School [near the slum], who used to wear short skirts [knee length]. In name of going to toilet she went to the ground and started playing with boys. When ma'am (teacher) came to know about it she scolded her for wearing short skirt in school. After the school got over, she was sitting alone when a boy went inside the school and raped her as she was wearing short skirt.
      In Ghent, respondents mentioned how girls need to be careful in selecting their clothing; otherwise, they could be considered as “too easy” or “prostitutes” and become victims of violence. Conversely, not wearing skirts “like other girls” in other contexts was viewed as challenging gender norms. As one Shanghainese 13-year-old boy noted about a girl he knew: “she cut short hair and she never wears a skirt, just wears [pants] like the boy. Others regard her as a tomboy.”

      Consequences of challenging gender norms

      The consequences of challenging stereotypical gender norms varied across sites. In some settings, going against stereotypes was considered less of an issue. For example, in Belgium, knitting was generally not considered as a normative expression of masculinity, and yet, boys who did so were still considered among the most popular boys in the class. In Baltimore and Ghent, some young adolescents expressed high tolerance for nonstereotypical attire; I…don’t care, like, I mean, it is your life you can do whatever you want. Another said: That's his choice. I wouldn’t say a thing. In Shanghai, girls who challenge norms by wearing boys' clothes were seen by some as not strange but handsome.
      That said, tolerance for atypical or what was viewed as cross gender attire was not the rule. Rather, negative consequences were still common across all four sites, including being physically bullied, teased, or blamed of rejecting norms. Parents—at least in Shanghai—talked about the mental health consequences of those who face such rejections. Boys who challenge gender norms by their dress or behavior were by many respondents seen as socially inferior: Boys who are not like boys will be laughed at by other boys, be despised or talked about, or be called names like gay or faggot (Baltimore, Ghent), or sissy or weirdo (Shanghai).
      The same, however, was less true for girls whose appearance (e.g., wearing pants) or behavior (e.g., playing soccer/American football) was seen as masculine. They were more likely to be labeled “tomboy” than pejorative names. While it was less common that girls were called names, peers, and parents commonly admonished them and had their behavior and dress “corrected.” When girls were called names, it was usually because of their attire being viewed as sexual, using names such as slut. In Delhi and Belgium, the consequences for girls of being seen as wearing “provocative clothing” putting them at risk of sexual violence because—as is seen elsewhere in this volume—boys were viewed as not being in control of their sexual urges. Likewise, as young adolescent girls playing with boys was seen as provocative and inappropriate. As one girl from Delhi noted:I was forbidden [by my mom] from playing with boys, moreover people would accuse my family saying that your daughter is disobedient. If she was good, then she would have stayed in the house rather than going out and playing with boys.

      Discussion

      In this paper, we compared how boys and girls across four sites in Asia, Europe, and North America challenge gender norms and the associated consequences. We identified three behaviors reflecting gender comportment or performance, each traditionally associated with one or another sex, which were especially characteristic of challenging norms: boys wearing nail polish, girls playing soccer/football, and violations of gender-appropriate clothing. We saw some striking similarities and some important differences across sites in terms of how young adolescents challenged these norms, and the consequences that they faced when doing so. For example, we saw a growing acceptability in a number of settings for girls to wear boyish clothes and engage in masculine activities. However, there was no comparable acceptance of boys engaging in stereotypical feminine behaviors such as wearing nail polish or dresses.
      Clothing was a clear public statement of gender, and in different settings, the same clothing carried with it different connotations. Wearing skirts was considered as a female gender expression and not wearing it was a way of challenging gender norms in Shanghai, while similar dressing in New Delhi was seen as inappropriate for adolescent girls and even sexually provocative. In Ghent, respondents also talked about how girls should dress in a feminine way, yet not too feminine or they could risk being considered as “easy” or “prostitutes.” Thus, similar dress and behaviors in different cultural contexts connote different meanings [
      • Boudet A.M.M.
      • Petesch P.
      • Varolyn Turk
      • et al.
      On norms and agency: Conversations about gender equality with women and men in 20 countries.
      ].
      Perceptions of gender norms and consequences of challenging such norms also revealed that while it is sometimes acceptable for young children to cross gender boundaries, once it becomes clear that a behavior is socially defined as typical for the other sex (which usually happens in adolescence), it is shunned out of fear of being ostracized. In the current study, we saw this in the examples of boys wearing nail polishing and girls wearing short skirts. The social sanctions for certain gender norms were strong and appeared to be consistent among young adolescents across the different study sites. That certain gender norms (e.g., boys should not be feminine and girls should not be “provocative”) were more resistant to change than others (e.g., playing certain sports) echoes findings from a World Bank review by Boudett et al. on norms changing in 20 countries [
      • Boudet A.M.M.
      • Petesch P.
      • Varolyn Turk
      • et al.
      On norms and agency: Conversations about gender equality with women and men in 20 countries.
      ], as well as findings from the Young Lives Study in Peru, India, Vietnam, and Ethiopia [
      • Marcus R.
      • Harper C.
      Gender justice and social norms-processes of change for adolescent girls.
      ].
      What makes soccer/football interesting from a gender norms perspective is that it appeared to be a behavior in transition from one that once had negative sanctions for girls (like wearing nail polish is for boys) to one for which acceptability is increasing. In fact, it appears that tomboys (girls) are granted more peer and parental acceptance than their male sissy counterparts, who appear to face significantly more stigma and rejection. This is in line with findings from the 2016 systematic review cited earlier, which showed that while many young adolescents in different cultural settings commonly challenge gender norms, it was more common among girls, as boys appeared to face more cultural stigma when doing so [
      • Kågesten A.
      • Gibbs S.
      • Blum R.W.
      • et al.
      Understanding factors that shape gender attitudes in early adolescence globally: A mixed-methods systematic review.
      ]. A potential explanation for this may be that girls who “act like boys” display masculine characteristics associated with power and dominance, while conversely boys who “act like girls” are generally not granted the same social acceptance because of the lower power or prestige associated with femininity traits and behaviors (e.g., gentleness, softness) [
      • Grant J.A.
      “Real boy” and not a sissy: Gender, childhood and masculinity, 1890–1940.
      ]. Interestingly, conversations and efforts to increase gender equity or gender equality often refer to the need for girls and women to become more like boys and men than the other way around (see, e.g., Sheryl Sandberg's Lean In) [
      • Sandberg S.
      Lean in: Women, work, and the will to lead..
      ]. It has been acknowledged by literature that promoting and privileging masculine traits (e.g., violence, risk-taking, substance use) may bring negative health and social consequences to both boys and girls [
      • Berenbaum S.A.
      • Blakemore J.E.O.
      • Beltz A.M.
      A role for biology in genderrelated behavior.
      ,
      • Blakemore J.E.O.
      Children’s beliefs about violating gender norms: Boys shouldn’t look like girls, and girls shouldn’t act like boys.
      ]. Previous studies have shown how young men may face peer pressure to engage in unprotected sexual relationship in order to prove their manliness and sexual prowess [
      • Pulerwitz J.
      • Michaelis A.
      • Verma R.
      • et al.
      Addressing gender dynamics and engaging men in HIV programs: Lessons learned from Horizons research.
      ,
      • Sommer M.
      • Likindikoki S.
      • Kaaya S.
      “Bend a fish when the fish is not yet dry”: Adolescent boys' perceptions of sexual risk in Tanzania.
      ,
      • Kisler K.A.
      • Williams J.K.
      Image versus health: The role of perceptions of masculinity on sexual risk behaviors among HIV-positive African American men who have sex with men and women.
      ]. Additionally, the emphasis of masculine traits may bring negative consequences for women and girls as well by imposing a double burden that expects them to be competitive and successful in terms of education and labor while still carrying the main responsibility for domestic duties and care taking [
      • Marcus R.
      • Harper C.
      Gender justice and social norms-processes of change for adolescent girls.
      ].

      Limitations

      Several limitations of the current study need to be noted. First, given the purposive sample and qualitative nature of the study, adolescent participants are not representative of all young people from the study sites or countries. Moreover, few participants noted that they themselves or their children have experiences of challenging of gender norms; they merely refereed to what happens when other people do so. Deeper investigations of individual experiences of challenging norms are therefore needed. Additionally, as is always the case in qualitative analyses, the coding of what was considered as challenging gender norms was from the perspectives of the data analysts. That said, the data analysts represented a range of disciplines and cultural/linguistic perspectives. Finally, all data were cross-sectional so conclusions of causality or social trends cannot be deduced. Longitudinal studies are needed to assess to what direction and to what extent femininity and masculinity norms, in different cultural settings and through other agents such as parents, peers, or media, influence adolescent health.
      The current study showed that while stereotypical gender norms prevail, such norms are challenged by young adolescents in different cultural settings in various ways. These findings reflect that gender is constructed through socialization and that gender attitudes and norms during the early adolescent period are amenable to change. Findings further highlight the complexity of gender norms across different cultural settings; violations of similar gender norms bring different consequences in different sites.
      Our findings suggest that researchers working in the field of adolescent health should not only pay attention to those who are bullied or teased because of their violation of stereotypical gender norms, but also work to help young people recognize and transform harmful stereotypical gender norms so as to create a more gender equal society. A study found that sexuality and HIV education programs that address gender and power in intimate relationships are five times more likely to be effective than programs that do not [
      • Haberland N.A.
      The case for addressing gender and power in sexuality and HIV education: A comprehensive review of evaluation studies.
      ]. Since early adolescence is a period where perceptions of gender norms may be more amenable to change compared to later adolescence, interventions, such as It’s All One Program created by Population Council [

      Haberland NA, Rogow D, Aguilar O, et al. It's all one curriculum: Guidelines and activities for a unified approach to sexuality, gender, HIV, and human rights education. New York: Populatiion Council.

      ] and the Save the Children's CHOICES curriculum [
      Institute for Reproductive Health
      Transforming gender norms among very young adolescents: An innovative intervention and evaluation in Nepal.
      ] which have proven successful for transforming gender attitudes, are needed to create equal gender norms and challenge harmful masculinity and femininity stereotypes.

      Acknowledgments

      This work was undertaken as part of the Global Early Adolescent Study; a study led by Johns Hopkins Bloomberg School of Public Health, the World Health Organization, and United Nations Population Fund in collaboration with 15 global institutions. The authors would also like to thank the Ford Foundation's China office, Shanghai Municipal Health and Family Planning Commission (by grant no.20144Y0068) provided funds for Shanghai site to make this collaborative study possible.
      Authors' contributions: Every coauthors in the list contributed to the paper. C.Y., Q.L. S.D.M., and S.B. did the site-specific analysis. C.Y. synthesized them and did the comparison across sites. C.Y. and X.Z. wrote the draft, and R.W.B. and A.K. provided extensive edits to the paper. Experts specialized in gender (D.L.T.) and global/regional adolescent health (R.W.B., K Mmari, A.K., K Michielsen, R.A., C.L.) as well as other authors contributed to the analyses and writing as these progressed.

      Funding Sources

      This work was funded in part by the World Health Organization, David and Lucile Packard Foundation, United States Agency for International Development, the Ford Foundation's China office, the fund for scientific research program of Shanghai Municipal Health and Family Planning Commission, and the Fund for Scientific Research-Flanders, Flemish Ministry of Innovation, Public Investment, Media and Poverty Reduction.

      References

        • Eagly A.H.
        • Wood W.
        • Diekman A.B.
        Social role theory of sex differences and similarities: A current appraisal.
        in: Eckes T. Trautner H.M. The Developmental Social Psychology of Gender. Lawrence Erlbaum Associates, Mahwah, NJ2000: 123-174
        • Bussey K.
        • Bandura A.
        Social cognitive theory of gender development and differentiation.
        Psychol Rev. 1999; 106: 676-713
        • Tolman D.L.
        • Striepe M.I.
        • Harmon T.
        Gender matters: Constructing a model of adolescent sexual health.
        J Sex Res. 2003; 40: 4-12
        • Scott J.W.
        Gender: A useful category for historical analysis.
        Am Hist Rev. 1986; 91: 1053-1075
        • Budgeon S.
        The Dynamics of gender hegemony: Femininities, masculinities and social change.
        Sociology. 2014; 48: 317-334
        • Hawkesworth M.
        Confounding gender.
        Signs. 1997; 22: 649-685
        • Connell R.W.
        Masculinities: Knowledge, power and social change.
        University of California Press, Berkeley and Los Angeles1995
        • Connell R.W.
        • Messerschmidt J.W.
        Hegemonic masculinity: Rethinking the concept.
        Gend Soc. 2005; 19: 829-859
        • Schippers M.
        Recovering the feminine other: Masculinity, femininity, and gender hegemony.
        Theor Soc. 2007; 36: 85-102
        • Tolman D.L.
        • Davis B.R.
        • Bowman C.P.
        “That’s just how it is”: A gendered analysis of masculinity and femininity Ideologies in adolescent girls’ and boys’ Heterosexual relationships.
        J Adolesc Res. 2016; 31: 3-31
        • Herdt G.
        • McClintock M.
        The magical age of 10.
        Arch Sex Behav. 2000; 29: 587-606
        • Galambos N.L.
        • Almeida D.M.
        • Petersen A.C.
        Masculinity, femininity, and sex role attitudes in early Adolescence: Exploring gender intensification.
        Child Dev. 1990; 61: 1905-1914
        • Priess H.A.
        • Lindberg S.M.
        • Hyde J.S.
        Adolescent gender-role identity and mental health: gender intensification revisited.
        Child Dev. 2009; 80: 1531-1544
        • Hill J.P.
        • Lynch M.E.
        The intensification of gender-related role expectations during early adolescence.
        in: Brooks-Gunn J. Peterson A.C. Girls at Puberty. Springer US, NY1983: 201-228
        • Egan S.K.
        • Perry D.G.
        Gender identity: A multidimensional analysis with implications for psychosocial adjustment.
        Dev Psychol. 2001; 37: 451-463
        • West C.
        • Zimmerman D.H.
        Doing gender.
        Gend Soc. 1987; 1: 125-151
        • Courtenay W.H.
        Constructions of masculinity and their influence on men's well-being: A theory of gender and health.
        Social Sci Med. 2000; 50: 1385-1401
        • Boudet A.M.M.
        • Petesch P.
        • Varolyn Turk
        • et al.
        On norms and agency: Conversations about gender equality with women and men in 20 countries.
        The World Bank, Washington DC2012
        • Kågesten A.
        • Gibbs S.
        • Blum R.W.
        • et al.
        Understanding factors that shape gender attitudes in early adolescence globally: A mixed-methods systematic review.
        PLoS ONE. 2016; 11: e0157805
        • Mmari K.
        • Blum R.W.
        • Atnafou R.
        • et al.
        Exploration of gender norms and socialization among early adolescents: The use of qualitative methods for the Global Early Adolescent Study.
        J Adolesc Health. 2017; 61: S12-S18
        • Tolman D.L.
        • Brydon-Miller M.
        Transforming psychology: Interpretive and participatory research methods.
        J Social Issues. 1997; 53: 597-603
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Schmalz D.L.
        • Kerstetter D.L.
        Girlie girls and manly men: Children's stigma consciousness of gender in sports and physical activities.
        J Leis Res. 2006; 38: 536-557
        • Butler J.
        Undoing gender.
        Routledge, New York2004
        • Marcus R.
        • Harper C.
        Gender justice and social norms-processes of change for adolescent girls.
        Overseas Development Institute, London2014
        • Grant J.A.
        “Real boy” and not a sissy: Gender, childhood and masculinity, 1890–1940.
        J Social Hist. 2004; 37: 829e51
        • Sandberg S.
        Lean in: Women, work, and the will to lead..
        Knopf, New York2013
        • Berenbaum S.A.
        • Blakemore J.E.O.
        • Beltz A.M.
        A role for biology in genderrelated behavior.
        Sex Roles. 2011; 64: 804-825
        • Blakemore J.E.O.
        Children’s beliefs about violating gender norms: Boys shouldn’t look like girls, and girls shouldn’t act like boys.
        Sex Roles. 2003; 48: 411-419
        • Pulerwitz J.
        • Michaelis A.
        • Verma R.
        • et al.
        Addressing gender dynamics and engaging men in HIV programs: Lessons learned from Horizons research.
        Public Health Rep. 2010; 125: 282-292
        • Sommer M.
        • Likindikoki S.
        • Kaaya S.
        “Bend a fish when the fish is not yet dry”: Adolescent boys' perceptions of sexual risk in Tanzania.
        Arch Sex Behav. 2015; 44: 583-595
        • Kisler K.A.
        • Williams J.K.
        Image versus health: The role of perceptions of masculinity on sexual risk behaviors among HIV-positive African American men who have sex with men and women.
        J AIDS Clin Res. 2012; Suppl. 1: S1-008
        • Haberland N.A.
        The case for addressing gender and power in sexuality and HIV education: A comprehensive review of evaluation studies.
        Int Perspect Sex Reprod Health. 2015; 41: 31-42
      1. Haberland NA, Rogow D, Aguilar O, et al. It's all one curriculum: Guidelines and activities for a unified approach to sexuality, gender, HIV, and human rights education. New York: Populatiion Council.

        • Institute for Reproductive Health
        Transforming gender norms among very young adolescents: An innovative intervention and evaluation in Nepal.
        Institute for Reproductive Health, US2013 ([EB/OL]. Available at:) (Accessed June 22, 2016)