J Immigrant Minority Health (2013) 15:350–356 DOI 10.1007/s10903-012-9668-5
ORIGINAL PAPER
Sex Education Among Asian American College Females: Who is Teaching them and What is Being Taught Christine Lee • Denise Yen Tran • Deanna Thoi Melissa Chang • Lisa Wu • Sang Leng Trieu
•
Published online: 5 July 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Many parents are reluctant to educate their Asian American adolescents on sexual health topics because sexuality is taboo in most Asian cultures. A survey was conducted with Chinese, Filipina, Korean, and Vietnamese college females ages 18–25 to assess sources of abstinence and birth control education and age of sexual debut. Parents were the least reported source of sex education for all four ethnic groups, with the majority of respondents reporting school as their source of sex education. Respondents who reported family as their source of abstinence education had a sexual debut of 6 months later than those who did not. Females who reported family as their source of birth control education began having sex more than 7 months later than those who reported other sources. Disaggregation of data by Asian ethnic groups and examining differences in delivery of sex education among ethnic groups may improve school curricula and sexual health. Keywords Asian American Sex education Sexual debut College females
C. Lee (&) D. Y. Tran D. Thoi M. Chang L. Wu S. L. Trieu Department of Asian American Studies, University of California Irvine, 3000 Humanities Gateway, Irvine, CA 92697, USA e-mail:
[email protected] S. L. Trieu National Asian Pacific American Women’s Forum, 1511 Water St., New York, NY 11201, USA
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Introduction There is an existing need for comprehensive sexual health education (CSHE), especially among Asian American adolescents. The Guttmacher Institute reports there is little evidence linking abstinence-only education with later teen sexual activity; a quarter of adolescents receive abstinenceonly education without instruction on birth control [1]. Despite the model minority myth, which posits Asian Americans tend to have better health status and engage in less risky behavior, sexually active Asian Americans reported similar rates of risky sexual behavior relative to other ethnic groups [2]. Although California’s Education Code on CSHE states sex education must be culturally appropriate and include parent–child communication, there is a lack of resources aimed at involving Asian American parents [3–5]. Additionally, only 0.2 % of federal health-related grants in 2003 were dedicated to Asian American health issues, even though Asian Americans comprise approximately 5 % of the United States population [6, 7]. The heterogeneity of this population requires disaggregation of data in order to unmask health issues in specific ethnic groups. Currently, there is limited literature on sex education in the Asian American community. What little has been reported focuses on the reluctance of Asian parents to directly engage in educating their children on sex. Studies focusing on Asian Americans have shown that parents and adolescents believe sex education should primarily be taught in school; parents stated they were satisfied with the sex education curricula taught in school, despite having little knowledge of the content being covered [8]. Asian American adolescents placed school as their preferred source of sex education, with parents as their least [9]. Parents and adolescents rarely talk about sex education topics with each other to avoid discomfort. When Asian
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parents do talk about sex with their children, the message is generally prohibitive, even in close parent-adolescent relationships [10, 11]. Age of sexual debut is a common proxy used to assess impact of sex education and interventions to improve the sexual health and well-being of adolescents. An important outcome of sex education is to equip students with the knowledge and skills to postpone sexual activity. In comparison to other ethnic groups, several studies have shown that Asian American females had the latest sexual debut at 17.63 years old [12, 13]. Even though parental influence may be a protective factor against earlier sexual debut, communication about sex topics is considered taboo [14, 15]. A large-scale study found that youth of all ethnicities who were formally taught how to say ‘‘no’’ by parents had fewer sex partners and were less likely to engage in sex compared to those who were not taught such skills. Furthermore, it was shown that if mothers approved of sexual activity, then Asian American adolescents were more likely to have a sexual debut prior to 15 years of age [16]. Past research revealed that for Asian American women, acculturation plays an important role in predicting earlier age of sexual debut [12, 17]. Birth control education is a critical and recommended component of CSHE [3]. Asian American females were found to be the least likely, compared to other ethnic groups, to use birth control in preventing pregnancy [18]. Such findings align with a study which reported that 37.1 % of Asian American females have had unprotected sex in their lifetime [19]. These studies show the need to increase birth control education at home. Though discussion of birth control is virtually absent in Asian American households, studies indicate that Asian American females do use birth control when they engage in sexual activity. For instance, one study of Chinese/Chinese American college students showed that 57 % of respondents relied on condoms alone as the most frequently used method of birth control the last time they had vaginal intercourse, whereas 22 % reported birth control pills [20]. The existence of mixed findings demands further investigation into birth control usage among this population. Sexual education is an important component of adolescent development—one that garners great attention in public health. In Asian American cultures, the topic of sex is taboo; families tend to defer the teaching of this issue to other sources, namely those deemed trustworthy. For issues of sexual education, schools and healthcare providers are considered credible; however, they are not and should not be the sole educators [21]. From whom are Asian American adolescents actually learning about sexual education and on what specific topics? How does the source and topic of sexual education affect a key aspect of sexual health behavior, specifically the age in which Asian American
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adolescents began to have sex? These questions serve as the framework for this study. The purpose of this paper is to report disaggregated data on sources of sex education, specifically abstinence and birth control, and its association with age of sexual debut among Chinese, Vietnamese, Filipina, and Korean undergraduate female students.
Methods This sample included undergraduate females ages 18–25 of all ethnicities at a public university in Southern California. The University Registrar provided 5,000 random email addresses of undergraduate female students to complete an anonymous online survey through SurveyMonkey, which took approximately 20–25 minute to complete. To participate in the study, the individual must have met the following criteria: 18–25 years old, female, and reported ethnic identity. Five $25 gift cards and an iPod touch (valued at $200) were offered to participants through random drawing upon survey completion. Twenty-three percent of e-mailed recipients completed the survey, which is comparable to surveys of similar size [22]. The survey tool consisted of 54 questions including two open-ended questions. The survey was divided into seven sections: Demographics, sexual education, sexual history, sexual health care and practices, opinions on sex and gender, sex selection, and views of abortion. For the purpose of this paper, demographics, sexual education, and sexual history were examined. Sexual education consisted of six topics: Abstinence, types of birth control, where to get birth control, reproduction/fertility, the Pap test, and sexual violence. For each of the six topics, participants were asked to identify the education source from a list of ten sources. These sources were then collapsed into five categories: Family (mother/ female guardian, father/male guardian, other relatives), significant other, school (K-12, college), healthcare professional, and social influences (friends, media). The question in the survey is as follows: ‘‘Please think about where you have learned about each of the following sex-related topics. Place a check next to the source(s) that provided information to you. (Check all that apply.)’’. It must be noted that the survey tool did not explicitly define what messages were provided for abstinence or birth control education, so there is no way of knowing whether the education was favorable or unfavorable (i.e., promoting or prohibiting abstinence or birth control). For sexual history, specifically age of sexual debut, participants were given a choice of selecting an age from 8 to 25 years, or responding with ‘‘do not remember’’, ‘‘decline to answer’’, or ‘‘no history of sexual activity.’’ Respondents were also asked about their current relationship status and could choose from: ‘‘not dating, not committed’’,
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‘‘dating, not committed’’, or ‘‘dating, in a committed relationship’’. Raw data were downloaded onto SSPS version 19.0 (IBM Somers, New York) and cleaned for missing values such as ethnicity, age, or sexual history. Descriptive statistics for demographics, sexual debut, sources of sexual education, and types of sexual education were tabulated. Analysis of variance was calculated to test the differences in abstinence and birth control education and their effects on the age of sexual debut. Significance was defined at an alpha level of .05 or less. Approval of this study was granted by the university Institutional Review Board.
Results The original sample included 1,100 respondents; a subset of 455 respondents was used for this paper. This subset
focused on the following ethnic groups: Chinese (46 %), Vietnamese (25 %), Filipinas (18 %), and Koreans (11 %) (Table 1). These four groups were the predominant Asian American groups on campus. Approximately half of the study sample consisted of freshmen and sophomore students (49 %) and the remaining half were junior and senior students (51 %). The respondents were predominantly heterosexual (96 %), while the remainder was collapsed into non-heterosexual (4 %). The majority of the sample associated themselves with a religion (62 %). About 2 in 5 students (42 %) had been sexually active. The relationship status for more than half of the sample was ‘‘not dating’’ (55 %), slightly more than one-third (36 %) were ‘‘in a committed relationship’’, and about one in ten were ‘‘dating’’ (9 %). Fifty percent of respondents reported their fathers as college-educated and nearly half (48 %) reported their mothers as college-educated. Vietnamese parents had the least amount of education compared to Chinese,
Table 1 Demographics of sample population Chinese (N = 210) % (N)
Vietnamese (N = 114) % (N)
Filipina (N = 81) % (N)
Korean (N = 50) % (N)
Age (N = 455) 18–20
67.1 (141)
69.3 (79)
71.6 (58)
74.0 (37)
21–25
32.9 (69)
30.7 (35)
28.4 (23)
26.0 (13)
Nativity (N = 455) US born
73.8 (155)
72.8 (83)
74.1 (60)
76.0 (38)
Non US born
26.2 (55)
27.2 (31)
25.9 (21)
24.0 (12)
41.9 (88)
70.2 (80)
92.6 (75)
82.0 (41)
58.1 (122)
29.8 (34)
7.4 (6)
18.0 (9)
Very important
38.6 (34)
17.5 (14)
46.6 (34)
60.0 (24)
Moderately important
30.7 (27)
45.0 (36)
37.0 (27)
27.5 (11)
Slightly important
30.7 (27)
32.5 (26)
16.4 (12)
10.0 (4)
Not important
0.0 (0)
5.0 (4)
0.0 (0)
2.5 (1)
Associates with religion (N = 455) Yes No Importance of religion (N = 281)
Relationship status (N = 452) Not dating, not committed
56.0 (117)
58.4 (66)
46.3 (37)
58.0 (29)
In a committed relationship
36.4 (76)
33.6 (38)
42.5 (34)
32.0 (16)
Dating, not committed
7.7 (16)
8.0 (9)
11.3 (9)
10.0 (5)
Heterosexual
93.3 (196)
95.6 (109)
93.8 (76)
90.0 (45)
Non-heterosexual
6.7 (14)
4.4 (5)
6.2 (5)
10.0 (5)
High school or less
33.0 (67)
46.4 (51)
6.2 (5)
34.0 (16)
Some college College educated
18.2 (37) 48.8 (99)
25.5 (28) 28.2 (31)
19.8 (16) 74.1 (60)
23.4 (11) 42.6 (20)
High school or less
29.1 (59)
30.2 (32)
12.8 (10)
25.5 (12)
Some college
18.2 (37)
33.0 (35)
30.8 (24)
17.0 (8)
College educated
52.7 (107)
36.8 (39)
56.4 (44)
57.4 (27)
Sexual orientation (N = 442)
Maternal education (N = 441)
Paternal education (N = 434)
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Respondents who reported family as a source of abstinence education began having sex half a year later (6 months) than those who reported another source; respondents who reported family as their source of birth control education began having sex approximately seven months later (7.2 months). Family as a source of abstinence and birth control education was associated with a later sexual debut. In contrast, respondents who reported school as a source of abstinence education began having sex about eight months (8.4 months) earlier than respondents who did not receive their abstinence education from school. There were no significant differences in age of sexual debut between those who received abstinence or birth control education from healthcare providers or social sources.
Filipina, and Korean parents; about 3 out of 4 Filipina mothers had a college degree or higher. Table 2 illustrates the sources of abstinence education by ethnicity. Among the four ethnic groups, Filipinas (85.2 %) had the highest rate of receiving abstinence education through school compared to Chinese (72.4 %), Vietnamese (68.4 %) and Koreans (64.0 %). Filipinas (63.0 %) also had the highest rate of learning about abstinence through family, compared to Vietnamese (54.4 %), Chinese (46.2 %), and Koreans (42.0 %). Vietnamese (44.7 %) and Koreans (42.0 %) were more likely to receive abstinence education through social means. Overall, healthcare providers ranked the lowest out of all five sources of abstinence education [8–11.4 %]. More than half of the respondents (55.6 %) reported school as a source of birth control education, followed by social sources (45.7 %) and healthcare providers (32.1 %), while family (10.8 %) was reported the least. When examining across ethnicities, Filipinas most frequently reported receiving birth control education from school (61.7 %), healthcare providers (42 %), and family (13.6 %). In comparison, Koreans reported more frequently receiving birth control education from social sources (62 %), but also reported the lowest levels of birth control education from school (50 %), healthcare providers (18 %), and family sources (8 %). The next set of analyses compared the mean age of sexual debut for women who reported receiving abstinence and birth control from family, school, healthcare providers, and social sources and those who did not, collapsed across ethnicity (Table 3). The overall mean age of sexual debut for respondents was 17.4 years old. The mean ages of sexual debut for the four ethnic groups were as follows: Filipinas 17.0 years old (SD = 1.5), Chinese 17.4 (SD = 1.5), Vietnamese 17.5 (SD = 1.6), and Koreans 17.8 (SD = 2.0). There was a gap of nearly one year (9.6 months) in age of sexual debut between Filipinas and Koreans.
Discussion This study focused on the largest Asian American ethnic groups at a public university: Chinese, Vietnamese, Filipina, and Korean. Moreover, the ratio of Chinese (19 %), Vietnamese (10 %), Filipina (7 %), and Korean (5 %) women represented in this study was consistent with the campus in terms of the proportion of the Asian American population [23]. These four are the largest and the fastest growing subgroups in the Asian American community [24]. Approximately 3 out of 4 were US born, reflecting a mostly-native born sample population. Sex is a taboo topic in Asian American communities, affecting how sex education is delivered [15]. Although this survey assessed six sex-related topics, the study focused on abstinence and birth control, which are content requirements of a comprehensive approach to sex education under the California Education Code [1, 4]. In Asian American families, parents often give strong messages on abstinence, rarely discussing birth control [11, 25, 26]. This is consistent with the study’s finding that family as a source
Table 2 Sources of abstinence and birth control education by ethnicity Chinese N
Vietnamese %
N
Filipina %
N
Korean %
N
%
Abstinence School
152
72.4
78
68.4
69
85.2
32
64.0
Family
97
46.2
62
54.4
51
63.0
21
42.0
Social (e.g. friends and media)
80
38.1
51
44.7
32
39.5
21
42.0
24
11.4
23
20.2
15
18.5
4
8.0
School
123
58.6
55
48.2
50
61.7
25
50.0
Family
20
9.5
14
12.3
11
13.6
4
8.0
Social (e.g. friends and media)
93
44.3
49
43.0
35
43.2
31
62.0
Healthcare provider
64
30.5
39
34.2
34
42.0
9
18.0
Healthcare provider Birth control
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was reported five times more frequently for abstinence (50.8 %) than birth control (10.8 %). When comparing sources of abstinence education by ethnicity (Table 2), Filipinas ranked the highest in the two most reported sources (school and family) possibly because their earlier immigration patterns to the US resulted in less of a language barrier [27]. Past studies’ assertion that Asian American parents and adolescents generally agree school should be the primary source of sex education may explain why school was reported higher than family as a source of sex education [8, 9]. Furthermore, some Asian American adolescents from previous studies stated they learn enough about sex from school, and were therefore less willing to discuss the topic with parents [8]. Compared to other ethnic groups in this study, Filipina respondents had the highest rates of birth control education from family, school, and healthcare professionals. Koreans had the lowest rates of birth control education from family and healthcare professionals, reporting social sources as their highest source of birth control education. Chinese respondents ranked in the middle for all four sources of education. Vietnamese respondents exhibited similar patterns as Chinese respondents, with the exception of school, which ranked lowest compared to other ethnic groups. Family was reported least often as a source of birth control education for all four ethnicities. Even when birth control was discussed in a family setting, a study found that nearly six in ten (57.3 %) Asian American adolescents perceived a disapproving message from their mothers [16]. Asian American parents remain conservative in discussing sexually-related topics, suggesting the belief that by educating
Table 3 Type of sex education by source and its effect on age of sexual debut Age of sexual debut
F
df
Received
Did not receive
School
17.2
17.9
7.479*
1,188
Family
17.6
17.1
4.356*
1,188
Social (e.g. friends and media)
17.3
17.4
0.367
1,188
Healthcare provider
17.4
17.4
0.007
1,188
School
17.3
17.5
0.361
1,188
Family
17.9
17.3
3.687
1,188
Social (e.g. friends and media)
17.5
17.3
0.718
1,188
Healthcare provider
17.4
17.4
0.000
1,188
Abstinence (N = 190)a
Birth control (N = 190)a
Conclusion
* p \ 0.05 a
Data is for sexually active participants only
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their children on birth control usage, parents are sending a permissive message to be sexually active at an earlier age. However, one study found that mothers’ approval of birth control usage did not have any effect on sexual outcomes such as earlier sexual debut and riskier sexual behavior, suggesting that parental concern of sending a permissive message by engaging in sexual discussion with children is unfounded [16]. The ages of sexual debut for participants in this study were similar to those in other studies involving Asian American women [12, 13]. Previous studies have shown that more acculturation is associated with riskier sexual behaviors [28, 29]. Filipinas (age 17.0), a relatively acculturated population within the Asian American community, have the earliest sexual debut among the other Asian ethnic groups. In contrast, Chinese, Vietnamese and Koreans had later sexual debut, which may be due to factors such as non-nativity of parents and their educational attainment. Family as a source of abstinence and birth control education was associated with later sexual debut, while school-based education was associated with an earlier sexual debut. This may be because Asian American parents tend to provide prohibitive, abstinence-based messages [11]. Even though both Asian American adolescents and parents prefer school to be the main source of sex education, open family communication about sex is associated with decreased sexual risks [8]. Additionally, California’s Education Code stresses sex education must be a shared responsibility between school and family [3, 4]. An unexpected result was the inverse relationship of Filipinas having an earlier age of sexual debut than Koreans, despite Filipinas having higher levels of sex education. This may be ascribed to Filipina’s higher rates of acculturation to American culture; higher rates of acculturation is commonly associated with riskier sexual behavior than traditional Asian cultures [28, 29]. Koreans have more recent immigration patterns in comparison to the earlier immigration patterns of Filipinos [28]. Acculturation may play a role in higher levels of sex education through family communication, but may be associated with an earlier age of sexual debut for Asian American adolescents.
Findings from this study may help improve the delivery of sex education to Asian American adolescents. For example, school boards who oversee sex education curricula are encouraged to be more culturally sensitive by taking into account cultural differences [4]. Healthcare providers, highly respected in the Asian community, may fill the gap
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on birth control education, and would therefore be a credible source [21]. Future studies should include Asian American men in order to explore gender differences in sex education, because Asian American adolescent men receive more permissive messages [11]. Inclusion of men in future studies could promote better decision-making between heterosexual partners, as well as improve communication between Asian fathers and their daughters. The need for disaggregated research data on Asian Americans has already led to recommendations of federal standards adding seven subgroups (including Chinese, Filipino, Vietnamese, and Korean) to national population health surveys [30]. Further studies should continue disaggregating Asian American data, particularly for other ethnic groups that are not as well represented, and the emergence of other Asian American groups, such as South Asians. This study’s findings align with previous studies that have focused on sources of sex education and sexual debut among Asian American young women; however, particular limitations should be noted. The survey instrument did not delineate whether the messages about abstinence were favorable or unfavorable, as the question asked was broad. This research was conducted at a single university in California; therefore, it is not possible to generalize these findings to other college campuses. Additionally, the disaggregation of data allowed for meaningful analysis of only the four most populous ethnic groups surveyed. Furthermore, statistical tabulations on age of sexual debut in relation to source and topic of sex education could not be disaggregated by ethnicity due to small numbers. Certain demographic factors not measured, such as socioeconomic status, could shed additional light on whether participants had access to other sources. Despite these limitations, this study contributes to the literature by providing disaggregated data on a topic that has been seldom researched for Asian Americans: Sexual debut in relation to abstinence and birth control education. The study used a community-based participatory research approach to disseminate the findings through a campuswide summit. Asians were the fastest emerging population compared to all other major racial groups between 2000 and 2010, and this trend is expected to continue [7]. Disaggregating data among Asian American adolescents reveals distinct differences in types of sexual education and the sources the education comes from. Because acculturation is associated with riskier sexual behavior, the political climate of how and where Asian Americans should receive sex education becomes more pertinent, not just to the Asian American community but also to other immigrant populations [12, 28]. This study can serve as a tool to inform policymakers on the importance of sex education and age of sexual debut differences within the Asian American community.
355 Acknowledgments This research is part of a study sponsored by the National Asian Pacific American Women’s Forum through the California Young Women’s Collaborative. We thank the Department of Asian American Studies at University of California, Irvine for hosting the AsianAm 150 Asian American Women’s Public Health Research and Field Studies course. We appreciate the students who participated in the survey, making this study possible. We would also like to thank the following individuals for their insightful comments in the manuscript review: Kelly Blanchard, Lidia Carlton, Tu-Uyen Nguyen, Miriam Yeung, Jacob Chang, and Divya Shenoy.
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