Global study of urban poor links childhood adversity to adolescent violence and depression

Washington, DC (May 20, 2019)--In poor urban areas around the world, exposure to adverse events as children--including physical and emotional neglect, violence, and sexual abuse--is strongly associated with both adolescent depression and violence perpetrated by young people, with the data suggesting that boys are suffering even more than girls, according to a new study in the Journal of Adolescent Health from the Johns Hopkins Bloomberg School of Public Health.

"This is the first global study to investigate how a cluster of traumatic childhood experiences known as ACEs, or adverse childhood experiences, work together to cause specific health issues in early adolescence with terrible, life-long consequences," said Dr. Robert Blum, lead researcher for the Global Early Adolescent Study (GEAS) that is based in multiple countries across five continents. "And while we found young girls often suffer significantly, contrary to common belief, boys reported even greater exposure to violence and neglect, which makes them more likely to be violent in return."

The study catalogued the ACEs suffered by 1,284 adolescents aged 10 to 14 in 14 "low-income urban settings" around the world. It found remarkably common experiences with trauma--and very similar impacts--regardless of where the children lived, which included Vietnam, China, Bolivia, Egypt, India, Kenya, UK and the United States. The report is the first to include an assessment of how adversity impacts young children in multiple low- and middle-income countries, where the vast majority of the 1.8 billion 10- to 24-year-olds worldwide live--about a quarter of the global population.

Overall, the study found that 46% of young adolescents reported experiencing violence, 38% suffered emotional neglect and 29% experienced physical neglect. But boys stood out in several categories. They were more likely to report physical neglect, sexual abuse and violence victimization. Also, for both boys and girls, the more adversity they experienced, the more likely they were to engage in violent behaviors, such as bullying, threatening or hitting someone. But the effect of the adversity was more pronounced for boys than girls, with boys 11 times more likely to be engaged in violence, and girls four times more likely to be violent.

Also, the study found that, in general, the cumulative effect of their traumas tended to produce higher levels of depressive symptoms among girls than boys, while boys tended to show more external aggression than girls.

Study Supports New Assessment from Global Coalition of Adolescent Health Experts

The study is part of the Global Early Adolescent Study, a major collaboration of the World Health Organization and the Johns Hopkins Bloomberg School of Public Health to understand more about the development of gender stereotypes in early adolescence and their impact on adolescent health around the world. And it buttresses a key conclusion from a major new report to be released next week at Women Deliver in Vancouver based on a global coalition of adolescent health experts: that the world will never achieve gender equality "by focusing on girls and women alone and excluding boys and men."

That report, from the Bellagio Working Group on Gender Equality, reflects the assessment of 22 experts from 15 countries. Their analysis, Achieving Gender Equality by 2030: Putting Adolescents at the Center, finds that boys have as equal a part to play as girls in achieving the fifth of the United Nation's Sustainable Development Goal (SDG5), which seeks to "achieve gender equality and empower all women and girls" by 2030. The report notes that the current indicators for SDG5 ignore boys and men. But it warns that "we cannot achieve a gender equitable world by ignoring half of its occupants."

In a commentary summarizing the Bellagio report for the Journal of Adolescent Health, working group members from the United States, Ethiopia, Kenya, Indonesia and Great Britain point to the growing amount of data that refute a "prevailing myth that girls alone are disadvantaged by gender norms." They note that evidence from the GEAS work shows that in the many settings around the world, "boys experience as much disadvantage as girls" and are "more likely to smoke, drink and suffer both unintentional and intentional injury and death in the second decade of life than their female counterparts."

They conclude that the key to achieving gender equality by 2030 involves addressing conditions and stereotypes that are harmful to both girls and boys--and to intervene much earlier, in early adolescence, at least by age 10, rather than at age 15 which is now the norm. Early adolescence is critical, the Bellagio group asserts, because "gender norms, attitudes and beliefs appear to solidify by age 15 or 16."

Their report calls a broader set of indicators for tracking progress on achieving SDG 5 that would include:

• Tracking the percentage of both boys and girls who at the community level feel that they can ask for help when needed since there appears to be a strong relationship between voice and empowerment

• Tracking the percentage of boys and girls who feel safe in their neighborhood, as safety and security is a critical factor in the healthy development of both boys and girls; for example, the new study on adverse childhood experiences found a third of children reported a persistent fear of physical harm

Gender Equality Critical to Economic Growth in Africa, South Asia

The Bellagio Working Group also finds gender equality is a critical component of efforts in the developing world to achieve what economists call a "demographic dividend." It refers to harnessing the vigor of a surging youth population to generate a period of sustained economic growth. A demographic dividend was a major factor behind in the rise of the economic "tigers" of East Asia and even in Ireland's economic boom of the 1990s.

There is now hope for something similar to propel the economies of sub-Saharan Africa, home to the fastest growing--and youngest--population in the world. Youth populations also are ascendant in South Asia and across much of the Middle East.

The Bellagio Working Group concludes that if these regions want to experience a demographic dividend, they need to "address gender inequalities and rigid gender expectations that limit the future of many of the world's young people."

"We must actively engage girls and boys at the onset of adolescence to increase total social inclusion and produce generational change," the report states.

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Global Early Adolescent Study

Over the past six years, an international consortium of 15 countries has been working on the Global Early Adolescent Study (GEAS). The GEAS aims to understand how gender norms are formed in early adolescence and how they predispose young people to subsequent sexual and other health risks.

As children move into early adolescence and start to develop into young men and women, they also start to take up social roles that are linked to masculinity and femininity. The roles they take on have huge implications for their own health and well-being and that of people around them. Hence, this is a critically important period to study.

The GEAS has generated valuable information from 15 countries around the world, and developed a tool kit to assess gender norms in early adolescents.

The GEAS is led by the Johns Hopkins Bloomberg School of Public Health in conjunction with WHO's Department of Reproductive Health and Research/Human Reproduction Programme.

For interviews or more information, please contact:

Katy Lenard at klenard@burness.com; +1 301-280-5719

Anne-Marie Schryer-Roy at aschryer-roy@burness.com; +254 727 305 525