SEXUAL NORMS, GENDER ROLE BELIEFS, CONDOM ATTITUDES AND SEXUAL BEHAVIORS AMONG YOUTH IN HANOI, SHANGHAI AND TAIPEI
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Date
2014-06-05
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Johns Hopkins University
Abstract
Background
Health behaviors are increasingly being understood through the lens of attitudes and beliefs that contribute to them. Youth in Asia face a world very different from that of their parents, however there is a dearth of research on sexual and reproductive health issues among Asian youth. Understanding the ways in which attitudes and beliefs shape sexual behaviors is an important first step in designing appropriate programming that empowers Asian youth to live healthy lives.
Methods
Using data from unmarried youth surveyed in the Three Cities Study of Hanoi, Shanghai and Taipei, I conducted exploratory, confirmatory and multiple group factor analyses to develop and examine scales for gender role beliefs, sexual norms and condom attitudes. Through these analyses I proposed and confirmed the factor structure of each latent construct, tested the fit of the models, and evaluated the heterogeneity of each scale by city, sex, and city and sex groupings. I used logistic regression analyses to examine the association of sexual norms and gender role beliefs with sexual experience on all unmarried youth. I performed multiple logistic regression modeling to examine the association between condom attitudes and condom use at first and last sex among all sexually experienced, unmarried youth.
Results
Exploratory analyses revealed a four item sexual norms scale, a three item gender role beliefs scale, and a four item condom attitudes scale, each showing acceptable reliability. Confirmatory analyses of both gender role beliefs and sexual norms showed acceptable fit, while sexual norms showed less than acceptable model fit. Multiple group analyses showed gender role beliefs to vary distinctly by city, sex, and city and sex grouping. Multiple group analyses showed that while condom attitudes appear to be invariant across sex, they vary by city and city and sex group.
Sexual norms is a more powerful correlate of sexual activity than gender role beliefs. The association between sexual norms and sexual experience is greater among young women than young men, and in less developed contexts compared to more developed contexts.
Condom attitudes have no significant association with condom use at first sex for any of the six groups. Attitudes towards condoms are a significant factor in condom use at last sex among young men in Taipei only. Condom use at first sex is the most salient factor in condom use at last sex, but this relationship varies by city and sex group.
Conclusions
This dissertation provides an in-depth and cross-cultural analysis of the respective influences of gender role beliefs, sexual norms and condom attitudes on sexual activity and condom use among youth in Hanoi, Shanghai and Taipei. While both gender and sexual norms are important factors in sexual activity, condom attitudes play less of a role in shaping condom use patterns. By highlighting the differences and commonalities in how knowledge, attitudes and beliefs and the relationship of each to sexual behaviors differ among male and female youth in three different Asian settings, this dissertation provides a basis for responding to Asian youth’s sexual and reproductive health needs.
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Keywords
Adolescents, sexual behavior, condoms, gender, attitudes