Whether you are child in Baltimore, Beijing, Nairobi or New Delhi, The onset of adolescence triggers a surprisingly common set of rigidly enforced gender expectations that are linked to increased lifelong risks of everything from HIV and depression to violence and suicide. 

This is the key finding from a groundbreaking 15-country study released today by the Global Early Adolescent Study, a collaboration between the Johns Hopkins Bloomberg School of Public Health and the World Health Organization (WHO) as a collection of articles in the Journal of Adolescent Health. 

Whether the adolescent is in Baltimore, Beijing, Nairobi or New Delhi, public health experts across the globe who collaborated to learn how an assortment of culturally enforced gender stereotypes long associated with an increased risk of mental and physical health problems become firmly rooted between the ages of 10 and 14. ÂWe found children at a very early ageÂfrom the most conservative to the most liberal societiesÂquickly internalize this myth that girls are vulnerable and boys are strong and independent, said Robert Blum, director of the Global Early Adolescent Study based at Johns Hopkins University. ÂAnd this message is being constantly reinforced at almost every turn, by siblings, classmates, teachers, parents, guardians, relatives, clergy and coaches. 

The findings emerged from a series of comprehensive interviews conducted over the last four years with approximately 450 early adolescents matched with a parent or guardian (totaling nearly 900) in Bolivia, Belgium, Burkina Faso, China, the Democratic Republic 2 of Congo, Ecuador, Egypt, India, Kenya, Malawi, Nigeria, Scotland, South Africa, the United States and Vietnam. Blum said the work shows a need to rethink adolescent health interventions, which typically focus on youth 15 years or older, so that they target a much younger age group. 

ÂAdolescent health risks are shaped by behaviors rooted in gender roles that can be well established in kids by the time they are ten or 11 years old, said Kristin Mmari, DrPH, associate professor and lead researcher for the qualitative research at the Global Early Adolescent Study. ÂYet we see billions of dollars around the world invested in adolescent health programs that donÂt kick in until they are 15, and by then itÂs probably too late to make a big difference. 

The Perils of Outfitting Adolescents with a ÂGender Straitjacket the conversations conducted by the researchers revealed that, around the world, young boys and girls are outfitted with Âgender straitjackets at a very early age, with lifelong negative consequences that are particularly perilous for girls. The researchers found that gender-based restrictions rationalized as Âprotecting girls actually made them more vulnerable by emphasizing subservience and implicitly sanctioning even physical abuse as punishment for violating norms. They observed that Âin many parts of the world these stereotypes leave girls at greater risk of dropping out of school or suffering physical and sexual violence, child marriage, early pregnancy, HIV and other sexually transmitted infections. 

For example, the researchers found boys in both New Delhi and Shanghai talked about being encouraged to spend time outside of the home in unsupervised exploration of their environment, while girls said they were advised to stay home and do chores. Shaming and beatings for those who sought to cross the divide was reported by girls and boys in both cities. 

In all but one city, Edinburgh, Scotland, both boys and girls were clear that it was the boy who had to take the initiative in any relationship. Across all settings, young girls reported a constant emphasis on their physical appearance and their bodies as their key asset. ÂIn New Delhi, the girls talked about their bodies as a big risk that needs to be covered up, while in Baltimore girls told us their primary asset was their bodies and that they need to look appealingÂbut not too appealing, Mmari said. The researchers noted that their findings bore out conclusions from previous work that Âduring adolescence, the world expands for boys and contracts for girls. 

But the researchers note that boys do not emerge unscathed. They point out that the stereotypes they learn in early adolescenceÂthe emphasis on physical strength and independenceÂmake them more likely to be the victims of physical violence and more prone to tobacco and other substance abuse, as well as homicide. Also, when researchers examined attitudes about gender roles among young adolescents in China, India, Belgium and the United States, they found a growing acceptance for girls pushing against certain gender boundaries, but almost zero tolerance for boys who do. 

In all four countries, it appeared to be increasingly acceptableÂto varying degreesÂfor girls to engage in certain stereotypically male behaviors, like wearing pants, playing sports and pursuing careers. But the researchers report that Âboys who challenge gender norms by their dress or behavior were by many respondents seen as socially inferior. Both boys and girls told researchers that the consequences for boys who were perceived as adopting feminine behavior, like painting their nails, ranged from being bullied and teased with harsh epithets to being physically assaulted. ÂWe know from research studies and programmatic experience that unequal gender norms can be changed, but this takes carefully planned and implemented interventions that target both young people and the environment they are growing and developing in, said V. Chandra Mouli, MBBS, MSc, co-director and scientist at the Adolescents and at Risk Populations Team, Reproductive Health and Research Department, World Health Organization. While many of the gender stereotypes documented in the study are not surprising, the fact they are so common across cultures and economic status and ingrained in children at such a relatively young ageÂis unexpected. She said the research could help shape new initiatives that foster greater awareness of the health consequences of gender stereotypes and focus on the critical Âtransitional years of early adolescence. 

Over the past six years, an international consortium of fifteen 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 fifteen countries around the world, and developed a tool kit to assess gender norms in early adolescents. 

Studies undertaken at Delhi and Shanghai suggest that parents teach their children to adhere to inequitable gender norms in both the places. However, education and career expectations for boys and girls in the two sites differed. Although gender norms varied by site according to the particular cultural and historical context, similar patterns of gender inequity reflect the underlying patriarchal system in both settings. The tendency of parents to pass on the norms they grew up with is evident, yet these results illustrate the social construction of gender through childrenÂs interaction with the social ecology, including evolving political and economic systems. Efforts to bend gender norms toward greater equality can build on these results by empowering children and parents to reflect critically on inequitable gender norms and roles and by mobilizing economic and social support at key turning points in adolescents lives.

Their findings reveal that boys and girls growing up in the same community are socialized differently during their transition from early to later adolescence. In both sites, for example, boys, in contrast to girls, spent time outside their home in undirected activities, taking advantage of the opportunity to explore their environment and develop dominant behaviors. Gender inequitable norms related to dress, demeanour, roles (education and career) and boy-girl relationships are transmitted by instruction, beating and scolding, as well as positive reinforcement and mitigation. 

Interactions with the opposite sex were tightly controlled for boys and girls in both countries during early adolescence. This may be due to the fear of pregnancy, which would jeopardize family honor and may put in play a series of lifelong negative physical and emotional consequences. Adolescents and their parents identified mothers as the primary socialization agent, but fathers, siblings, extended families, and peers also played important roles. These results are consistent with early cross-cultural research on socialization which demonstrated the influential roles of parents, siblings, peers, and task assignment on learning gender and suggested that socialization processes operating throughout the life course can increase, reduce, or eliminate gendered behavioural differences.