Cluster Randomized Trial of the Impact of the Breaking the Man Code Workshops on Adolescent Boys' Intentions toSeek Help.

Peer pressure and general conformity to adult norms have been found to be strongly associated with alcohol use among adolescents; however there is limited knowledge about the sociocultural factors that might influence this relationship. Theory and research suggest that masculine norms might directly and indirectly contribute to alcohol use through peer pressure and general conformity to adult norms. Whereas being male is typically identified as a risk factor for alcohol use, masculine norms provide greater specificity than sex alone in explaining why some boys drink more than others. There is growing evidence that girls who endorse masculine norms may be at heightened risk of engaging in risky behaviors including alcohol use. Data were provided by adolescents living in a rural area in the Northeastern United States and were collected in 2006. This study demonstrated that masculine norms were associated with peer pressure and general conformity and alcohol use for both adolescent girls (n = 124) and boys (n = 138), though the relationship between masculine norms and alcohol use was stronger for boys. The study's limitations are noted and theoretical and practical implications are discussed.

This baseline study aimed to assess the knowledge, information sources, and needs of adolescent boys and girls regarding puberty and menstruation. The study was conducted in selected schools before establishing school health clubs. The objective was to gather information that would inform the development of puberty education programs tailored to the specific needs of the adolescent population. A cross-sectional study was conducted in Kibaha Town council from 17th to 31st March, 2020 involving both adolescent boys and girls. Data was collected using a combination of quantitative and qualitative methods, including a semi-structured questionnaire and focus group discussions (FGDs). Quantitative data was analysed using descriptive statistics while qualitative data was analysed using a thematic approach. The study involved 591 students, with 461 completing a questionnaire and 130 participating in FGDs. Results showed that many adolescent boys and girls had limited knowledge about puberty and menstruation. Only about 34% of participants felt well informed about puberty, and 31% about menstruation. Participants' knowledge of specific aspects ranged from 36.2% to 97.4% for puberty and 21.7% to 87.4% for menstruation. Participants had inadequate knowledge of issues such as age at puberty, some physical changes in boys, the mechanism of menstruation, and the menstrual cycle. Before menarche, 39% of respondents primarily relied on schoolteachers for information about menstruation. However, this shifted significantly after menarche, with 51% of respondents citing their mothers as the primary source. However, students preferred to get information from school clubs (40%), health care providers (23%) and school teachers (11%). Further, very few students indicated receiving information before puberty. Girls indicated the need for more information as compared to adolescent boys, particularly on issues related to menstrual hygiene, the use of menstrual materials, and how to manage menstrual pains. This study reveals significant gaps in adolescents' knowledge of puberty and menstruation, underscoring the need for comprehensive and early education. School health clubs, particularly when facilitated by external health professionals and integrated with WASH programs, offer an effective platform for addressing these gaps, providing a comfortable space for learning and empowering both boys and girls with critical knowledge and skills. Empowering both boys and girls through such initiatives can reduce stigma, foster supportive behaviors, and promote adolescent well-being. Findings were used to inform the development of materials for the facilitation of school clubs, for both girls and boys.

We studied 50 (27 women and 23 men) GH-deficient (GHD) cancer survivors and 47 (24 women and 23 men) GHD patients with pituitary pathologies. All GHD patients were considered for GH replacement on the basis of subjectively poor quality of life (QOL). Primary outcome measures were scores of QOL instruments psychological general well-being schedule (PGWB) and assessment of GH deficiency in adults (AGHDA) at baseline and early (6-13 months) and long-term (24-77 months) treatment follow-up. Of secondary interest were six PGWB domains. Linear mixed effect regression was used to model each QOL outcome. The groups differed with respect to three covariates: age, gender, and body mass index. These variables were included in all fitted models. Baseline scores for PGWB and AGHDA were not different between groups. Ranking of PGWB domains were similar between groups at baseline (lowest domain, vitality). The pattern of change in mean scores for all outcome measures from baseline did not differ between groups (P = 0.86). All QOL variables improved significantly with treatment [estimated mean change +/- se: PGWB, 16.2 +/- 1.7; AGHDA, -6.2 +/- 0.6; PGWB domains (transformed percentage scales): anxiety, 12.4 +/- 1.7; depression, 14.1 +/- 2.1; health, 12.4 +/- 1.7; self-control, 11.3 +/- 2.0; well-being, 15.2 +/- 1.7; vitality, 22.5 +/- 2.0 (vitality, greatest change)]. There was no evidence of group difference in early follow-up or long-term follow-up means for any outcome variable. The QOL in adult GHD cancer survivors was comparable to that in GHD adults with pituitary pathologies and improved with GH replacement in a similar manner. We conclude that QOL impairment in adult GHD cancer survivors appears mainly related to GHD rather than cancer diagnosis and treatment.

Gender norms and the wellbeing of girls and boys

The aim of this study was to study the effect of modified maintenance doses (MDs) of infliximab on the quality of life (QoL) of patients with ankylosing spondylitis (AS) over a period of 3 years. Medical records of AS patients (n = 25) who received a normal induction dose but modified MDs as required were retrospectively analyzed. After induction dose and the first MD, patients were followed up every month and were treated with infliximab whenever Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was 4 or greater. The study end points were the percentage of responders defined as reduction of 40% or greater in BASDAI score and improvement in QoL defined by mean change in SF-36 Physical Component Summary score, SF-36 Mental Component Summary score, and Ankylosing Spondylitis Quality of Life (ASQoL) values at week 6 and after the last MD (ie, at the end of 3 years) compared with baseline. Majority of the patients were males (n = 20), and the mean age of the analysis population was 40.6 ± 10.79 years. At the end of 6 weeks and after the last MD, BASDAI 40 scores were achieved in 100% and 92% of the patients, respectively. From baseline, the mean change in BASDAI score at the end of 6 weeks and after the last MD is -3.56 and -3.40, respectively. The overall mean change in scores (BASDAI, SF-36 Physical and Mental Component Summary, and ASQoL) versus baseline, at 6 weeks, and after the last MD was statistically significant (P < 0.0001). The results of the study suggest that initial induction and an on-demand MD regimen of infliximab based on BASDAI were associated with significant improvement in disease activity and QoL.

Adolescent boys' music beliefs, values, and identity work in a single-sex independent school

Elevated suicide rates among adolescent boys in Australia reflect a critical need to address restrictive masculine norms that hinder help-seeking. Tomorrow Man’s ‘Breaking the Man Code’ workshop—a school-based gender transformative programme—aims to increase authentic self-expression and meaningful dialogue among adolescent boys. Evidence of the impacts of gender transformative programmes is limited. Within a cluster randomized trial, 183 boys (Years 10 upwards) from 11 Australian schools completed open-ended survey questions about their experiences of the ‘Breaking the Man Code’ workshop and its perceived impact on help-seeking with friends and family. Data were analysed using reflexive thematic analysis. Three themes were developed: (i) the workshop normalized struggle and strengthened connection, creating a safe space for self-expression and peer connection; (ii) defining the ‘man code’ postworkshop: many participants expressed desires for increased self-expression and to support others; and (iii) talking openly with friends and family postworkshop. Greater relational impacts were described with friends, including increased compassion, trust, connection, and use of active listening skills. Perspectives within themes varied: while many discussed positive attitudinal and behavioural change, others reported no changes. The lack of reported change was largely attributed to pre-existing open communication practices; others gave no explanation; some noted difficulties implementing changes. Future research should further explore varied impacts among diverse boys. Analysis suggests that many adolescent boys in this sample desired and perceived that they could shift towards a positive masculinity characterized by deeper social connections, providing examples of this change within their relationships with friends and family postworkshop.

Haemophilia and its treatment interfere with patients' life, so health-related quality of life (HRQoL) should be assessed when evaluating treatments. This study investigated the HRQoL of patients with haemophilia A treated prophylactically with a new recombinant factor VIII. Two phase 3 trials investigated turoctocog alfa in patients with severe haemophilia A: one in children, one in adults and adolescents. HRQoL was a secondary endpoint assessed by the HAEMO-QOL age-specific, self-administered questionnaires. Parent-completed versions were also included for parents of children and adolescents. All HAEMO-QOL questionnaires allow the calculation of domain-specific and total scores ranging from 0 to 100, lower scores indicating better HRQoL. Mean change in all scores was described for 25 children aged 4–7 years, 21 children aged 8–12 years, 18 adolescents aged 13–18 years and 129 adults, overall, and according to the treatment regimen received prior to the study (on-demand; prophylaxis; mixed). Mean changes in HAEMO-QOL total score were 1.4 for children aged 4–7 years, −2.6 for children aged 8–12 years, −5.8 for adolescents and −1.6 for adults. In parent-completed versions, mean changes in total score were −6.0 for children aged 4–7 years, −4.7 for children aged 8–12 years, and −10.0 for adolescents. Patients receiving on-demand treatment before the trial showed greater improvement in HRQoL scores than patients already on prophylaxis. HRQoL of patients remained fairly stable over the course of the trials. However, improvements were observed for adolescents. Switching to prophylaxis was identified as a potential driver of improvement of HRQoL in patients with haemophilia A.

We explored the masculinity norms shaping transitions through puberty in rural and urban Tanzania and how these norms and their social-ecological context contribute to high-risk health behaviors. We conducted a qualitative case study of adolescent boys in and out of school in 2011 and 2012. Tanzania's social and economic development is reshaping the transition into young manhood. Adolescent boys are losing traditional mechanisms of pubertal guidance, and new meanings of manhood are arising from globalization. Traditional masculinity norms, including pressures to demonstrate virility and fertility, remain strong. Adolescent boys in modernizing Tanzania receive inadequate guidance on their burgeoning sexuality. Contradictory masculinity norms from family and society are shaping their sexual expectations, with implications for their engagement in unsafe sexual behaviors.

Formal rites of passage (ROP) processes are largely lacking within Western culture. This scarcity is seen to be detrimental to adolescent boys’ masculine identity formation. With schools bearing increased responsibility for the well-being of students, and as a way of addressing the apparent cultural deficiency, interest in school-based ROP programs has expanded. This scoping review adopted a systematic methodology to refine an initial accumulation of 708 articles. Nine key articles investigating the impact of school-based ROP programs for adolescent boys were examined. The ROP programs were analyzed according to rationale, design, and impact, with each program focusing on three major domains of impact—community, responsibility, and identity. The review found that adolescent boys’ participation in ROP programs may enhance community engagement, build responsible citizenship, and improve self-perception through the development of positive masculine identity.

One hundred and seventy-four males completed a quality of life (QoL) assessment utilizing, a generic paediatric quality of life inventory (PedsQL) and the short form (36) health survey (SF36). The adolescents aged 13-16 years were in a Scottish Centre for young males with social, emotional, behavioural and educational problems. To identify similarities and differences, a comparison group (n = 110) of males in the third and fourth year in a mainstream secondary school were also administered the PedsQL and the SF36 self-rating scales. The effectiveness of the PedsQL and the SF36 for assessing QoL for adolescent males was investigated. There were significant differences between the groups in the Centre and between the Centre groups and the comparison group in terms of their QoL. The results between the groups were found in the PedsQL subscales 'physical functioning' where secure > comparison (P = 0.04); secure > residential (P = 0.008); and PedsQL subscale 'social functioning' day > comparison (P = 0.026); secure > comparison (P = 0.037). SF36 subscales 'role physical functioning' secure > residential (P < 0.001); day > residential (P < 0.001). SF36 'role mental functioning' day > residential (P = 0.001). This study provides a unique insight into the complex dimensions influencing the QoL of this specific group of young people.

Boys’ beliefs about prosocial behavior toward other boys may be negatively affected by masculine norm adherence, and there is evidence that early adolescence is a time when boys feel heightened levels of pressure from multiple sources (e.g., friends, family, and self) to adhere to masculine norms like emotional restriction (e.g., appearing stoic and uncaring). However, the relation between boys’ masculinity and their prosocial behavior beliefs is likely further affected by boys’ social competency. Generally, boys’ social competency is positively associated with prosocial behavior, but this is not the case for “tough” boys (boys who adhere to many traditionally masculine norms). We expected that analyzing the relation between early adolescent boys’ pressure to adhere to masculine norms and boys’ unique social profiles (created using adherence to masculine norms and aspects of social competency) would further illuminate boys’ patterns of prosocial behavior beliefs toward other boys. A latent profile analysis estimated profiles of masculinity and social competence among 260 early adolescent boys (59% White, M age = 11.45 years old, Range age = 10–12) in the southwestern U.S. Three profiles emerged which we labeled socially precarious (50%), socially self-confident (41%), and socially avoidant (9%). R3Step and BCH procedures indicated that higher levels of felt pressure from all three sources resulted in a significantly higher likelihood of being in the socially precarious profile compared to the socially self-confident profile and that boys in the socially self-confident profile had significantly higher mean levels of prosocial behavior beliefs toward other boys ( M = 3.22) compared to boys in the socially precarious profile ( M = 3.01). Overall, this study encourages the socialization of social competency while simultaneously discouraging the perpetuation of certain masculine norms among adolescent boys.

BackgroundVoluntary medical male circumcision is an integral part of the South African government’s response to the HIV and AIDS epidemic. However, there remains a limited body of economic analysis on the cost of VMMC programming, and the demand creation activities used to mobilize males, especially among adolescent boys in school. This study addresses this gap by presenting the costs of a VMMC program which adopted two demand creation strategies targeting school-going males in South Africa.MethodsCost data was collected from a VMMC program in the KwaZulu-Natal province of South Africa. A retrospective, micro-costing ingredient approach was applied to identify, measure and value resources of two demand creation strategies targeting young males.ResultsThe program circumcised 4987 young males between May 2011 and February 2013, at a cost of $127.68 per circumcision. Demand creation activities accounted for 32% of the total cost, HCT contributing 10% with the medical circumcision procedure accounting for 58% of the total cost. Using the first demand creation strategy, 2168 circumcisions were performed at a cost of $149.57 per circumcision. Following this first strategy, a second demand creation strategy was adopted which saw the cost fall to $110.85 per circumcision. More young males were recruited following the second strategy with clinic services more efficiently utilized. Whilst the cost per circumcision of demand activities rose slightly between the first ($39.94) and second ($41.65) strategy, there was a substantial reduction in the cost of the circumcision procedure; $90.01 under the first strategy falling to $60.60 following the adoption of the second demand creation strategy.ConclusionEnsuring the optimal use of clinic facilities was the primary driver in reducing the cost per circumcision. This VMMC program has illustrated the value of evaluating progress and instituting changes to attain better cost efficiencies. This adjustment resulted in a substantial reduction in the cost per circumcision.

Adolescent boys and young men (ABYM) in South Africa face a high burden of unmet mental health needs but are often overlooked in research and practice. Economic and racial inequalities, masculine norms, and limited access to targeted mental health promotion services may hinder their ability to understand psychological distress, seek support, and engage with psychosocial services. This qualitative study explored how ABYM in Alexandra, South Africa, perceive and experience mental health, to inform future interventions. Semi-structured interviews were conducted with 24 participants, including 12 adolescent boys (ages 15-19) and 12 male youth mentors and staff from a local adolescent health organization. Interviews were analyzed using reflexive thematic analysis. Participants were often unfamiliar with the term mental health but described distress through everyday language grounded in social and emotional experience. Their conceptualizations of mental health were shaped by family and community environments, gendered expectations, and a mix of psychological and supernatural explanations. Rigid masculine norms associated mental health challenges with weakness, discouraged emotional expression and help-seeking, and placed early and significant pressure on boys to succeed in school or sports to make money and fulfil the male provider role. Despite these pressures, many participants expressed personal views that challenged dominant norms, for example, valuing emotional expression and open conversations with trusted adults or peers about mental health. However, stigma and a lack of youth- and male-friendly services remained significant barriers to accessing formal support. Our findings highlight the need for gender-sensitive, culturally grounded mental health programming for ABYM. Interventions should involve youth in design and delivery, build on familiar coping strategies, normalize emotional expression among boys, and promote the attributes of good mental health. Embedding support within community or recreational settings may reduce stigma, improve engagement, and strengthen adolescent boys' mental health and well-being in low-resource urban contexts.

Adolescent boys and young men (ABYM) in South Africa face a high burden of unmet mental health needs but are often overlooked in research and practice. Economic and racial inequalities, masculine norms, and limited access to targeted mental health promotion services may hinder their ability to understand psychological distress, seek support, and engage with psychosocial services. This qualitative study explored how ABYM in Alexandra, South Africa, perceive and experience mental health, to inform future interventions. Semi-structured interviews were conducted with 24 participants, including 12 adolescent boys (ages 15–19) and 12 male youth mentors and staff from a local adolescent health organization. Interviews were analyzed using reflexive thematic analysis. Participants were often unfamiliar with the term mental health but described distress through everyday language grounded in social and emotional experience. Their conceptualizations of mental health were shaped by family and community environments, gendered expectations, and a mix of psychological and supernatural explanations. Rigid masculine norms associated mental health challenges with weakness, discouraged emotional expression and help-seeking, and placed early and significant pressure on boys to succeed in school or sports to make money and fulfil the male provider role. Despite these pressures, many participants expressed personal views that challenged dominant norms, for example, valuing emotional expression and open conversations with trusted adults or peers about mental health. However, stigma and a lack of youth- and male-friendly services remained significant barriers to accessing formal support. Our findings highlight the need for gender-sensitive, culturally grounded mental health programming for ABYM. Interventions should involve youth in design and delivery, build on familiar coping strategies, normalize emotional expression among boys, and promote the attributes of good mental health. Embedding support within community or recreational settings may reduce stigma, improve engagement, and strengthen adolescent boys’ mental health and well-being in low-resource urban contexts.