Adolescence and Gender Equality in Health
2019; Elsevier BV; Volume: 66; Issue: 1 Linguagem: Inglês
10.1016/j.jadohealth.2019.10.012
ISSN1879-1972
AutoresMargaret E. Greene, George Patton,
Tópico(s)Optimism, Hope, and Well-being
ResumoPuberty brings profound shifts in identity and sense of self. The external manifestations of sexual maturity propel a young adolescent into a different set of roles and expectations. Puberty also triggers a different engagement with peers and the external world [[1]Blakemore S.-J. Mills K.L. Is adolescence a sensitive period for sociocultural processing?.Annu Rev Psychol. 2014; 65: 187-207Crossref PubMed Scopus (851) Google Scholar,[2]Goddings A.-L. Mills K. Clasen L. et al.Longitudinal MRI to assess effect of puberty on subcortical brain development: An observational study.The Lancet. 2014; 383: S52Abstract Full Text Full Text PDF Google Scholar], leading to the adoption of values and aspirations a young person takes forward into adult life. Central to those values are gender norms and the sense of what it is to be a woman or man in a given culture. Gender norms are the often unspoken rules that determine attributes and behaviors that are valued and accepted for men, women, and gender minorities [[3]Heise L. Greene M.E. Opper N. et al.Gender inequality and restrictive gender norms: Framing the challenges to health.The Lancet. 2019; 393: 2440-2454Abstract Full Text Full Text PDF PubMed Scopus (310) Google Scholar]. They guide many life changing choices in adolescence and beyond. For girls, norms around leaving school, early marriage, and parenthood have profound effects on health and development that continue into adulthood and the next generation. In too many places, inequitable gender norms mean that a girl may not have a choice in these life altering decisions. For boys, norms likewise determine school and work decisions and how they transition into their adult sexual roles, with lasting effects on their health and well-being. The implications of gender norms adopted in adolescence extend well beyond reproductive health and are reflected in the different health trajectories of boys and girls. For boys, injuries and injury deaths from homicide and accidents rise sharply across adolescence [[3]Heise L. Greene M.E. Opper N. et al.Gender inequality and restrictive gender norms: Framing the challenges to health.The Lancet. 2019; 393: 2440-2454Abstract Full Text Full Text PDF PubMed Scopus (310) Google Scholar]. Although rates of adolescent self-harm and suicide attempts tend to be higher in girls, deaths from suicide are, in most places, higher among young men [[4]Mokdad A.H. Forouzanfar M.H. Daoud F. et al.Global burden of diseases, injuries, and risk factors for young people's health during 1990–2013: A systematic analysis for the global burden of disease study 2013.The Lancet. 2016; 387: 2383-2401Abstract Full Text Full Text PDF PubMed Scopus (573) Google Scholar]. Substance use disorders and risks linked to alcohol, tobacco, and illicit drug use are also almost everywhere higher in young men. One consequence is that from mid-adolescence onward, boys die at higher rates than girls; in contrast, girls and women generally have higher levels of health-related disability and lower subjective well-being [[5]Lindahl-Jacobsen R. Hanson H.A. Oksuzyan A. et al.The male–female health-survival paradox and sex differences in cohort life expectancy in Utah, Denmark, and Sweden 1850–1910.Ann Epidemiol. 2013; 23: 161-166Crossref PubMed Scopus (44) Google Scholar]. These sex differences in premature death, disease burden, and health risk vary across time and by place and to a large extent reflect the prevalent gender norms [[3]Heise L. Greene M.E. Opper N. et al.Gender inequality and restrictive gender norms: Framing the challenges to health.The Lancet. 2019; 393: 2440-2454Abstract Full Text Full Text PDF PubMed Scopus (310) Google Scholar]. For girls, gender norms that emphasize girls' sexual and reproductive capacity at the expense of education, agency, and capabilities should be one target for prevention. Adolescence is a time of particular vulnerability for many mental disorders that occur much more in girls, including eating disorders, depression, and anxiety [[6]Kessler R.C. Amminger G.P. Aguilar-Gaxiola S. et al.Age of onset of mental disorders: A review of recent literature.Curr Opin Psychiatry. 2007; 20: 359-364Crossref PubMed Scopus (1765) Google Scholar]. Male gender norms characterized by a need to prove themselves and dominate women and minority groups of men (e.g., those with different sexual orientations or masculine identities) similarly predict a range of health hazards related to injury, violence, and substance use in addition to violence against others including women and girls [[7]Connell R. Gender and power: Society, the person, and sexual politics. Polity Press in association with B. Blackwell, Cambridge, UK1987Google Scholar]. Gender norms adopted in adolescence reflect and reinforce inequitable hierarchies, whose consequences ripple forward across the life course, with health effects later in life for those young people as well as for the children of the next generation. For these reasons, adolescents should be at the forefront of research and policy action for more equitable gender norms. In girls, research on the effects of gender norms on adolescent health has often focused on reproductive health and, in sub-Saharan Africa, vulnerability to HIV. In boys, the work has focused more on alcohol consumption and demonstrations of physical prowess through fighting and dangerous driving [[8]Patton G.C. Darmstadt G.L. Petroni S. Sawyer S.M. A gender lens on the health and well-being of young males.J Adolesc Health. 2018; 62: S6-S8Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar,[9]Ragonese C. Shand T. Barker G. Masculine norms and men's health: Making the connections. Promundo-US, Washington, DC2019: 121https://promundoglobal.org/wp-content/uploads/2019/02/Masculine-Norms-Mens-Health-Report_007_Web.pdfGoogle Scholar]. In that context, the series of papers presented in this supplement sheds new light on the determinants of gender norms in the adolescent years, their consequences for different aspects of health, and the potential for taking action to shift norms. Meinhart et al. [[10]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 and affiliation of authorship.J Adolesc Health. 2020; 66: S3-S8Abstract Full Text Full Text PDF Scopus (6) Google Scholar] examine the effects of peers, marital status, and educational attainment on attitudes toward tolerance of intimate partner violence in Tanzania and Nigeria. Marriage among adolescent girls and young women is associated with a greater tolerance of intimate partner violence, although they were not able to determine the direction of causality. Parents play a central role in shaping gender-related attitudes among children, illustrated in Brazil by Abdalla et al. [[11]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-S16Abstract Full Text Full Text PDF Scopus (12) Google Scholar], where adolescent girls were particularly susceptible to parental views: children's perception of their parents' opinion of their weight at age 11 years predicted weight control attempts at age 18 years for girls but not boys. Urbanization and Western acculturation around thinner ideal bodies have contributed to girls' greater inclination to try to lose weight. Cohen et al. [[12]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-S24Abstract Full Text Full Text PDF Scopus (7) Google Scholar] found that although the sons of heavier mothers in South Africa were less likely to try to lose weight, there was no association between mothers' body mass index and daughters' weight loss attempts, suggesting a generational shift among women to ideals of thinness. Chae et al. [[13]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-S33Abstract Full Text Full Text PDF Scopus (7) Google Scholar] explored in Zambia the role that schooling might play in changing girls' gender norms. A girl's school attendance in urban areas reinforced norms emerging from the comparatively progressive environment, whereas in rural areas, it served as a "liberalizing influence" in more conservative settings. An article by Nagata et al. [[14]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-S41Abstract Full Text Full Text PDF Scopus (21) Google Scholar] illustrates the powerful effects of gender norms on body image in the U.S. A greater alignment of an individual's gender norms with the dominant views of same-sex peers was associated with greater weight loss attempts in girls and weight gain attempts in boys. The analysis by Falconi et al. [[15]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-S50Abstract Full Text Full Text PDF Scopus (4) Google Scholar] illustrates the malleability of gender norms and their long-term consequences by examining women's employment opportunities during World War II (WWII). Those women who took the opportunity to work intermittently during WWII and then remained in the labor force post-WWII had lower mortality across their lifetimes. Buffarini et al.'s [[16]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-S57Abstract Full Text Full Text PDF Scopus (7) Google Scholar] cohort study illustrates how the effects of inequitable gender norms are greatest on the most disadvantaged. Girls from low-income families fared the worst on outcomes of smoking, weight, violence, happiness, and mental health. This supplement takes a welcome step forward in understanding the emergence and consequences of gender norms among adolescents. Yet, the articles also illustrate our limited investment in norms research. A common feature of the articles is the use of measures defined and data collected for other purposes. Many other aspects of adolescent health risks are likely to be linked to gender norms. Petroni et al. [[17]Petroni S. Patel V. Patton G. Why is suicide the leading killer of older adolescent girls?.The Lancet. 2015; 386: 2031-2032Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar], for example, recently noted the links with suicide and self-harm, now, astoundingly, the major global cause of death in adolescent girls. Kapungu et al. [[18]Kapungu C. Petroni S. Allen N.B. et al.Gendered influences on adolescent mental health in low-income and middle-income countries: Recommendations from an expert convening.Lancet Child Adolesc Health. 2018; 2: 85-86Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar] took the analysis further and made recommendations about the value of a gender lens in adolescent mental health research, prevention and service delivery, and mental health policy. Through the inclusion of gender equity in the Sustainable Development Goals, the health needs of young women and girls have achieved greater prominence with targets around violence against women, universal access to education and sexual and reproductive health care, and equal political and economic participation [[19]Gates M.F. Putting women and girls at the center of development.Science. 2014; 345: 1273-1275Crossref PubMed Scopus (59) Google Scholar,[20]Langer A. Meleis A. Knaul F.M. et al.Women and health: The key for sustainable development.The Lancet. 2015; 386: 1165-1210Abstract Full Text Full Text PDF PubMed Scopus (218) Google Scholar]. Where such targets have been pursued, they have been accompanied by striking gains in maternal health for girls and young women, and often, the benefits extend to their children [[21]Woetzel J. The power of parity: How advancing women's equality can add $12 trillion to global growth. eSocialSciences, 2015Google Scholar]. Although girls and young women have been the major focus of attention, that agenda remains far from complete. Indeed, technological change, including the rise of social media, may have introduced new risks related to the focus on physical appearance in seeking a gender ideal. For boys and young men, work on gender norms has just begun. They have much to contribute to achieving gender equality: the benefits for their own health and well-being in doing so are likely to be great. Gender Norms and Weight Control Behaviors in U.S. Adolescents: A Prospective Cohort Study (1994–2002)Journal of Adolescent HealthVol. 66Issue 1PreviewThe aim of this article was to determine the relationship between gender norms and weight control behaviors in U.S. adolescents. Full-Text PDF Open AccessThe Influence of Schooling on the Stability and Mutability of Gender Attitudes: Findings From a Longitudinal Study of Adolescent Girls in ZambiaJournal of Adolescent HealthVol. 66Issue 1PreviewInequitable gender norms are thought to harm lifelong health and well-being. We explore the process of gender attitude change and the role of schooling in shifting or reinforcing gender norms among adolescent girls in Zambia. Full-Text PDF Open AccessParent-Related Normative Perceptions of Adolescents and Later Weight Control Behavior: Longitudinal Analysis of Cohort Data From BrazilJournal of Adolescent HealthVol. 66Issue 1PreviewBody image–related norms can be imposed by parents and can shape adolescents' body satisfaction in consequential ways, yet evidence on long-term effects is scarce. Longitudinal data from a country with strong body image focus provided a unique opportunity to investigate long-term influences of normative parent-related perceptions. Full-Text PDF Open AccessShifts in Women's Paid Employment Participation During the World War II Era and Later Life HealthJournal of Adolescent HealthVol. 66Issue 1PreviewThe greatest proportional increase in female labor force participation of the 20th century occurred post–World War II (WWII) when shifts in policy and growth in service and clerical work spurred an influx of women into the labor force. Research has yet to demonstrate how variation in women's employment participation during this era related to their later life health. We examined how shifts in women's employment patterns during the WWII era influenced their disease and mortality risk. Full-Text PDF Open AccessAttitudinal Acceptance of Intimate Partner Violence Among Adolescents and Young Adults in Nigeria and Tanzania: An Exploration Into Target Reference GroupsJournal of Adolescent HealthVol. 66Issue 1PreviewAttitudinal programming for the prevention of intimate partner violence (IPV) among adolescents and young adults often focuses on whom to target based on gender or age; yet other pivotal junctures may relate to when to intervene, such as critical events (e.g., marriage). Using data from the nationally representative Violence Against Children Survey in Nigeria and Tanzania, this study examines the gendered association of acceptance of IPV across 3 reference groups—age, marital status, and education attainment—for male and female adolescents and young adults. Full-Text PDF Open AccessThe Intersectionality of Gender and Wealth in Adolescent Health and Behavioral Outcomes in Brazil: The 1993 Pelotas Birth CohortJournal of Adolescent HealthVol. 66Issue 1PreviewBrazilian society is characterized by deep socioeconomic inequalities. Using data from a population-based birth cohort, we explored how the intersectionality of family income and gender may affect adolescent health and behavioral outcomes. Full-Text PDF Open AccessRelationships Between Maternal Factors and Weight Loss Attempts Among Urban Male and Female Adolescents Living in Soweto, Johannesburg, South AfricaJournal of Adolescent HealthVol. 66Issue 1PreviewSouth Africa is undergoing rapid urban transition favoring ideals of thinness, which increases eating disorders risk for female adolescents, whereas older women continue to uphold corpulence as a female cultural value. This study aimed to assess the potential conflicting relationship between urban male and female adolescents' weight loss attempts (WLA) and maternal body image norms within households. Full-Text PDF Open Access
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