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July 2007 Monthly Monitor

Advocates for Youth's Youth of Color Initiative

Feature: The Sexual Health of Asian--American/Pacific Islander Young Women

Young Asian and Pacific Islander (API) women face unique challenges to good reproductive and sexual health, including barriers to good communication about sex, low rates of condom use, and a lack of culturally specific sexual health programs and services. But cultural factors also provide them with unique assets they can draw upon to protect their well-being. Youth-serving professionals and policy makers should be mindful of these assets in order to better promote good outcomes for these young women. Following is a list of such assets as well as recommendations to incorporate them within programs.

1. Family Support and Communication:
   
   Family involvement and support are crucial for teens to develop self-protective sexual health behaviors. Open discussion about sex and sexuality between parents and teenagers reduces a number of sexual risk behaviors among teens.[1]
   
   Fewer than 10 percent of young API women in the National Longitudinal Study of Adolescent Health (Add Health) study who reported high parental attachment reported having had intercourse; more than half of those with low parental attachment had had intercourse.[2] API youth were more likely than other youth to believe their parents would disapprove of them having sex.[3] Asian mothers knew more about their daughters' sexual status, despite reporting feeling less comfortable talking about sex and communicating less with their daughters about sex.[4]
   
   Recommendations:
   
   Help Parental Communication Skills. API parents are exerting a positive influence over their children, yet they struggle with communicating with them about sexual health issues, a struggle which may be exacerbated by cultural and language differences between parents and children. API parents should be offered education about sex and sexuality, including HIV and pregnancy prevention.
   
   Additionally, parent-child discussions are critically important for young women's identifying and clarifying their own values with regard to sexuality. While there may be taboos within the culture about discussing sexual health issues, research shows that parental communication is crucial in young people's maintenance of good sexual health. "Values and expectations need to be communicated more explicitly in an American context than in an Asian environment," remarks one researcher.[5] Furthermore, young people want their parents to talk to them about sex; parents are often their preferred sources of information on these issues.[6,7]Schools and community centers should offer workshops on parent-child communication on sexuality.
2. Asian and Pacific Islander Cultural Identity:
   Identifying with API culture is very much a protective factor for young API women and it is the main factor shaping their sexual behavior.[8] Asian norms "inhibit premarital romantic and sexual expression more strongly than do the norms prevalent among other groups."[9] But aside from discouraging young women from engaging in sexual behaviors at a young age, ethnic identity affirmation "serves as a buffer for the negative effects of discrimination by peers on self-esteem."[10] In other words, those who feel good about their ethnic group are less hurt by discrimination - an important protective factor in a society that has not yet achieved racial harmony.
   
   Recommendations:
   • Promote appreciation of and respect for API cultures, for both Asian and non-Asian youth. Asian cultures are a strong protective factor for young women, but may also inhibit them from seeking reproductive health care. Research shows that if an API adolescent maintains strong ties with her heritage, then, even as she becomes acculturated, she does not become more sexually active or take more sexual risks.[11] Ideally, then, the adolescent would acquire HIV knowledge and learn to take care of her reproductive and sexual health, without falling prey to sexual risk behaviors. Research has also shown that for young API women, low self-esteem is associated with perceived discrimination; high-self-esteem and emotional health are important in young people's willingness and ability to use condoms and other contraception. [12]
   • Create culturally sensitive HIV and sexuality education programs. Since acculturation may lead to more sexual risk behavior, and since API parents and their children have difficulty communicating about sex, culturally sensitive, gender-specific sexuality education and HIV-prevention programs must be developed by schools, health care providers, and communities. To be most effective, such programs would take into account both the needs of the adolescent, and the norms in Asian cultures, allowing young women to learn about their sexual health while acknowledging their traditions.
   • Promote cultural competency. Cultural competency is an understanding and willingness to learn about unique worldviews of different people and communities. It includes avoiding cultural generalizations, listening instead to people's social construction of their own ethnic identity, and working to understand the social realities that they face.[13] Schools, health-care providers, and youth-serving professionals must be culturally competent to be effective in helping to protect young API women's health.
3. Self-efficacy for healthier sexual behaviors:
   Self-efficacy is a measure of young women's confidence to take steps toward outcomes they desire. Young API women show that they are capable of self-efficacy for refraining from sexual behaviors; an important step is to empower them to apply that confidence to condom use, reproductive health care, and other good sexual health behaviors. Research shows that young API women who report high self-efficacy scores are more likely to use condoms; feel more comfortable asking a partner to use a condom; and feel more comfortable refusing sex when their partner will not wear a condom.[14]
   
   Recommendations:
   • Provide complete sexuality education, including education about condom use. Research shows that programs that have successfully reduced the age of first sexual debut and/or increased abstinence among youth are programs that provide information about both abstinence and condoms as well as increase young people's communication and decision making skills.[15] Educating about contraceptives does not increase sexual risk behavior.[16]
     
     Research has shown that young API women have gaps in their HIV knowledge and may be less likely to use condoms than their peers.3 But one researcher found high receptivity for condom use, meaning that young women were not opposed to condom use.[17] Young women should be encouraged to carry condoms, because API youth who carry them are more likely to use them than youth who do not. Young women's sexuality education should include practicing how to use a condom, so that they will be further empowered to use them.
     
     Because of Asian cultural taboos that prohibit frank discussions of sex, learning about condom negotiation is especially important for young API women.[18] Furthermore, if there is a breakdown in parental communication about healthy sexual behaviors, school may be the only source these young women have for information about sexuality, so comprehensive sexuality education is vital.[19] One researcher has found that the most effective condom negotiation strategy for API women is "nonverbal-direct" (i.e., getting a condom out without discussion).[20] But young women should be instructed in various ways to negotiate condom use.
   • Include youth in creating, designing, and implementing programs and policies around sexuality education. Young people are at great risk from HIV and other negative sexual health outcomes, and must be included in helping to combat the epidemic. Furthermore, research shows that young API women are greatly influenced by peer behaviors and perceptions, so it simply makes good sense to utilize that influence by involving youth. Culturally specific peer education could be effective for this population.
   • Provide accessible and affordable health care. Since API young women may be reluctant to seek out reproductive health care, it is very important for providers' services to be affordable, youth-friendly, culturally sensitive, and confidential.[21]
4. School Achievement and Good Health Behaviors
   While we must not fall prey to stereotypes, and while underreporting must be taken into consideration, the fact is that API youth on the whole do well in school and have low rates of risk behaviors. API youth had the lowest dropout rate of all racial/ethnic groups in 2002/2003, and very high rates of attending college. In the Add Health study, young API women scored well in all areas and the best in several: they were the least likely of all youth to smoke cigarettes, take drugs, or have an STD.
   
   Recommendations:
   • Foster academic achievement for young API women. One aspect of the "model minority" myth is that the dominant culture feels threatened by Asian "superachievers."[22] But good grades appear to be a protective factor against sexual risk behaviors for these youth. Young women must be encouraged to do well in school and must be rewarded for doing so, regardless of race.
   • Make sure students have complete education about HIV transmission and prevention. API youth are good learners who do well at not putting their health at risk by smoking and using drugs. Educators and providers must link these priorities to HIV risk behaviors. Young API women are clearly very capable of making decisions that protect their futures; society should provide them with the tools they need to do so.
   For more information, click here.

References

1. Lagina N. "The Facts: Parent-child communication: promoting sexually healthy youth." Advocates for Youth, 2002.
2. Hahm CH, Lahiff M, and Barreto RM. "Asian American adolescents' first sexual intercourse: gender and acculturation differences." Perspectives on Sexual and Reproductive Health 2006; 38(1) 28-36.
3. Schuster MA et al. "The sexual practices of Asian and Pacific Islander High School Students." Journal of Adolescent Health 1998; 23: 221-231.
4. Meneses LM et al. "Racial/ethnic differences in mother-daughter communication about sex." Journal of Adolescent Health 2006; 39: 128-131.
5. Hahm CH, Lahiff M, and Barreto RM. "Asian American adolescents" first sexual intercourse: gender and acculturation differences." Perspectives on Sexual and Reproductive Health 2006; 38(1) 28-36.
6. Kaiser Family Foundation. "National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes and Experiences."; Henry J. Kaiser Family Foundation, 2003.
7. Hacker KA et al. Listening to youth: teen perspectives on pregnancy prevention. Journal of Adolescent Health 2000; 26:279-288.
8. So DW, Wong FY, and DeLeon JM. "Sex, HIV risks, and substance use among Asian American college students." AIDS Education and Prevention 2005; 17(5): 457-468.
9. Regan PC et al. "Gender, ethnicity, and the developmental timing of first sexual and romantic experiences." Social Behavior and Personality 2004; 32(7): 667-676.
10. Greene ML, Way N and Pahl K. "Trajectories of perceived adult and peer discrimination among Black, Latino, and Asian American adolescents: Patterns and Psychological Correlates." Developmental Psychology 2003; 42(2): 218-238.
11. Brotto LA et al. "Acculturation and sexual function in Asian women." Archives of Sexual Behavior 2005; 34(5): 613-626.
12. Zweig JM, Phillips SC, Lindberg LD. Predicting adolescent profiles of risk: looking beyond demographics. Journal of Adolescent Health 2002; 31(4):343-353.
13. Alford S. "From Research To Practice: The Sexual Health of Latina Adolescents - Focus on Assets." Advocates for Youth 2006.
14. Maxwell A et al. "Knowledge and attitudes toward condom use - do they predict behavior among Filipino Americans?" Ethnicity and Disease 2000; 10: 113-124.
15. Agha S. A quasi-experimental study to assess the impact of four adolescent sexual health interventions in sub-Saharan Africa. International Family Planning Perspectives 2002; 28:67-70, 113- 118.
16. Smoak ND et al. Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual risk behavior: a meta-analysis of 174 studies with 116,735 participants. Journal of Acquired Immune Deficiency Syndrome 2006; 31: 374-384.
17. Agha S. A quasi-experimental study to assess the impact of four adolescent sexual health interventions in sub-Saharan Africa. International Family Planning Perspectives 2002; 28:67-70, 113- 118.
18. Lam AG and Barnhart JE. "It takes two: the role of partner ethnicity and age characteristics on condom negotiations of heterosexual Chinese and Filipina American college women." AIDS Education and Prevention 2006; 18(1): 68-80.
19. "Reproductive Health Care and APA Women: A Fact Sheet." National Asian Pacific American Women's Forum, 2005. Accessed on August 1, 2006 from http://www.napawf.org/file/issues/Repro_Health_FactSheet.pdf
20. "Dropout rates in the United States: 2002 and 2003." National Center for Education Statistics 2006. Accessed on August 1, 2006 from http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006062
21. Okazaki S. "Influences of Culture on Asian Americans' Sexuality." The Journal of Sex Research 2002; 39(1):34-41.
22. "Native Hawaiians/Other Pacific Islanders." U.S. Department of Health and Human Services Office of Minority Health. Accessed from http://www.omhrc.gov/templates/browse.aspx?lvl=1&lvlID=5 on August 20, 2006.

The U.S. Department of Health and Human Services' Office of Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention (CDC) will host the 2007 National Prevention and Health Promotion Summit: Creating a Culture of Wellness. Two national associations, the Directors of Health Promotion and Education and the National Association of Chronic Disease Directors, join in sponsoring this conference. This groundbreaking event will unite health professionals, business entrepreneurs, and government leaders at all levels who are dedicated to health promotion; chronic disease prevention; health preparedness; preventing birth defects and disabilities; genomics; and wellness.

This conference will take place from November 27th - 29th in Washington DC. For more information, please visit: http://www.healthierus.gov.

Announcements

In June the CDC announced the launch of its first Web site dedicated to the health of gay, lesbian, bisexual, and transgender populations. This Web site is intended to inform and educate on the specific health issues of GLBTQ persons, including GLBTQ youth.

Visit the site here: http://www.cdc.gov/lgbthealth/

Job Opening At Advocates for Youth: International Policy Director

The International Policy Director promotes international policies that will improve adolescent access to comprehensive reproductive and sexual health information and services. The Director acts as the organization's voice on these issues on Capitol Hill, the United Nations, foreign governments, and with colleague organizations. The Director also develops policy and education materials for policy makers and the media.

To read the full description and to learn how to apply, please click here.

Job Opening at National Alliance of State and Territorial AIDS Directors (NASTAD):
Senior Program Associate, Racial and Ethnic Health Disparities

The Senior Program Associate, as part of NASTAD's Racial & Ethnic Health Disparities Team, will assist in expanding the organization's priority of addressing the disproportionate impact of HIV/AIDS among Black gay men, as well as supporting the development of NASTAD's youth portfolio and activities. Tasks include supporting on-going robust efforts to examine state and community-level responses to the HIV crisis among Black gay men and youth, while identifying the facilitators and barriers to effective programming targeting these populations.

To read the full description and to learn how to apply, please visit:
http://www.nastad.org/About/JobOpportunities.aspx

New Publications from Advocates for Youth:

• The Facts: Male Circumcision as HIV Prevention
• The Facts: The Impact of Homophobia and Racism on GLBTQ Youth of Color

Resources

• Advocates for Youth
• The Asian & Pacific Islander American Health Forum
• Asian & Pacific Islander Wellness Center
• The Office of Minority Health Resource Center

You can help Advocates for Youth with a contribution today. To donate, visit http://www.advocatesforyouth.org/about/donatetoday.htm

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