Effect of a Community-Based Gender Norms Program on Sexual Violence Perpetration by Adolescent Boys and Young Men: A Cluster Randomized Clinical Trial

"The changes in intentions to intervene are promising, and literature suggests that improvement in bystander attitudes may translate to reduced violence perpetration at the individual level over time..."

Prevention of sexual violence (SV) and adolescent relationship abuse (ARA) requires modifying the behaviours of perpetrators. Prior research has found that gender-transformative approaches that encourage development of healthy masculinities (i.e., respectful sexual behaviours and exploration of masculinity norms that promote gender equity), combined with bystander skills development, may be helpful in improving sexual health and reducing SV and ARA perpetration. This cluster-randomised trial tested effectiveness among adolescent boys and young men of a community-based gender-transformative programme - Manhood 2.0) - on perpetration of gender-based violence by adolescent boys and young men in the United States (US).

The trial took place in 20 Pittsburgh, Pennsylvania, US, urban neighbourhoods and 1 centrally located site with high prevalence of poverty, school suspension, and community violence. Pittsburgh-based adolescent boys and young men (ages 13 to 19 years) were recruited between July 27 2015 and June 5 2017 through youth-serving organisations and groups engaging with juvenile-justice-involved youth.

Manhood 2.0 was a US adaptation of Program H, a gender-transformative curriculum for adolescent boys and young men in Brazil. Modifications to produce Manhood 2.0 included addition of content on racial justice, social media, and pornography. The control group took part in a job-readiness curriculum called JumpStart Success (JSS).

An 18-hour curriculum was divided into 6 sessions, each delivered once or twice a week; the sessions were delivered among 45 unique intervention groups and 41 unique control groups, generally consisting of 8 to 12 individuals, between July 2015 and August 2017. Facilitators were community leaders from the participants' neighbourhoods, providing significant dosage via content repetition and skills practice.

Neighbourhoods were designated as the unit of clustering (1:1 allocation). Three-month and 9-month follow-ups were conducted. Intention-to-treat analysis was conducted from June 2018 to November 2019. Among 866 participants, 465 individuals (54%) enrolled in 11 intervention clusters and 401 individuals (46%) enrolled in 10 control clusters. Of the participants, 609 (70%) self-identified as non-Hispanic Black, and 178 (20%) self-identified as Hispanic, multiracial, or other race/ethnicity other than White.

Table 3 in the article shows outcome values at each time point by treatment group; Table 4 shows intervention effects comparing intervention to control. In short, there was no evidence of an intervention effect for the primary outcome, which was change in participant-level perpetration of SV or ARA. That is, the difference in reduction between groups was not significant. Contrary to expectations, participants in job-readiness training (the control group) had greater reductions in reported incidents of SV or ARA perpetration at endline, including cyber-sexual abuse. Participants in job-readiness training also had more equitable gender attitudes at endline, but this difference was not statistically significant.

Among secondary outcomes, participants in intervention groups reported significantly greater intentions to intervene when witnessing peers' harmful behaviours compared with participants in control groups.

In comparing these results to findings elsewhere (beyond the US), the researchers suggest several reasons for the differential findings: (i) 6 sessions (compared with programmes ranging from 14-26 sessions) may not have been adequate for building skills to meaningfully challenge masculinity norms; (ii) the follow-up interval may have been too short; (iii) it is possible that involvement of youth in community mobilisation would have offered additional opportunities for skills-building; and (iv) although the job-readiness curriculum did not address gender equity, scenarios in the programme discussed expected behaviours in the workplace, which may have contributed to reflection on respectful interactions with women in these neighbourhoods with concentrated disadvantage.

Thus, the researchers suggest that combining gender-transformative approaches with job-readiness programmes may be relevant for violence prevention in low-resource urban settings. They also indicate that, with regard to gender-transformative programmes in general, extended time for intervention implementation, youth leadership opportunities to engage in social norms change, community mobilisation, and greater attention to practicing skills discussed in the curriculum merit further consideration. "Increasing such opportunities in community settings for adolescent boys and young men, especially those living in neighborhoods with concentrated disadvantage, may be associated with reducing multiple forms of violence and promoting youth flourishing."