Gender differences in cigarette smoking and alcohol drinking among adolescents and young adults in Hanoi, Shanghai, and Taipei.

OBJECTIVE: This study aimed to examine gender differences in smoking and alcohol drinking behaviors in three Asian cities of Hanoi, Shanghai, and Taipei, and to assess the magnitude of gender differences across the three cities. METHODS: A total of 17,016 adolescents (age: 15-19 years) and young adults (age: 20-24 years) were selected using multi-stage sampling methods and surveyed in face-to-face interviews. A total of 16,554 unmarried respondents were included in this analysis. RESULTS: Gender differences were significant for smoking only, drinking only, and both behaviors in each city. Male respondents were 30.66 times more likely to report smoking only than female respondents in Hanoi, followed by Shanghai and Taipei. This pattern was similar for drinking only and both smoking and drinking behaviors. CONCLUSIONS: The magnitude of gender differences in smoking only, drinking only, and both behaviors widely varies across the three cities. Further research can examine how these differences may be used to prevent and reduce smoking and drinking in the adolescent and young adult population.

Patterns of sexual behaviors among unmarried adolescents and youth in three Asian cities.

We examined patterns of sexual behaviors of unmarried adolescents and youth (UAY) in three Asian cities (Shanghai, Taipei, and Hanoi) and identified factors related to the timing of initial sexual experience. From analysis of a sample of 16,554 UAY aged 15-24 years recruited from Shanghai, Taipei, and Hanoi plus data collected from face-to-face interviews complemented by computer-assisted self-interviews for intimate questions, we learned: UAY in Shanghai, Taipei, and Hanoi have different sexual behaviors. Affluent economic status increases the likelihood of early initial sexual experiences. Higher educational attainment may delay initial intercourse. Compared with Shanghai UAY, study participants from Taipei and Hanoi were 3.64 times and 0.33 times as likely to participate intercourse. These data can provide a basis for developing effective government policies and social interventions.

The childhood sexual abuse among youth in three Asian cities: Taipei, Shanghai, and Hanoi.

The article describes the prevalence and risk factors of childhood sexual abuse (CSA) among youth in Hanoi, Shanghai, and Taipei. Data used in this study are from the Three-City Asian Study of Adolescents and Youth, 2006-2007. Descriptive analysis and logistic regression models were used. The self-reported lifetime prevalence of CSA was 5.2% in Taipei, 1.3% in Shanghai, and 0.5% in Hanoi. The overall prevalence was 2.2% for females and 1.7% for males. The average age of first CSA was 10.5 years. Household instability, migration before age 14, and low maternal warmth were found to be positively associated with CSA, whereas discussing problems with father and being close to mother were negatively associated with CSA, after adjusting for sociodemographic characteristics. Our findings suggested the importance of prevention programs for preteen aged children, public education to raise awareness, and further prospective studies to identify various risk markers for CSA in Asia.

Drunkenness and its association with health risk behaviors among adolescents and young adults in three Asian cities: Hanoi, Shanghai, Taipei.

PURPOSE: To assess the prevalence of drunkenness among adolescents in Hanoi, Shanghai, and Taipei and explore the association between heavy drinking and other health risk behaviors. METHODS: The data are drawn from the Three-city Collaborative Study of Adolescent Health, conducted in Hanoi, Shanghai, and Taipei in 2006. A sample of 17,016 adolescents and young adults, aged 15-24 years, was selected by multistage sampling. Descriptive analysis was used to estimate the proportion of drunkenness and other health risk behaviors. Multivariate logistic regression was used to investigate relationships between drunkenness and risky health behaviors. RESULTS: The proportions of the sample getting drunk during the past month were 6.36%, 4.53%, and 8.47% in Hanoi, Shanghai, and Taipei, respectively. More males than females reported drunkenness in all three cities, with the difference highest in Hanoi (11.08% vs. 1.14%) and lowest in Taipei (9.69% vs. 7.18%). Different levels of relationship between drunkenness and health risk behaviors, such as anxiety, suicidal ideation, smoking, gambling, fighting, drinking and driving, and having sexual intercourse, were found across the three cities; an exception was nonuse of contraception. CONCLUSION: Drunkenness was positively associated with many health risk behaviors. It may serve as an indicator of other risky behaviors. Interventions to reduce drinking and drunkenness may contribute considerably to the prevention of other risk behaviors and to adolescent safety and well-being.

Child Sexual Abuse and Its Relationship With Health Risk Behaviors Among Adolescents and Young Adults in Taipei.

This study explores the association of child sexual abuse (CSA) with subsequent health risk behaviors among a cross-section of 4354 adolescents and young adults surveyed in urban and rural Taipei. Descriptive analysis and logistic regressions were employed. The overall proportion of CSA was 5.15%, with more females (6.14%) than males (4.16%) likely to experience CSA. CSA was differently associated with multiple adverse health outcomes, after adjusting other factors, such as age, residence, economic status, education, employment status, and household instability. Both males and females with CSA experience were more likely to report drinking, gambling, and suicidal ideation compared with those who had no history of CSA. However, the significant association between CSA and smoking, fighting, and suicidal attempt was not observed among females. Effective interventions are needed to reduce CSA and its adverse effects on adolescent well-being.

Association between childhood sexual abuse and adverse psychological outcomes among youth in Taipei.

PURPOSE: The objective of this study was to examine the relationship between a history of childhood sexual abuse (CSA) and negative psychological consequences in adulthood, controlling for family environments and Confucian values. METHODS: The data used in this study were collected from Taipei. The final analysis sample comprised 4,084 participants aged 15-24 years. Three sets of logistic regression models were fitted to verify the association between CSA and negative psychological outcomes. Sociodemographic variables, household instability, and parenting variables, as well as Confucian value variables were controlled in models step by step. The overall prevalence of CSA in our analysis sample was 5.2%. RESULTS: The overall prevalence of depression, anxiety, and suicidal ideation among Taipei respondents was 11.8%, 16.4%, and 16.7%, respectively, but young people who experienced CSA had significantly higher rates of all three than young adults who had not experienced CSA. After controlling for other covariates, the odds ratios of depression, anxiety, and suicidal ideation associated with a history of CSA were 1.78 (95% confidence intervals [CI]: 1.25-2.54), 1.77 (95% CI: 1.28-2.44), and 2.56 (95% CI: 1.56-4.29), respectively. CONCLUSIONS: Our findings suggested that CSA was an independent predictor of negative psychological consequences in adulthood. In our analysis, we controlled for household, parenting, and Confucian culture factors, which provides a better understanding of how they work together to affect adult psychological status.

How does traditional Confucian culture influence adolescents' sexual behavior in three Asian cities?

PURPOSE: To investigate whether and how the presence of Confucian cultural norms influences the sexual behaviors of adolescents and young adults in three Asian cities experiencing different levels of economic development. METHODS: Data for this article were drawn from the international cross-sectional survey on sexual and reproductive health of adolescents and young adults aged 15-24 years in three Asian cities (Hanoi, Shanghai, and Taipei), conducted in 2006. The original sample consisted of a representative group of 17,016 adolescents; while in this study, 16,554 never-married adolescents were included in the analysis. Both face-to-face interview and computer-assisted self-interview approaches were adopted in the survey. Exposure to family concepts, self-cultivation values, gender role concepts, and sexual values were the main measures of traditional Confucian cultural influence. Sexual and intimate behaviors were the main outcome measures, and multi-Cox regression models were used to assess the association between traditional cultural concepts and values and sexual behavior after adjusting for potentially confounding factors. Data were analyzed with SAS software 9.1. RESULTS: The traditional Confucian cultural norms were not weakening evenly, with more entrenchment in Hanoi than in Shanghai and Taipei. Prevalence of sexual coitus among adolescent and young adults was lowest in Hanoi and highest in Taipei, while similar profiles of other intimate behaviors were displayed in the three cities. Associations between respondents' sexual behavior and their cultural concepts and values differed by city. In Hanoi, for all four cultural measures, respondents with more traditional views were less likely to engage in sexual activity. This was also true in Shanghai and Taipei with respect to traditional sexual values and self-cultivation values. However, there was an inverse relationship between sexual behavior and traditional family concepts and gender roles in Shanghai and Taipei; those with more traditional values were more likely to have premarital sexual intercourse, except with regard to family values among female youth in Taipei. CONCLUSIONS: The findings suggest that different aspects of Confucian values eroding unevenly in different Asian cities may have distinct association with adolescent or young adults' sexual behaviors.

Gender differences in adolescent premarital sexual permissiveness in three Asian cities: effects of gender-role attitudes.

PURPOSE: Gender is an important factor in understanding premarital sexual attitudes and behaviors. Many studies indicate that males are more likely to initiate sexual intercourse and have more permissive perceptions about sex than females. Yet few studies have explored possible reasons for these gender differences. With samples of unmarried adolescents in three Asian cities influenced by Confucian cultures, this article investigates the relationship between underlying gender norms and these differences in adolescents' premarital sexual permissiveness (PSP). METHODS: In a collaborative survey conducted in 2006-2007 in urban and rural areas of Hanoi, Shanghai, and Taipei, 16,554 unmarried participants aged 15-24 years were recruited in the three-City Asian Study of Adolescents and Youth, with 6,204, 6,023, and 4,327 respondents from each city, respectively. All the adolescents were administered face-to-face interviews, coupled with computer-assisted self-interview for sensitive questions. Scales on gender-role attitudes and on PSP for both male and female respondents were developed and applied to our analysis of the data. Multilinear regression was used to analyze the relationship between gender-role attitudes and sexual permissiveness. RESULTS: Male respondents in each city held more permissive attitudes toward premarital sex than did females, with both boys and girls expressing greater permissiveness to male premarital sexual behaviors. Boys also expressed more traditional attitudes to gender roles (condoning greater inequality) than did girls in each city. Adolescents' gender-role attitudes and permissiveness to premarital sex varied considerably across the three cities, with the Vietnamese the most traditional, the Taiwanese the least traditional, and the adolescents in Shanghai in the middle. A negative association between traditional gender roles and PSP was only found among girls in Shanghai and Taipei. In Shanghai, female respondents who held more traditional gender-role attitudes were more likely to exercise a double standard with respect to male as opposed to female premarital sex (odds ratio [OR] = 1.18). This relationship also applied to attitudes of both girls and boys in Taipei (OR = 1.20 and OR = 1.22, respectively). CONCLUSIONS: Although with variation across sites, gender differences in PSP and attitudes to gender roles among adolescents were very significant in each of the three Asian cities influenced by Confucian-based values. Traditional gender norms may still be deeply rooted in the three cities, especially among females; while it is important to advocate gender equity in adolescent reproductive health programs, the pathway of traditional gender norms in influencing adolescent reproductive health outcomes must be understood, as must differences and similarities across regions.

Media's contribution to sexual knowledge, attitudes, and behaviors for adolescents and young adults in three Asian cities.

PURPOSE: Evidence in western countries indicates that the media have associations with adolescents' and young people's sexual behavior that may be as important as family, school, and peers. In this new study of Asian adolescents and young adults in the three cities of Hanoi, Shanghai, and Taipei, the associations between exposure to sexual content in the media and adolescents' and young adults' sex-related knowledge, attitudes, and behaviors are explored in societies with traditional Confucian culture, but at different stages in the process of modernization. METHODS: The data are from a questionnaire-based cross-sectional study conducted from 2006 to 2007, where a sample of 17,016 adolescents and young adults aged 15-24 years from Shanghai, Hanoi, and Taipei completed face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions. For the objectives of this article, analysis was restricted to the 16,554 unmarried respondents. Exposure to sexual content in the mass media (including the Internet and traditional media), pornographic videos, and a preference for western/Asian movies/videos were the main media influence measures. Sex-related knowledge, premarital sexual permissiveness (PSP), and sex-related behaviors were the main outcome measures. The impact of each of four contexts including family, peer, school, and media on sex-related knowledge, attitudes, and behaviors were assessed using multiple linear regression stratified by gender and city, controlling for age, urban/rural residence, education, and economic status. The change in adjusted R(2) from the multiple linear regression analysis was adopted to indicate the contribution of family, peer, school, and media variables to respondents' sex-related knowledge, attitudes, and behaviors. RESULTS: The contextual factors, including family, peer, school, and media, explained 30%-50% of the variance in sex-related knowledge, 8%-22% of the variance in PSP, and 32%-41% of the variance in sex-related behaviors. Media variables explained 13%-24% of the variance in sexual knowledge, 3%-13% in PSP, and 3%-13% in sex-related behaviors, which was comparable with that of family, peer, and school variables. These associations differed by city and gender. CONCLUSIONS: Access to and use of mass media and the messages they present are influential factors on sex-related knowledge, attitudes, and behaviors of unmarried Asian adolescents and young adults, and should be considered in future research and intervention programs attempting to improve reproductive health outcomes.

The relationship between external contact and unmarried adolescents' and young adults' traditional beliefs in three East Asian cities: a cross-sectional analysis.

PURPOSE: There is growing contact with the outside world among adolescents and young adults in the three Asian cities of Hanoi, Vietnam, Shanghai, mainland China, and Taipei, Taiwan because of the open policies implemented by the national governments of each of these cities. Because these policies were enacted at different points in time, their concomitant social impact has not been simultaneous, with the result that these societies are at different stages of change. The goal of this current analysis is to examine the dimensions of external contact and respondents' departures from Confucian values-for example, embracing individualism, a woman's taking the initiative in expressing affection to a man, and permissiveness toward premarital sex-among unmarried adolescents and young adults in these three cities and the potential relationship between them. This will contribute to our understanding of contemporary Asian adolescents' and young adults' attitudes during different social transition periods, attitudes that are frequently contrary to traditional Confucian principles. METHODS: This is a cross-sectional study. The multicenter survey of 17,016 male and female adolescents and young adults aged 15-24 years from three cities with Confucian-influenced cultures-Shanghai, Hanoi, and Taipei-was conducted from May 2006 to January 2007 through face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions; 16,554 unmarried respondents were included in this analysis. Binary logistic regression and general linear models were used to explore the associations between respondents' external contact and their nontraditional attitudes. All the analyses were done through SAS 9.1. RESULTS: There were significant differences in the positive association between respondents' external contact and non-Confucian values among adolescents in the three cities. More respondents in Taipei and Shanghai had external contact and identified with nontraditional values than those in Hanoi. The percentages of respondents reporting non-Confucian values were the highest in Taipei and the lowest in Hanoi. The analysis presented significant associations between respondents' exposure to Western culture and their adoption of nontraditional values across the three cities. Respondents who spoke Western languages and who preferred Western videos/actors/singers were more likely to exhibit Western individualism, concurrence with women taking the initiative in a romantic relationship with a man, and permissiveness toward premarital sexual behavior. CONCLUSIONS: Although these Asian cities are at different stages of social transition, exposure to Western culture is associated with unmarried adolescents' and young adults' departure from traditional Confucian social rules in all three.

The relationship between sexual behavior and nonsexual risk behaviors among unmarried youth in three Asian cities.

BACKGROUND: Health risk behaviors in adolescents and youth, such as smoking, alcohol, drug use, violence, suicide, and unprotected sexual behavior, are issues of major public health concern. Addressing the relationship between sexual behavior and nonsexual risk behaviors will make a significant contribution to the design of effective intervention programs for this population of adolescents and unmarried youth. METHODS: This cross-sectional study was conducted in three Asian cities with a common heritage of Confucian values: Hanoi, Shanghai, and Taipei. Data were collected in 2006 from 17,016 youth aged 15-24 years residing in both urban and rural districts of the three settings. The relationships between sexual behavior and seven nonsexual risk behaviors among unmarried adolescents were examined using χ(2) tests, logistic regression models, Cox regression models, and cluster analysis. RESULTS: Sexual behavior was associated with seven nonsexual risk behaviors, especially with smoking, drinking, drug use, and running away from home. In terms of the age at initiation of risk behaviors, smoking and drinking were usually initiated before sexual intercourse. Sexual behavior and nonsexual risk behaviors co-occurred in the high-risk group in all three cities. Youth having the highest risk of sexual behavior were more likely to have the highest risk of nearly all nonsexual risk behaviors, with the exception of fighting in Hanoi and gambling in Shanghai and Taipei. CONCLUSIONS: Sexual behavior among unmarried youth is correlated with nonsexual risk behaviors but with different patterns across the three settings. Interventions aimed at reducing unprotected sex generally focus only on the sexual behavior; however, considering the correlations found here between sexual and nonsexual risk behaviors, they should target multiple risk behaviors.

Adolescents' and young adults' perception of homosexuality and related factors in three Asian cities.

PURPOSE: Adolescents' and young adults' perception of homosexuality plays an important role in the marginalization and stigmatization of the homosexual, thereby influencing his or her health. This article aims to study that perception and to examine its predictors in three Asian cities that are culturally dominated by Confucianism. METHODS: From May 2006 to January 2007, a cross-sectional survey of 17,016 adolescents and young adults, aged 15-24 years old, in both urban and rural sites of three Asian cities (Hanoi in Vietnam, Shanghai in the mainland of China, and Taipei in Taiwan) was conducted through interview and computer-assisted self-interview for sensitive questions. Chi-square tests and multivariate logistic regression were performed to identify the predictors for their perception of homosexuality. RESULTS: The percentage of adolescents and young adults who hold a positive view of homosexuality (i.e., thought it was normal and/or acceptable) was low, especially in Hanoi and Shanghai; these figures increased from Hanoi to Shanghai to Taipei for both males and females. Overall, those factors significantly associated with adolescents' and young adults' perception of homosexuality included individuals' demographic characteristics (urban/rural, age, economic status, student status, and educational level), preferred origin of movies/videos, self-identified sexual orientation, sexual and reproductive health knowledge, family values, gender role values, and attitudes toward premarital sex. CONCLUSIONS: In these three Asian cities composed of populations whose views are largely influenced by Confucianism, adolescents and young adults mainly hold a negative perception of homosexuality. The most common and important predictors for a respondent's perception of homosexuality were his or her knowledge of sexual and reproductive health and how traditional his/her values may be. Greater attention needs to be paid to the popularization of knowledge about sexual and reproductive health including homosexuality-and to efforts aimed at instilling more liberal attitudes to improve adolescents' and young adults' perception of homosexuality. This could then reduce the marginalization and stigmatization of the homosexual, and thus improve his/her health.

Gender and ethnic differences in the co-occurrence of adolescent risk behaviors.

OBJECTIVES: We consider gender and ethnic differences in the co-occurrence of adolescent behaviors related to health and well-being. DESIGN: Using a nationally representative sample of adolescents in the National Longitudinal Survey of Youth (1997-2000), we examine behavior among students as well as school drop-outs. We use latent class models (LCMs) to identify subpopulations of adolescents with similar patterns of co-occurring behaviors. The generalizability of the findings for African American adolescents in the 1970s is considered using a sample of inner-city youth from the Pathways to Adulthood Survey. RESULTS: For all ethnic groups, we find a subpopulation with 'problem behavior' characteristics (in which early sexual initiation, alcohol use, smoking, marijuana use, and truancy are all highly prevalent). This cluster is most common among European American adolescents and among young men. A subpopulation characterized by behaviors often leading to poor social outcomes (e.g. truancy, early sexual initiation and fighting) is most common for African American adolescents, especially young African American men. CONCLUSION: Our findings suggest that multi-factorial interventions which address the interrelationships between all of the behaviors are relevant regardless of gender or ethnicity. However, the ethnic and gender differences in the likelihood of specific patterns of interrelationships highlight the importance of considering the ethnic and gender composition of a population when developing future research and interventions.