Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Netw Open. 2020 Dec 1;3(12):e2028499. doi: 10.1001/jamanetworkopen.2020.28499.
Engaging adolescent boys and young men in preventing violence against women is a potentially impactful public health strategy.
To evaluate the effectiveness of a community-based, gender-transformative program (ie, Manhood 2.0) on perpetration of gender-based violence by adolescent boys and young men.
DESIGN, SETTING, AND PARTICIPANTS: In this unblinded cluster randomized clinical trial, neighborhoods were designated as the unit of clustering (1:1 allocation). Three-month (ie, time point 2 [T2]) and 9-month (ie, time point 3 [T3]) follow-ups were conducted. The trial took place in 20 Pittsburgh, Pennsylvania, neighborhoods and 1 centrally located site with concentrated disadvantage. 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 organizations and community-based alternatives to residential placement for juvenile justice-involved youth. Intention-to-treat analysis was conducted from June 2018 to November 2019.
Manhood 2.0, an international program adapted for adolescent boys and young men in US urban communities, encourages these individuals to challenge gender norms that foster violence against women and unhealthy sexual relationships. Individuals in the control population received job-readiness training. Each program was 18 hours.
The primary outcome was change in participant-level perpetration of sexual violence (SV) or adolescent relationship abuse (ARA) at T3.
Among 866 participants, 465 individuals (54%) enrolled in 11 intervention clusters and 401 individuals (46%) enrolled in 10 control clusters. In the intervention group, 325 participants (70%) were analyzed at T2 and 334 participants (72%) were analyzed at T3; in the control group, 262 participants (65%) were analyzed at T2 and 301 participants (75%) were analyzed at T3. Mean (SD) age was 15.5 (1.6) years; 609 participants (70%) self-identified as non-Hispanic Black, and 178 (20%) self-identified as Hispanic, multiracial, or other race/ethnicity other than White. Among individuals in the intervention group, 296 participants (64%) reported any SV or ARA perpetration at baseline, and 173 participants (52%) reported any SV or ARA perpetration at T3. Among individuals in the control group, 213 participants (53%) reported any SV or ARA perpetration at baseline, and 124 participants (41%) reported any SV or ARA perpetration at T3). The difference in reduction between groups was not significant. There was no evidence of an intervention effect for the primary outcome (adjusted odds ratio [OR], 1.32; 95% CI, 0.86-2.01; P = .20).
The findings from this evaluation of a community-based gender-transformative program for adolescent boys and young men did not show a significant intervention effect in reducing SV or ARA perpetration between Manhood 2.0 and a job-readiness control program. Combining gender-transformative approaches with job-readiness programs may be relevant for violence prevention in low-resource urban settings. Attention to improving implementation and strategies to sustain such community-based efforts are needed.
ClinicalTrials.gov Identifier: NCT02427061.
让青少年男孩和年轻男性参与预防针对妇女的暴力行为是一种具有潜在影响力的公共卫生策略。
评估基于社区的性别转换项目（即 Manhood 2.0）对青少年男孩和年轻男性实施基于性别的暴力行为的效果。
设计、地点和参与者：这是一项未设盲的聚类随机临床试验，将社区指定为聚类单位（1:1 分配）。进行了 3 个月（即时间点 2 [T2]）和 9 个月（即时间点 3 [T3]）的随访。该试验在匹兹堡的 20 个社区和一个集中贫困的中心地点进行。匹兹堡的青少年男孩和年轻男性（年龄在 13 至 19 岁之间）通过青年服务组织和针对少年司法涉案青年的社区替代居住安置的社区机构招募。从 2018 年 6 月到 2019 年 11 月进行了意向治疗分析。
Manhood 2.0 是一项为美国城市社区的青少年男孩和年轻男性改编的国际项目，鼓励这些人挑战助长暴力侵害妇女和不健康性关系的性别规范。对照组接受了就业准备培训。每个项目持续 18 小时。
主要结果是 T3 时参与者在性暴力（SV）或青少年关系虐待（ARA）方面的行为变化。
在 866 名参与者中，465 人（54%）参加了 11 个干预组，401 人（46%）参加了 10 个对照组。在干预组中，325 名参与者（70%）在 T2 时进行了分析，334 名参与者（72%）在 T3 时进行了分析；在对照组中，262 名参与者（65%）在 T2 时进行了分析，301 名参与者（75%）在 T3 时进行了分析。平均（SD）年龄为 15.5（1.6）岁；609 名参与者（70%）自我认定为非西班牙裔黑人，178 名（20%）自我认定为西班牙裔、多种族或其他种族/民族，而不是白人。在干预组中，296 名参与者（64%）在基线时报告有任何 SV 或 ARA 行为，173 名参与者（52%）在 T3 时报告有任何 SV 或 ARA 行为。在对照组中，213 名参与者（53%）在基线时报告有任何 SV 或 ARA 行为，124 名参与者（41%）在 T3 时报告有任何 SV 或 ARA 行为。两组之间减少的差异不显著。干预对主要结果没有影响（调整后的优势比 [OR]，1.32；95%CI，0.86-2.01；P=0.20）。
这项对青少年男孩和年轻男性基于社区的性别转换项目的评估结果表明，在 Manhood 2.0 与就业准备对照组之间，SV 或 ARA 行为的减少没有显著的干预效果。将性别转换方法与就业准备计划相结合可能与低资源城市环境中的暴力预防有关。需要注意提高实施质量，并制定策略来维持这种基于社区的努力。
ClinicalTrials.gov 标识符：NCT02427061。
