Transcript Abstinence From Sex and Condom Use Among Asian

Abstinence From Sex and
Condom Use Among Asian
American Adolescents
Inseon Hwang, DNSc, RN
October 23, 2001
129th APHA meeting, Atlanta
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Acknowledgement
This dissertation and doctoral training were supported
by National Research Service Award
from National Institute of Nursing Research
Outline of Presentation
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Research Questions
 Theoretical Framework
 Definitions
 Study Design
 Methodology
 Sampling
 Limitations
 Data analysis
 Measures
 Results
 Conclusions
 Implications
Research Questions
What are the factors related to
abstinence from sex and condom
use among Asian American
Adolescents?
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Research Questions (continued)
1. What is the strongest predictor of intention to abstain:
attitudes, subjective norms, self-efficacy, or demographic
background variables?
2. What is the strongest predictor of reported abstinence
behaviors: attitudes, subjective norms, self-efficacy,
demographic background, or intention variables?
3. What is the strongest predictor of intention to use
condoms: attitudes, subjective norms, self-efficacy, or
demographic background variables?
4. What is the strongest predictor of reported condom use
behaviors: attitude, subjective norms, self-efficacy,
demographic background, or intention variables?
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Theoretical Framework
Demographics
. Sex
. Age
. Ethnicity
. Parental
education
. Family
structure
. Acculturation
status
Behavioral
beliefs
Attitude
*
Outcome
evaluations
Normative
beliefs
Intention
Behavior
Subjective
norm
*
Motivation to
comply
Self-efficacy
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Definitions
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1. Adolescent : person whose age is between 10 to 19
years
2. Asian American : person having origins in any of the
original peoples of the Far East, Southeast Asia, and the
Indian subcontinent (Office of Management and Budget,
1978)
3. Intention : one’s probability judgment of how the person
intends to behave
4. Attitude : evaluation of the favorability of the target
behavior
5. Behavioral belief : perceived likelihood that the behavior
will lead to certain outcomes
6. Outcome evaluation : evaluation of each of the outcomes
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Definitions (continued)
7. Subjective norm : one’s judgment concerning the perceived
pressure to perform or not perform the behavior
 8. Normative belief : perceived likelihood that specific individuals
or groups want the person to perform the behavior
 9. Motivation to comply : willingness to follow the expectations of
the specific individuals or groups
 10. Self-efficacy : perceived capability to perform behavior in
question under different circumstances
11. Acculturation comprehends those phenomena which result
when groups of individuals having different cultures come into
continuous first-hand contact, with subsequent changes in the
original culture patterns of either or both groups (Redfield, Linton,
& Herskovits, 1936).
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Study Design
Phase
I: Open-ended
Questionnaire
Purpose
Elicit Information
To validate tools from
previous study
II: Pilot study
Evaluate tool’s readibility 10-11, 1999
& understandability
Evaluate reliability &
validity of 3 instruments
III: Final survey Identify factors related to
abstinence from sex
and condom use
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Period
4-7, 1999
2-3, 2000
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Participants
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45
84
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Methodology
A self-administered survey
A convenience sample of 84 Asian
American adolescents (Chinese &
Korean) in New York City
Recruited from street and a church
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Sampling
A convenience sample was obtained from
areas surrounding local high schools and
a church in Queens
Criteria for inclusion were AAA who identify
themselves as Asian Americans, read and
understand English, and had consent from
parents.
Adolescents were defined as between 15 to
18 years of age.
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Limitations
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Limited to AAA living in one neighborhood
New York City during Feb to March, 2000
Limited to AAA who received permission
from their parents
Participant bias
Self-reported outcome behaviors
Cultural variation within each Asian
country and between countries
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Measures
Behavioral
beliefs
(AB:27
CO:26)
Demographics
. Sex (1)
. Age (1)
. Ethnicity (1)
. Parental education
(2)
Outcome
evaluations
(AB:27 CO
26)
Normative
beliefs (AB:4
CO:4)
Motivation to
comply (AB &
. Acculturation status CO:4)
Attitude
(AB:1
CO:1)
Subjective
norm
(AB:1
CO:1)
Intention
(AB:1
CO:1)
Behavior
(AB:2
CO:2)
. Family structure (1)
(21)
Self-efficacy
(AB:14
CO:15)
* # in parentheses indicates # of questions of each scale. AB: abstinence CO: condom
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Independent Variables
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Demographics: Age (1), Sex (1), Ethnicity (1), Parental education (2), Family
structure (1), Steady partner info (4), and others (8)
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Asian Acculturation Scale (21)
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Direct abstinence attitude (1)
Abstinence behavioral beliefs
(27)*
Abstinence outcome evaluations
(27)*
Direct abstinence subjective
norm (1)
Abstinence normative beliefs (4)
Motivation to comply (4)
Direct abstinence self-efficacy (1)
Indirect abstinence self-efficacy
(14)*
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Direct condom use attitude (1)
Condom use behavioral beliefs
(26)*
Condom use outcome
evaluations (26)*
Direct condom use subjective
norm (1)
Condom use normative beliefs (4)
Direct condom use self-efficacy
(1)
Condom Use Self Efficacy Scale
(CUSES) (15)
* Developed by researcher (New scale)
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Dependent Variables
Intention to abstain from sex (1)
 Intention to condom use (1)
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Vaginal intercourse behavior with
steady and casual partner (2)
 Condom use frequency with steady
and casual partner (2)
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Measures: example of abstinence items
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Intention: How likely is it that you will decide to abstain from sex
in the next 3 months?
Direct Attitude: How do you feel about abstaining from sex in the
next 3 months?
Behavioral beliefs: I am too young to have sex.
Outcome evaluations: In your opinion, having sex at young age is
Direct subjective norm: Would most people who are important to
you approve or disapprove of you abstaining from sex in the next
3 months?
Normative beliefs: Would your mother approve or disapprove of
abstaining from sex in the next 3 months?
Motivation to comply: In general, how important to you are your
mother’s opinions about what you do?
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Measures: scoring of abstinence items
Response Score convert
Intention (1)
Direct attitude (1)
Indirect attitude (19)
- behavioral belief
- outcome evaluations
Direct subjective norm (1)
Indirect subjective norm (4)
- normative belief
- motivation to comply
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1-5
1-5
1-5
1-5
1-5
1-5
1-5
-2 - +2
-2 - +2
1-5
1-5
1-5
-2 - +2
1-5
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Total
1-5
1-5
-4 - +4
1-5
-10 - +10
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Data Analysis
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SPSS 9.0 window version
Reliability and validity analyses for new
scales
Descriptive analyses
Bivariate analyses (Chi-square, Pearson
product moment correlation, & T-tests)
Logistic regression analysis: Multiple and
Univariate analysis
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Data Analysis (continued)
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How to dichotomize ordinal variables
- Observed frequencies
- Divided into three groups: positive,
neutral, and negative
- Positive group (1) vs. Neutral and
negative group (0)
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Results - demographics
Average age: 16.4 years old
 Females (61%) vs. Males (39%)
 Mainly Chinese (50%) and Korean
(44%) American adolescents
 Born in US (61%) vs. Immigrated
(39%)
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Results – demographics (continued)
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Living with both parent (79%) vs. singles
or relatives (21%)
Parental education: not college graduate
(40%) vs. college graduate and more (60%)
37% of participants were in boy/girlfriend
relationship
18% of participants had ever vaginal sex
6 out of 15 participants were ‘Always
Condom Users’
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Q1:Predictors of intention to abstain
Multiple logistic regression analysis
 Positive direct abstinence attitude
(OR=15, p=.0002)
 Positive indirect abstinence
subjective norms (OR=4.8, p=.0261)
 Living with both parent (OR=3.9,
p=.0861)
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Q2: Predictors of abstinence behaviors
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Univariate logistic regression analyses
Not having a partner (OR=42, p=.0005)
Direct positive abstinence attitude (OR=28, p=.0019)
Positive abstinence intention (OR=17, p=.0001)
Indirect positive abstinence attitudes (OR=7, p=.0190)
Indirect positive abstinence self-efficacy (OR=6, p=.0083)
Living with both parent (OR=5, p=.0205)
Direct positive abstinence self-efficacy (OR=3, p=.0602)
Younger age (OR=.44, p=.0311).
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Q2: Sub-group analysis (abstainers vs nonabstainers among those in partner relationship
Multiple logistic regression
 Positive direct abstinence attitude
(OR=33, p=.0034)
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Q2: Sub-group analysis (relationship between
abstinence beliefs and abstinence behaviors)
Category
Virginity beliefs
Beliefs about
delaying sex
Prevention beliefs
Future focusing
beliefs
Intimacy beliefs
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Abstinence Behavioral Beliefs
I believe that a teen should be a virgin.
I believe that I will proud of myself if I remain a virgin during my
teen years
I believe that women should not have sex until they get married.
I believe that I am too young to have sex.
I believe that I would prefer to wait until I am older to begin having
sex.
I believe that if I have sex, I am likely to get AIDS.
I believe that if I have sex, then I am likely to get STDs.
I believe that if I have sex during my teen years, then I am less likely
to graduate from high school.
I believe that if I have sex during my teen years, then I am less likely
to have the career that I hope for.
I believe that if I don’t have sex, it means that I don’t really love my
boyfriend/girlfriend.
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Q3: Factors related to use condoms
Multiple logistic regression
 Positive direct condom use attitude
(OR=16.5, p=.0098)
 Positive indirect condom use
subjective norm (OR=8.9, p=.0678)
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Q4: Factors related to condom use behaviors
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Due to small number of condom
users no predictors were found to
have significant relationship from
bivariate analysis
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Conclusions: abstinence
Protective factors: high value for
virginity and delaying sex, futurefocused, positive attitude &
subjective norm about abstinence,
positive family structure, and
support from peers
 Negative factors: intimacy beliefs
 The role of self-efficacy is not clear.
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Conclusion: condom use
Positive factors: positive attitude and
subjective norm about using
condoms
 Role of self-efficacy is not clear.
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Conclusion: measures
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Theory of reasoned action
- attitude and subjective norm can be applicable
to Asian American youth
- moderate correlation between direct and
indirect measures implies the possibility of
dropping outcome evaluations and motivation to
comply for shorter questionnaires
- Improvement of instrument; changing double
negative items, factor analyses of indirect
attitude measures, and separate items for
motivation to comply for abstinence and condom
use
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Conclusion: measures (continued)
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Self-efficacy
- role of self-efficacy is not clear
- high score of abstinence self-efficacy
- low score of condom use self-efficacy
- Improvement of abstinence self-efficacy
items
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Implications: abstinence
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Encouraging children’s academic
achievement & career development
Expressing values around virginity and
later sex
Discussing about the development of
romantic relationship
Skill training to resist partner or friends’
influences
Optional information about condoms
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Implications: condom use
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Teaching ways to ask their partners about using
condoms
 Teaching the fact that partners are expecting their
request to use condoms
 Encouraging assertive attitudes, ‘no condom = no
sex’ before developing relationship
 Teaching how to carry condoms always
 Teaching facts about condom’s effectiveness and
proper use
 Teaching where to get free condoms
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