Boyce Sabrina C, Minnis Alexandra M, Deardorff Julianna, McCoy Sandra I, Goin Dana E, Challa Sneha, Johns Nicole E, Aliou Sani, Brooks Mohamad I, Nouhou Abdoul-Moumouni, Baker Holly, Silverman Jay G
Maternal, Child, and Adolescent Health Program, Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States.
Women's Global Health Imperative, RTI International, San Francisco, CA 94105, United States.
Am J Epidemiol. 2025 May 7;194(5):1221-1229. doi: 10.1093/aje/kwae294.
Previous research has demonstrated that the Reaching Married Adolescents intervention (RMA) was associated with changes in inequitable gender norms, intimate partner violence (IPV), and modern contraceptive use. This study seeks to understand if changes in inequitable gender norms mediate the RMA intervention's effects on contraceptive use and intimate partner violence (IPV). A 4-arm cluster randomized control trial was conducted to evaluate effects of the RMA intervention (household visits, small groups, combination, control) on married adolescent girls and their husbands in Dosso, Niger (baseline: 1042 dyads; 24 months follow-up: 737 dyads; 2016-2019). Mediation was assessed using inverse odds ratio weighting. In the small group intervention, of the total effect on IPV prevalence (8% reduction), indirect effects via inequitable gender norms are associated with a 2% decrease (95% CI, -0.07 to 0.12) and direct effects with a 6% decrease (95% CI, -0.20 to -0.02). For household visits, of the total effect on contraceptive use (20% increase), the indirect effect accounts for an 11% decrease (95% CI, -0.18 to -0.01) and direct effect, a 32% increase (95% CI, 0.13-0.44); this is similar to findings for the combination arm. This experimental evidence informs the value of changing underlying social norms to reduce IPV and increase contraception use.
先前的研究表明，“接触已婚青少年”干预措施（RMA）与不平等的性别规范、亲密伴侣暴力（IPV）以及现代避孕方法的使用变化有关。本研究旨在了解不平等性别规范的变化是否介导了RMA干预对避孕方法使用和亲密伴侣暴力（IPV）的影响。在尼日尔多索对已婚少女及其丈夫开展了一项四臂整群随机对照试验，以评估RMA干预措施（家访、小组活动、综合干预、对照）的效果（基线：1042对；24个月随访：737对；2016 - 2019年）。采用逆概率比加权法评估中介效应。在小组干预中，对于IPV患病率的总体影响（降低8%），通过不平等性别规范产生的间接效应导致降低2%（95%CI，-0.07至0.12），直接效应导致降低6%（95%CI，-0.20至-0.02）。对于家访，对于避孕方法使用的总体影响（增加20%），间接效应占降低11%（95%CI，-0.18至-0.01），直接效应占增加32%（95%CI，0.13 - 0.44）；这与综合干预组的结果相似。这一实验证据说明了改变潜在社会规范对于减少IPV和增加避孕方法使用的价值。
