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Centering Gender in Our Clinical, Public Health, and Research Programs

      In the supplement to this month's issue of the Journal of Adolescent Health, “Gender Norms and Adolescent Health,” a series of seven articles from three regions of the world (Africa and North and South America) focus on the health, policy, and sociodemographic issues that are most profoundly interrelated with (binary) gender during adolescence and young adulthood [
      • Abdalla S.
      • Buffarini R.
      • Weber A.M.
      • et al.
      Parent-related normative perceptions of adolescents and later weight control behavior: Longitudinal analysis of cohort data from Brazil.
      ,
      • Buffarini R.
      • Abdalla S.
      • Weber A.M.
      • et al.
      The intersectionality of gender and wealth in adolescent health and behavioral outcomes in Brazil: The 1993 Pelotas Birth Cohort.
      ,
      • Cohen E.
      • Richter L.M.
      • Chidumwa G.
      • et al.
      Relationships between maternal factors and weight loss attempts among urban male and female adolescents living in Soweto-Johannesburg, South Africa.
      ,
      • Chae S.
      • Haberland N.
      • McCarthy K.J.
      • et al.
      The influence of schooling on the stability and mutability of gender attitudes: Findings from a longitudinal study of adolescent girls in Zambia.
      ,
      • Nagata J.M.
      • Domingue B.W.
      • Darmstadt G.L.
      • et al.
      Gender norms and weight control behaviors in U.S. Adolescents: A prospective cohort study (1994–2002).
      ,
      • Falconi A.M.
      • Weber A.M.
      • Cullen M.R.
      • et al.
      Shifts in women's paid employment participation during the World War II era and later life health.
      ,
      • Meinhart M.
      • Seff I.
      • Darmstadt G.L.
      • et al.
      Attitudinal acceptance of intimate partner violence among adolescents and young adults in Nigeria and Tanzania: An exploration into target reference groups.
      ]. The findings build on the existing body of research on gender and health and provide new evidence on the importance of gender norms for adolescent and young adult health [
      • Heise L.
      • Greene M.E.
      • Opper N.
      • et al.
      Gender inequality and restrictive gender norms: Framing the challenges to health.
      ]. Another recent supplement to the Journal focused its attention on Adolescent Sexual and Reproductive Health and Rights [
      • Irwin Jr., C.E.
      Improving adolescent sexual and reproductive health and Rights: Reflections on the past 25 years.
      ]. The current supplement expands that discussion to include the role that gender plays beyond reproductive health and, as Greene and Patton point out in their editorial, the importance of considering different health outcomes for boys and girls [
      • Greene M.
      • Patton G.C.
      Adolescence and gender equality in health.
      ].
      Six of the seven articles tackle unique issues in different countries—Brazil [
      • Abdalla S.
      • Buffarini R.
      • Weber A.M.
      • et al.
      Parent-related normative perceptions of adolescents and later weight control behavior: Longitudinal analysis of cohort data from Brazil.
      ,
      • Buffarini R.
      • Abdalla S.
      • Weber A.M.
      • et al.
      The intersectionality of gender and wealth in adolescent health and behavioral outcomes in Brazil: The 1993 Pelotas Birth Cohort.
      ], South Africa [
      • Cohen E.
      • Richter L.M.
      • Chidumwa G.
      • et al.
      Relationships between maternal factors and weight loss attempts among urban male and female adolescents living in Soweto-Johannesburg, South Africa.
      ], Zambia [
      • Chae S.
      • Haberland N.
      • McCarthy K.J.
      • et al.
      The influence of schooling on the stability and mutability of gender attitudes: Findings from a longitudinal study of adolescent girls in Zambia.
      ], and the U.S. [
      • Nagata J.M.
      • Domingue B.W.
      • Darmstadt G.L.
      • et al.
      Gender norms and weight control behaviors in U.S. Adolescents: A prospective cohort study (1994–2002).
      ,
      • Falconi A.M.
      • Weber A.M.
      • Cullen M.R.
      • et al.
      Shifts in women's paid employment participation during the World War II era and later life health.
      ]—using longitudinal data sets. The seventh paper, from Nigeria and Tanzania, uses cross-sectional data and describes associations [
      • Meinhart M.
      • Seff I.
      • Darmstadt G.L.
      • et al.
      Attitudinal acceptance of intimate partner violence among adolescents and young adults in Nigeria and Tanzania: An exploration into target reference groups.
      ]. With this approach, we can observe not only the nuances of gender in regional cultures but also the similarities across regions, particularly in four distinct areas: (1) weight control and body image, (2) the role of SES on health outcomes, (3) violence, and (4) schooling.

      Weight control and body image

      Three of the manuscripts—from Brazil, South Africa, and the U.S. [
      • Abdalla S.
      • Buffarini R.
      • Weber A.M.
      • et al.
      Parent-related normative perceptions of adolescents and later weight control behavior: Longitudinal analysis of cohort data from Brazil.
      ,
      • Cohen E.
      • Richter L.M.
      • Chidumwa G.
      • et al.
      Relationships between maternal factors and weight loss attempts among urban male and female adolescents living in Soweto-Johannesburg, South Africa.
      ,
      • Nagata J.M.
      • Domingue B.W.
      • Darmstadt G.L.
      • et al.
      Gender norms and weight control behaviors in U.S. Adolescents: A prospective cohort study (1994–2002).
      ]—examine weight control and body image. Studies in these markedly different areas of the world show similar findings: parental perceptions and messages about weight have an impact on weight management and body image. With data from the Pelotas, Brazil Longitudinal Growth, we learn that mother-related perceptions early in adolescence had a profound impact on the trajectory of body dissatisfaction for girls, but not for boys [
      • Abdalla S.
      • Buffarini R.
      • Weber A.M.
      • et al.
      Parent-related normative perceptions of adolescents and later weight control behavior: Longitudinal analysis of cohort data from Brazil.
      ].
      From Cohen et al.'s [
      • Cohen E.
      • Richter L.M.
      • Chidumwa G.
      • et al.
      Relationships between maternal factors and weight loss attempts among urban male and female adolescents living in Soweto-Johannesburg, South Africa.
      ] analysis of data from the Birth to Twenty Plus cohort study in South Africa, we also observe differing patterns of weight loss attempts by gender and their association with maternal factors. Boys' behavior is highly correlated with their mothers' attempts, but there is no association between girls' and mothers' behaviors. The lack of a relationship between maternal norms and daughters' behavior may be related to shifting cultural norms. That is, daughters' behavior could be influenced by the shift away from traditional norms in Africa to ideals of thinness that are more consistent with Western culture.
      And from the U.S., Nagata et al.'s [
      • Nagata J.M.
      • Domingue B.W.
      • Darmstadt G.L.
      • et al.
      Gender norms and weight control behaviors in U.S. Adolescents: A prospective cohort study (1994–2002).
      ] analysis of data from the National Longitudinal Study of Adolescent and Young Adult Health again highlights the role that gender norms play in weight control. Higher individual gender normativity scores were protective of weight loss behaviors and attempts in males but not in females. Gender norms appear to reinforce a thinner body ideal for girls and a larger ideal for boys.

      Role of socioeconomic status on health outcomes

      Buffarini et al. [
      • Buffarini R.
      • Abdalla S.
      • Weber A.M.
      • et al.
      The intersectionality of gender and wealth in adolescent health and behavioral outcomes in Brazil: The 1993 Pelotas Birth Cohort.
      ] use the same data as Abdalla et al.— the 1993 Pelotas Longitudinal Growth Study—to explore the role of gender and wealth on adolescent health and behavioral outcomes. Here again, where income plays a distinct role in most areas measured, we see unique outcomes for boys and girls. Girls from poor families have worse outcomes than boys in smoking, weight, and mental health. Reported violence was twice as common among boys than among girls, with lower income being a stronger predictor for boys than for girls. Beyond the role of gender, these data also shed further light on the role of low income in adverse outcomes.

      Violence

      Violence against women remains a critical issue for girls and women of all ages, especially in the context of intimate partner violence. Using data from the Violence Against Children Survey in Nigeria and Tanzania, Meinhart et al. [
      • Meinhart M.
      • Seff I.
      • Darmstadt G.L.
      • et al.
      Attitudinal acceptance of intimate partner violence among adolescents and young adults in Nigeria and Tanzania: An exploration into target reference groups.
      ] examine the impact of age, peers, marriage, and educational status on attitudes toward violence. Marriage and age appear to be associated with an increased tolerance for violence, but the data set did not allow the authors to determine the direction of the causality.

      Schooling

      Chae et al. [
      • Chae S.
      • Haberland N.
      • McCarthy K.J.
      • et al.
      The influence of schooling on the stability and mutability of gender attitudes: Findings from a longitudinal study of adolescent girls in Zambia.
      ] report from the Adolescent Girl Empowerment Program in Zambia, where they evaluated the role of age, schooling, and region (urban vs. rural) on changing gender norms over time. Attending school in an urban area reinforces equitable gender norms, whereas girls going to school in rural areas did not even experience stable gender norms. The importance of schooling cannot be overlooked here even when the findings are mitigated by geographical location, but there is still some fluidity in gender norms among rural adolescent girls.
      Readers familiar with the Journal's focus on recent, cutting-edge science might be surprised to see Falconi et al. [
      • Falconi A.M.
      • Weber A.M.
      • Cullen M.R.
      • et al.
      Shifts in women's paid employment participation during the World War II era and later life health.
      ] in this supplement. The article explores health outcomes for young women who entered the labor force during World War II (WWII) when women's opportunity for employment was rapidly changing. The reason behind our decision to include this article was straightforward: these analyses may help us understand the impact of a rapidly changing social environment on young women's health and well-being. The results are mixed, with two different outcomes.
      The older cohort of women, who entered the workforce before the onset of WWII, showed mixed to no differences in health relative to homemakers. The younger cohort of women, who entered the workforce during WWII, tended to show negative relationships between work during their late/post-childbearing years and health, experiencing higher risks for mortality. These findings reinforce the importance of evaluating the gender-based differential impact of policies, social forces, and environmental context.
      The editors hope that the content of this supplement will stimulate more investigative work done through the lens of gender. As Greene and Patton state in their editorial, “This supplement takes a welcome step forward in understanding the emergence and consequences of gender norms among adolescents. Yet the papers also illustrate our limited investment in norms research. A common feature of the papers is the use of measures defined and data collected for other purposes” [
      • Greene M.
      • Patton G.C.
      Adolescence and gender equality in health.
      ].
      One missing piece in this supplement, alluded to in my parenthetical caveat at the outset of this editorial, is the lack of attention to gender minorities. The analyses presented in this supplement used data that did not query participants about gender minority status. As we move forward with research, it is critical that future data collection includes all adolescents and young adults.
      Collectively, these articles call for a re-examination of our clinical, public health, and research programs. We must incorporate what we already know about the differential impacts and outcomes based on gender, and we cannot hesitate to develop programs that embrace the full range of gender.

      References

        • Abdalla S.
        • Buffarini R.
        • Weber A.M.
        • et al.
        Parent-related normative perceptions of adolescents and later weight control behavior: Longitudinal analysis of cohort data from Brazil.
        J Adolesc Health. 2020; 66: S9-S16
        • Buffarini R.
        • Abdalla S.
        • Weber A.M.
        • et al.
        The intersectionality of gender and wealth in adolescent health and behavioral outcomes in Brazil: The 1993 Pelotas Birth Cohort.
        J Adolesc Health. 2020; 66: S51-S57
        • Cohen E.
        • Richter L.M.
        • Chidumwa G.
        • et al.
        Relationships between maternal factors and weight loss attempts among urban male and female adolescents living in Soweto-Johannesburg, South Africa.
        J Adolesc Health. 2020; 66: S17-S24
        • Chae S.
        • Haberland N.
        • McCarthy K.J.
        • et al.
        The influence of schooling on the stability and mutability of gender attitudes: Findings from a longitudinal study of adolescent girls in Zambia.
        J Adolesc Health. 2020; 66: S25-S33
        • Nagata J.M.
        • Domingue B.W.
        • Darmstadt G.L.
        • et al.
        Gender norms and weight control behaviors in U.S. Adolescents: A prospective cohort study (1994–2002).
        J Adolesc Health. 2020; 66: S34-S41
        • Falconi A.M.
        • Weber A.M.
        • Cullen M.R.
        • et al.
        Shifts in women's paid employment participation during the World War II era and later life health.
        J Adolesc Health. 2020; 66: S42-S50
        • Meinhart M.
        • Seff I.
        • Darmstadt G.L.
        • et al.
        Attitudinal acceptance of intimate partner violence among adolescents and young adults in Nigeria and Tanzania: An exploration into target reference groups.
        J Adolesc Health. 2020; 66: S3-S8
        • Heise L.
        • Greene M.E.
        • Opper N.
        • et al.
        Gender inequality and restrictive gender norms: Framing the challenges to health.
        The Lancet. 2019; 393: 2440-2454
        • Irwin Jr., C.E.
        Improving adolescent sexual and reproductive health and Rights: Reflections on the past 25 years.
        J Adolesc Health. 2019; 65: 713-714
        • Greene M.
        • Patton G.C.
        Adolescence and gender equality in health.
        J Adolesc Health. 2020; 66: S1-S2

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