Acculturation and the Sexual and Reproductive Health Of Latino Youth in the United States:A Literature Review By Aimee Afable-Munsuz and Claire D. Brindis CONTEXT: The high birthrate among Latina teenagers in the United States has generated increased interest in the role of acculturation in their sexual and reproductive health. It is critical to identify gaps in the existing research and to ascertain the relationship between acculturation and Latino sexual behavior. METHODS: PUBMED,ERIC and POPLINE were searched for journal articles published between 1985 and 2006 that ex- Aimee Afable-Munsuz is a postdoctoral fellow, and Claire D. Brindis is professor of pediatrics and health policy and associate director, both at the Institute for Health Policy Studies, University of California, San Francisco. plicitly examined acculturation and sexual and reproductive health among Latino youth. All fertility-related outcomes (pregnancy,birth,abortion) and their proximate determinants (attitudes,knowledge,norms,sexual activity,contraceptive use) were considered sexual or reproductive health outcomes.Eligible studies used a cross-sectional or longitudinal design; had a sample of males,females or both aged 25 or younger; and included Latino-specific analyses. RESULTS: Seventeen studies met the screening criteria,and these studies used 23 distinct measures of acculturation that captured four primary dimensions: time (duration of exposure to U.S.culture),language,culture and residence. The measures’robustness varied,and none of the studies was widely generalizable.Ten studies investigated sexual initiation,and eight of these found a positive association between the likelihood of this outcome and acculturation.Acculturation also was associated with increased condom use and with beliefs and norms related to healthy outcomes, although the evidence was less conclusive. CONCLUSIONS: Ideal studies of acculturation would stratify analyses by gender and country of origin,and would include time measures related to acculturation.When feasible,studies should be population-based and longitudinal, and should build on existing theories of the relationship between acculturation and the sexual behavior,norms and beliefs that are unique to Latino culture. Perspectives on Sexual and Reproductive Health,2006,38(4):208–219 Latinos in the United States have been described as a people “in flux.”1 In 2004, an estimated 40.4 million Latinos were living in the country, representing 14% of the total population.2 Because a large proportion are of childbearing age, the Latino population is projected to reach 60.4 million by 2020; Latinos are expected to account for 46% of the nation’s population growth over this period, and non-Latino whites for 24%. While the national teenage birthrate has declined 67% in the last decade, the birthrate among Latina teenagers has declined only 21% and remains the highest among all ethnicities—83 births per 1,000, nearly twice the national average of 43 per 1,000.3 High fertility among foreign-born Latinas may fuel these high birthrates. In a Los Angeles–based study, foreignborn Mexican teenagers were less likely to initiate sex than their U.S.-born Mexican and non-Mexican counterparts, but those who initiated sex were more likely to get pregnant and to give birth.4 Thus, Mexican teenagers born outside the United States may be at relatively high risk of childbearing. Whether this risk persists or diminishes with longer U.S. residency is of increasing interest. In one study of young women of Mexican origin and low socioeconomic status, later generations had a higher likelihood of having a premarital birth by age 22 than earlier generations 208 (i.e., second- or third-generation vs. first-generation), suggesting that the risk persists and is magnified.5 These two studies did not explicitly discuss underlying acculturation processes, but other sexual and reproductive health studies have implicated acculturation. Acculturation has been viewed as a linear progression, whereby immigrants gradually adopt the values, behaviors and traits of their host culture and discard those of their country of origin.6 Studies of “integration” or “assimilation” have focused on immigrants’ educational and employment status as compared with that of the native population.7 Yet an immigrant can adopt behaviors of the host culture or achieve social mobility without fully identifying with the host culture.8 Research among Latino adults that has explicitly investigated the role of acculturation has found that sexual risktaking increases with greater acculturation. Yet this relationship does not apply to all outcomes, and there is need for improved understanding of the mechanisms through which acculturation influences sexual behavior. For example, although acculturation among adult Latinas has been associated with a greater number of lifetime sexual partners9 and elevated rates of potentially risky sexual behavior such as oral sex,10 it may encourage contraceptive use among sexually active adult males and females.11 Perspectives on Sexual and Reproductive Health To improve efforts aimed at reducing childbearing among Latina teenagers, it is necessary to understand how acculturation influences their sexual and reproductive health.12 This article presents a systematic review of the existing research and seeks to answer the following questions: What is the relationship between acculturation and the sexual and reproductive health of Latino youth in the United States? What acculturation theories have been employed to explain this relationship? What measures of acculturation have been used, and which best explain variations in sexual and reproductive health outcomes? METHODS We selected articles in three stages. First, we searched PUBMED, POPLINE and ERIC for the period 1985–2006, using key search terms, including “acculturation,” “Hispanic,” “Latin Americans” and “Hispanic Americans.” This database search yielded a total of 705 articles, from which we collected abstracts of all empirical studies that were published in an English-language journal and that specifically investigated a sexual or reproductive health outcome. All fertility-related outcomes (pregnancy, birth, abortion) and their proximate determinants (attitudes, knowledge, norms, sexual activity, contraceptive use) were considered sexual or reproductive health outcomes. Second, we reviewed each abstract to determine the study’s eligibility. Acceptance criteria included use of a crosssectional or longitudinal design and explicit investigation of the relationship between acculturation and sexual or reproductive health, or use of acculturation as a covariate in the analysis. We excluded studies that used proxy measures of acculturation (e.g., U.S. nativity) but that did not explicitly refer to them as acculturation measures. Other criteria were having a sample of males, females or both aged 25 or younger and conducting Latino-specific analyses. This last criterion was chosen to facilitate interpretation of the findings. For example, it was difficult to interpret a lack of association between acculturation and sexual and reproductive health if Latino adolescents were a minority in a study’s sample. In the third stage, four additional studies were selected from the reference lists of the articles identified in the first two stages, using the same criteria. In total, 82 studies from the database search focused on sexual and reproductive health outcomes. We excluded adult-focused studies, as well as adolescent-focused studies that examined violence in relationships or HIV risk among males who have sex with males. Following these various screening steps, 17 studies remained for our analysis. RESULTS Study Designs Among the 17 studies that met our criteria, only the one by Guilamo-Ramos et al. was nationally representative, and it sampled youth in grades 7–11 (Table 1, page 210).13 Upchurch et al., Ford and Norris, Norris and Ford, and Slonim-Nevo used area probability samples.14 The remaining 12 studies used school-based,15 clinic-based16 or other Volume 38, Number 4, December 2006 convenience samples.17 Two studies were longitudinal,18 and the other 15 had cross-sectional designs. Sample sizes varied from 61 respondents19 to 7,270 respondents.20 Study populations tended to represent Latinos of Mexican origin, although some included considerable representation of other subgroups, such as Puerto Ricans and Central Americans.21 A New York City study, with its predominantly Dominican sample, and a south Florida study, with its Cuban sample, were the exceptions.22 Data on respondents’ socioeconomic status, education level and recruitment site, which were available in 14 studies,23 showed that the Latino youth typically were disadvantaged, which further limits generalizability. For example, in most of these studies, either the entire sample or a large proportion received some form of public assistance or had parents with low education levels. Exceptions were the sample for the Guilamo-Ramos et al. study, 20% of whom received public assistance, and the Raffaelli, Zamboanga and Carlo sample, who were college students.24 The studies used different analytic approaches. For example, nine studies had only female samples,25 and two analyzed males and females separately;26 the remaining six combined males and females in their analyses,27 making it difficult to assess whether associations varied by gender. All but two studies28 adjusted the analyses for various demographic, socioeconomic, behavioral and sociocultural factors. Theories of Acculturation All studies except one29 commented on theories that might explain how acculturation influences sexual and reproductive health. Overall, two general theories were employed. One, which we label “stress theory,” emphasizes the stress that immigrant teenagers face in adapting to a different culture. According to this theory, teenagers who are faced with negotiating competing values and norms of different cultures may experience stress and be vulnerable to high-risk or maladaptive behaviors, such as early sexual initiation. Thus, the more acculturated a teenager is, the more stress he or she faces and the more likely he or she is to engage in risky behaviors.30 The second general theory, “cultural norms theory,” describes acculturation as a process of change in values and norms regarding gender, sexual activity and family formation.31 For example, the less acculturated Latinas are, the more value they may place on virginity, family responsibility and obedience to men, a concept known as marianismo.32 Thus, increased acculturation might lead to heightened awareness of alternative roles for women and a reduced likelihood of adolescent childbearing. Acculturation can also be viewed in terms of losing or retaining traditional norms that shape family relationships. For example, greater acculturation might lead to a loss of traditional norms such as simpatia, which emphasizes maintenance of harmonious relations; respeto, which emphasizes avoidance of conflict and respect for authority within the family;33 and familism, which stresses the importance of family life and 209 Acculturation and the Sexual and Reproductive Health of Latino Youth TABLE 1. Selected characteristics of studies of acculturation and the sexual and reproductive health of Latino youth in the United States, by type of outcome studied, 1985–2005 Outcome and study Sample Primary outcome Acculturation theory and measures Adjustment variables N=7,270 females and males;ages 12–18;Mexican and white;48% received public assistance Ever had intercourse No discussion; measured language Age,gender,family structure, Arizona;school-based; crossreligiosity,rural residence, sectional; no separate public assistance gender analyses Ebin et al.,200116 N=609 females and males;ages 11–19;country of origin not specified;low-income Ever had intercourse Stress theory; measured nativity, language None Los Angeles;public clinic– based;cross-sectional; no separate gender analyses Flores, Tschann and Marín,200217 N=84 females;ages 14–19; Mexican and Central American; parents had average of 8 yrs. of schooling Intention to have intercourse Cultural norms theory; measured language Sexual experience, dating California and Texas;call-back sample of population- and clinic-based sample; cross-sectional Fraser et al., 199816 N=116 suicidal females;ages 12–18;70% Dominican,16% Puerto Rican,14% Central or South American;low-income Ever had intercourse Stress theory; measured nativity, ethnic identity, biculturalism Age,substance use, psychopathology New York City;university clinic–based;cross-sectional Guilamo-Ramos et al.,200513 N=2,035 females and males; grades 7–11;63% Mexican,20% Puerto Rican,17% Cuban;about 20% received public assistance Ever had intercourse Stress theory; measured no.of yrs. living in United States, language Ethnicity,gender,grade, mother’s education, religiosity National Longitudinal Study of Adolescent Health;crosssectional (Wave 1 data); no separate gender analyses Raffaelli, Zamboanga and Carlo,200517 N=61 females;ages 17–23; Cuban American Ever had voluntary intercourse,sexual risk Cultural norms theory; measured nativity, language,ethnic identity Age,parents’education, religiosity South Florida;universitybased;cross-sectional Reynoso,Felice and Shragg,199316 N=116 postpartum females;ages 12–18;Mexican;88% received public assistance Age at first intercourse Stress theory; measured language, residence,citizenship None San Diego;university clinic– based;cross-sectional Slonim-Nevo, 199214 N=988 never-married females;ages 13–19;68% Mexican American, 32% white Age at first premarital intercourse Cultural norms theory; measured language, self-identity Socioeconomic status, mother’s education, perceived parental control, religiosity,attitudes toward premarital sex,perceived age at which average girl is ready for sex Los Angeles;area probability sample;cross-sectional Tschann et al., 200216 N=141 females and males;ages 12– 14;Mexican;parents had average of 8 yrs.of schooling Sexual experience Cultural norms theory; measured language, cultural enjoyment Emotional distress Northern California;HMO clinic–based;longitudinal;no separate gender analyses Upchurch et al., 200114 N=497 females and males;ages 12– 17;75% Mexican;62% lived with both biological parents Time to first intercourse Cultural norms theory; measured generation, language Ethnicity,gender,singleparent household,parentteenager relationship and interaction,neighborhood Latino composition, neighborhood ambient hazard* Los Angeles;area probability sample; longitudinal;no separate gender analyses Sexual activity Adam et al.,200515 Setting and design table continues interdependent relations among the individual, family and community.34 Thus, less acculturated teenagers would tend to avoid engaging in behaviors that violate these norms; greater acculturation might lead to more sexual risk-taking. Acculturation Measures A total of 23 measures of acculturation were used in these studies (Table 2, page 212). We classified them into four primary dimensions of acculturation: time, language, culture and residence. A fifth classification included measures that capture multiple dimensions. •Time. Three principal measures were employed to assess respondents’ exposure to U.S. culture: nativity, generation and number of years living in the country.35 Nativity (re- 210 spondent’s or a parent’s) referred to the country of birth— the United States or elsewhere. A foreign-born respondent was classified as a first-generation immigrant; a U.S.-born respondent who had at least one foreign-born parent was classified as second-generation; if the respondent and both parents were born in the United States, he or she was classified as third-generation. •Language. English language acquisition is one of the modifications that may accompany acculturation.36 Eight measures of the language dimension were used, all of which tried to capture the respondents’ degree of preference for, usage of or proficiency in Spanish versus English. Four studies used the Short Language Acculturation Scale developed by Marín et al.; it asks respondents which lan- Perspectives on Sexual and Reproductive Health TABLE 1. Selected characteristics of studies of acculturation and the sexual and reproductive health of Latino youth in the United States, by type of outcome studied, 1985–2005 (continued) Outcome and study Norms and beliefs Norris and Ford, 199414 Sorenson,198515 Contraceptive use Jones,Kubelka and Bond,200116 Fertility Kaplan et al., 200116 Sample Primary outcome Acculturation theory and measures Adjustment variables Setting and design N=1,042 females and males;ages 14–24;54% black, 46% Latino (73% Mexican);41% of mothers had ≤8 yrs. of schooling; low-income Condom beliefs Cultural norms theory; measured language Age,gender,marital status, religion,ethnicity,education Detroit;area probability sample;cross-sectional; no separate gender analyses N=1,955 females and males; Mexican American and white youth Expected parity Cultural norms theory; measured nativity, language,residence No.of siblings in the home,gender Tucson and Nogales,AZ; school-based;cross-sectional; separate gender analyses N=63 pregnant females;ages 13–19;Mexican;low-income Family planning visit ≤1 yr.postpartum Cultural norms theory; measured generation, cultural orientation Age,marital status,ordinal no.of the pregnancy,no.of prenatal visits,gestational age of fetus,prenatal care Southwestern United States; public clinic–based; cross-sectional N=1,307 females;ages 14–24; predominantly Mexican; low-income Ever had abortion Cultural norms theory; measured language Age,education,marital status,nativity Los Angeles;public clinic– based;cross-sectional Intercourse in last year, ever had anal intercourse,ever had oral sex,no. and type of partners in last year, condom use in last year Cultural norms theory; measured language Ethnicity,age,marital status, interview language,no.of yrs.living in United States, parents’education Detroit;area probability sample;cross-sectional; separate gender analyses Multiple outcomes Ford and Norris, N=711 females and males; 199314 ages 14–24;73% Mexican, 23% Puerto Rican; parents had average of 8 yrs.of schooling; low-income Jimenez,Potts and Jimenez,200217 N=290 females;ages 14–19; predominantly Mexican Ever had intercourse, Cultural norms theory; ever used contraceptive, measured nativity, attitudes toward sex language Age,attitudes toward sex, parents’educational aspirations for children, respondents’educational aspirations Los Angeles;evaluation of adolescent pregnancy program in schools, clinics and community organizations;cross-sectional Kaplan,Erickson and Juarez-Reyes, 200216 N=670 females;ages 14–19;54% Mexican,30% Central American; 33% low-income Age at first intercourse, no.of lifetime partners, no.of pregnancies Age,education,school attendance,married or living with partner,income, risk-proneness,substance experimentation Los Angeles;public clinic– based;cross-sectional Cultural norms theory; measured language *Ambient hazard indicates level of perceived social disorder,personal threat and deterioration of the neighborhood. Note: Superscript numbers refer to the reference list,page 217. guage they prefer to read in, they prefer to think in, they usually speak at home and they prefer to use when speaking with friends.37 The scale, adapted from acculturation scales dating to the late 1970s, correlates highly with generation, time living in the United States and other acculturation proxies, and has high reliability.38 The Linguistic Acculturation Scale, employed in two studies, comprises three items about respondents’ preferred language for reading, writing and speaking. This scale was adapted from the 11-item acculturation scale of Cuéllar, Harris and Jasso, which was developed and validated for the Mexican American population.39 The other measures were language spoken at home, primary language spoken, childhood language, current language, language of interview and language spoken with friends. •Culture. Measures used to capture the cultural dimension of acculturation were cultural enjoyment, ethnic identity, biculturalism and cultural orientation. Tschann et al.40 adapted the Latino and American cultural enjoyment scales from validated scales of an earlier study.41 The original scales were based on a multidimensional model that views acculturation as both a process of “relinquishing or retaining characteristics” of the culture of origin and a Volume 38, Number 4, December 2006 process of accommodating to the host culture. They assessed the degree to which a person enjoys aspects of each culture—Latino or “Anglo-American” culture—and were tested among Cuban American high school students in the Miami area. Two six-item subscales were used. Items for the Latino enjoyment subscale included “How much do you enjoy Hispanic music?” and “How much do you enjoy Hispanic books and magazines?” Items for the American enjoyment subscale were similar. Fraser et al.42 used nine items adapted from a validated scale developed by Padilla to measure ethnic identification.43 The original scale was developed to indicate respondents’ cultural awareness and ethnic loyalty and was tested in a population of Mexican American adults in southern California. Padilla defined cultural awareness as knowledge of specific cultural material (e.g., language, values, history, art), and ethnic loyalty as a preference for one cultural orientation over another (e.g., seeking out friends or marrying within one’s ethnic group). A low score on the ethnic identification scale indicated a strong identification with the Latino culture of origin; a high score indicated a strong identification with mainstream American culture. Fraser et al. also adapted the ethnic identification scale to 211 Acculturation and the Sexual and Reproductive Health of Latino Youth TABLE 2. Findings on associations between acculturation and the sexual and reproductive health of Latino youth, by dimension and measures of acculturation studied, according to type of outcome Dimension and measure Study Sexual activity Time Nativity Ebin et al.,200116 Sexual initiation (+) Fraser et al.,199816 Sexual initiation (0)* Jimenez,Potts Sexual initiation (+) Norms and beliefs Contraceptive use or fertility Ever used contraceptive (0) and Jimenez,200217 Raffaelli,Zamboanga and Carlo,200517 Sexual initiation (0)* Sexual risk (+) Father’s nativity Sorenson,198515 Expected parity (–) Mother’s nativity Sorenson,198515 Expected parity (0) Generation Jones,Kubelka and Bond,200116 No.of yrs.living in the United States Language Short Acculturation Scale Family planning visit ≤1 yr.postpartum (–) Upchurch et al.,200114 Sexual initiation (0)* Guilamo-Ramos et al.,200513 Sexual initiation (+) Flores,Tschann and Marín,200217 Intention to have intercourse (0) Ford and Norris,199314 Intercourse in last year (+)† Ever had anal intercourse (+)† Ever had oral sex (+) No.of partners in last year (0) Norris and Ford,199414 Linguistic Acculturation Scale Condom use in last year (+)† Condom beliefs (+) Tschann et al.,200216 Sexual experience (+)‡ Kaplan,Erickson and Juarez-Reyes,200216 Sexual initiation (+) No.of lifetime partners (+) No.of pregnancies (+) Kaplan et al.,200116 Language spoken at home Ever had abortion (0) Guilamo-Ramos et al.,200513 Sexual initiation (+)§ Jimenez,Potts and Jimenez,200217 Sexual initiation (0)* Sorenson,198515 Ever used contraceptive (0) Expected parity (–) table continues create a biculturalism scale: The more bicultural an adolescent was, the more he or she identified equally with U.S. culture and the culture of origin. Raffaelli, Zamboanga and Carlo44 used a nine-item version of Phinney’s multiethnic identity measure,45 which was validated in a diverse group of high school students and includes such items as “I have a strong sense of belonging to my own ethnic group.” A higher score indicates a higher level of ethnic identification, conceptualized as a sense of ethnic group membership and the degree of involvement in one’s ethnic group activities. Jones, Kubelka and Bond used a more recent version of the Linguistic Acculturation Scale. Items were adapted to reflect orientation toward Anglo and Mexican culture, and were scored on a five-point scale (from 1=very Mexican-oriented to 5=very assimilated, anglicized).46 212 •Residence. One study used city of residence as a measure of acculturation.47 In this Arizona study, Sorenson indicated whether respondents lived in a city near Mexico (Nogales) or in one more distant (Tucson). She hypothesized that respondents living in a border city would be in constant contact with their culture of origin and therefore be less acculturated. •Multiple dimensions. Three studies used multiple dimensions to define a respondent’s acculturation status. Jimenez, Potts and Jimenez used language spoken at home and U.S. nativity to develop three categories: “immigrant” (those born outside the United States), “U.S. born and spoke Spanish in the home” and “U.S. born and spoke English in the home.”48 Reynoso, Felice and Shragg asked several questions about language, residency and generation to determine whether female teenagers were “accul- Perspectives on Sexual and Reproductive Health TABLE 2. Findings on associations between acculturation and the sexual and reproductive health of Latino youth, by dimension and measures of acculturation studied, according to type of outcome (continued) Dimension and measure Study Sexual activity Primary language spoken Adam et al.,200515 Sexual initiation (+) Ebin et al.,200116 Sexual initiation (0) Childhood language Raffaelli,Zamboanga and Carlo,200517 Sexual initiation (0)* Sexual risk (0)* Current language Raffaelli,Zamboanga and Carlo,200517 Sexual initiation (0)* Sexual risk (0)* Language of interview Upchurch et al.,200114 Sexual initiation (+) Language spoken with friends Sorenson,198515 Culture Latino cultural enjoyment Tschann et al.,200216 Sexual experience (0) American cultural enjoyment Tschann et al.,200216 Sexual experience (0) Padilla’s ethnic identity Fraser et al.,199816 Sexual initiation (0)* Biculturalism Fraser et al.,199816 Sexual initiation (–)** Phinney’s ethnic identity Raffaelli,Zamboanga and Carlo,200517 Sexual initiation (–)†† Sexual risk (–)†† Cultural orientation Jones,Kubelka and Bond,200116 Residence City of residence Multiple dimensions Language and residence Norms and beliefs Contraceptive use or fertility Expected parity (0) Family planning visit ≤1 yr.postpartum (0)* Sorenson,198515 Expected parity (–) Jimenez,Potts and Jimenez,200217 Attitudes toward sex (0) Language,residence and citizenship Reynoso,Felice and Shragg,199316 Sexual initiation (+) Language and self-identity Slonim-Nevo,199214 Sexual initiation (+) *No significant association in analyses adjusting for other acculturation measures. †Significant for females. ‡Significant when interacted with emotional distress. §Significant when interacted with other acculturation measures.**Positive association between biculturalism and risk.††Positive association between ethnic identity and risk. Notes: Except where otherwise noted, +=positive association with level of acculturation; – = negative association with level of acculturation; 0=no significant association.Superscript numbers refer to the reference list,page 217. turated” or were “recent immigrants.”49 Specifically, they asked whether respondents and their parents were born in the United States, whether respondents were U.S. citizens, whether English was their preferred language and whether they had been U.S. residents for more than five years. Respondents were classified as acculturated if they met three out of five conditions; otherwise, they were classified as recent immigrants. Adapting the 1980 version of the Linguistic Acculturation Scale, Slonim-Nevo created a four-item scale on respondents’ self-identity (Mexican, Chicana, Mexican American, Spanish), preferred language, spoken language and mother’s spoken language.50 Outcomes Studied The broad categories of outcomes were sexual activity, norms and beliefs, contraceptive use and fertility. Thirteen studies investigated sexual activity outcomes: intention to have vaginal intercourse,51 sexual initiation,52 vaginal intercourse in the last 12 months,53 types of sexual experience,54 sexual risk,55 number of partners in the last year Volume 38, Number 4, December 2006 and number of lifetime partners,56 ever had anal intercourse57 and ever had oral sex.58 In general, sexual initiation was defined in these studies by whether respondents had ever had vaginal intercourse. Measures used to assess sexual initiation were age at first intercourse,59 age at first premarital intercourse60 and ever had intercourse.61 One longitudinal study measured the time between first survey and first intercourse.62 No consistent period of exposure to the risk of sexual initiation was used; for example, Upchurch et al. studied a sample of 12–17-year-olds, while Jimenez, Potts and Jimenez studied 14–19-year-olds. One study constructed a composite score of sexual experience by assigning a value of one for each of the following: kissing on lips, kissing with mouth open, breast touching, genital touching, oral sex, and vaginal or anal intercourse.63 Another used a composite score to measure sexual risk, assigning a value of one for each of the following: ever having had voluntary intercourse, having had voluntary intercourse before age 16, having had four or more 213 Acculturation and the Sexual and Reproductive Health of Latino Youth The evidence for a positive association between acculturation and sexual activity was strongest for sexual initiation. 214 lifetime sexual partners, having used condoms less than 75% of the time and ever having been forced to have sex.64 Two studies investigated only norms and beliefs pertinent to sexual and reproductive health: condom beliefs65 and expected number of children.66 A study that examined multiple outcomes looked at attitudes toward sex.67 A single study investigated only contraceptive use (i.e., whether family planning clinic clients returned within the first year postpartum);68 two other studies considered sexual activity as well as contraceptive use: condom use (in general and with a partner the respondent knew well) in the last year69 and ever-use of contraceptives.70 Finally, two studies looked at fertility outcomes: One examined whether women had ever had an abortion,71 and the other examined number of pregnancies and sexual activity.72 Associations Between Acculturation and Sexual Activity Of the 13 studies that examined sexual activity, two in particular found no association with several measures of acculturation.73 Specifically, Ford and Norris found no association between language and number of partners in the last year among either gender, and no relationship between language and having had vaginal intercourse in the last year or ever having had anal intercourse among males. Flores, Tschann and Marín found no association between language and intention to have intercourse among their sample of adolescent females. Almost all of the studies found a positive association between acculturation and sexual activity. For example, Tschann et al. found a positive relationship between language and sexual experience, while Kaplan, Erickson and Juarez-Reyes found one between language and the number of lifetime sexual partners.74 Analyses by Ford and Norris revealed positive associations between language and both having had vaginal intercourse in the last year and ever having had anal intercourse among females; they also found a positive association between language and ever having had oral sex among females and males.75 The evidence for a positive association between acculturation and sexual activity was strongest for sexual initiation; eight of the 10 studies that examined this outcome reported that greater acculturation was associated with an increased likelihood that youth had initiated sex.76 Only Fraser et al. and Raffaelli, Zamboanga and Carlo had somewhat contrasting findings, suggesting that greater identification with Latino culture, rather than greater acculturation, was associated with an increased risk of sexual initiation. The latter study found a greater degree of ethnic identification to be associated with an increased likelihood of ever having had intercourse and with greater sexual risk among its sample of female, Cuban American college students. In contrast, Fraser et al. found a greater degree of biculturalism to be associated with having had intercourse among their predominantly Dominican, clinic-based sample. Notably, these two studies had small convenience samples, and were the only ones to use ethnic identification measures and predominantly non-Mexican respondents. Associations Between Acculturation and Other Outcomes Two of the three studies that investigated norms and beliefs found an association with acculturation.77 According to Norris and Ford, Latino teenagers who were more acculturated tended to have more positive condom beliefs. In Sorenson’s school-based sample of Arizona Latinas, those whose fathers were born in the United States (vs. Mexico), those who spoke English at home (vs. Spanish) and those who resided in a city farther from Mexico (vs. a border city) reported a lower expected number of children. The three studies that considered contraceptive use are difficult to compare because of differences in design, outcomes and acculturation measures.78 Jimenez, Potts and Jimenez did not find an association between either of two measures of acculturation and ever-use of contraceptives. In their Detroit-based study, Ford and Norris found that greater acculturation was associated with an increased likelihood that female (but not male) teenagers reported using a condom in the last year. In contrast, Jones, Kubelka and Bond found that greater acculturation was associated with a decreased likelihood that respondents returned for a family planning visit within a year of giving birth. However, this study used a small sample of pregnant females attending publicly funded clinics; the less acculturated (earlier-generation) respondents may have been disadvantaged, dependent on subsidized services and thus particularly likely to return for a first-year postpartum visit. Of the two studies that looked at fertility, one found a significant association.79 In their clinic-based sample of lowincome, 14–19-year-old Latinas in Los Angeles, Kaplan, Erickson and Juarez-Reyes found that those who preferred speaking, reading and writing in English had had more pregnancies than those who preferred Spanish. In a larger sample of 14–24-year-old Latinas, Kaplan et al. did not find a relationship between acculturation and ever having had an abortion, possibly because only 7% of respondents reported abortions. Relative Importance of Acculturation Measures Studies that simultaneously examine multiple measures of acculturation can identify which measures are the most robust. Six of the 17 studies fit this criterion. Guilamo-Ramos et al. studied the association between sexual initiation and number of years living in the United States, language spoken at home and the interaction of these two variables; years in the United States and the interaction term were the only significant variables in this model.80 Upchurch et al. studied the relationship between sexual initiation and two measures of acculturation—generation and language of interview.81 They analyzed generation as a dichotomous variable, distinguishing first-generation from others, because they found no significant differences between second and higher generations. Only language of interview reached significance in their adjusted model. Their interpretation was that generational status influences sexual initiation through teenagers’ language preference. Perspectives on Sexual and Reproductive Health Fraser et al. considered nativity, ethnic identity and biculturalism in their adjusted analysis; only biculturalism significantly predicted ever having had intercourse.82 Raffaelli, Zamboanga and Carlo analyzed nativity, childhood language, current language and ethnic identity in investigating both sexual initiation and sexual risk.83 In their adjusted model, only ethnic identity had a significant association with sexual initiation. For sexual risk, however, both nativity and ethnic identity were significant predictors. Jones, Kubelka and Bond included cultural orientation and generation in their model assessing postpartum family planning visits, but only generation was significant.84 Finally, Jimenez, Potts and Jimenez examined both nativity and language spoken at home in relation to sexual initiation and contraceptive use.85 Only nativity predicted initiation in their adjusted model; neither measure predicted contraceptive use. DISCUSSION Adverse and Protective Associations with Acculturation Our first research question focused on the relationship between acculturation and sexual and reproductive health among Latino youth. Our finding of both positive and negative associations among the 17 studies reviewed highlights the need for a better understanding of the mechanisms through which acculturation may be operating. Consistent with the research literature on Latino adults,86 nearly all 13 studies on sexual activity found that sexual risk-taking increased with greater acculturation. In particular, eight of the 10 studies that considered sexual initiation reported that greater acculturation was associated with an increased risk of initiation or earlier age at first intercourse among Latino youth in the United States. This relationship was observed despite variation in study design and sample characteristics, and persisted even after adjustment for socioeconomic status. However, because these studies investigated sexual initiation over a wide age interval, it is unclear whether acculturation influences the age at which teenagers initiate intercourse. Thus, age-specific studies are needed to elucidate this aspect of sexual behavior. The remaining two studies on sexual initiation suggested a more complex relationship between acculturation and sexual behavior, showing that greater ethnic identification or biculturalism, rather than greater acculturation, was associated with an increased likelihood of initiation.87 Because acculturation may involve the balancing of norms from two cultures, by which immigrants can relinquish and retain norms of their culture of origin while adapting to norms of the host culture, these findings do not necessarily conflict with those of the other eight studies.88 They are consistent with the stress theory: Greater biculturalism, or identification with one’s own ethnic culture in the presence of competing norms and values of the dominant culture, can lead to stressful situations, placing adolescents at risk for adverse outcomes, such as early sexual initiation.89 The evidence on whether acculturation was associated Volume 38, Number 4, December 2006 with fertility was less convincing. Of the two fertility studies reviewed, one found that greater acculturation was associated with a larger number of pregnancies among 14–19-year-old Latinas.90 This finding was consistent with that of earlier work showing a greater likelihood of premarital birth before age 22 among later generations of Mexican women of low socioeconomic status;91 however, it should be interpreted with caution, as the data were collected from women attending publicly funded family planning clinics. Furthermore, although these studies suggest that young Latinas who are more acculturated are more likely to get pregnant or give birth than less acculturated Latinas, they do not shed light on acculturation’s influence on whether Latina teenagers are delaying childbirth. More precise fertility measures are needed to elucidate the relationship between acculturation and fertility among Latina teenagers. Evidence supporting acculturation’s protective association with sexual and reproductive health outcomes was also inconclusive, as it relied on findings from only three studies. Two studies suggested that the more acculturated the Latino adolescent was, the more likely he or she was to have used condoms in the last year or to have held positive beliefs about condoms.92 These findings were consistent with results of studies among Latino adults.93 The third study, by Sorenson, suggested that greater acculturation was associated with an expectation of smaller family size.94 This was consistent with a Los Angeles–based study that found greater acculturation to be associated with the desire for a smaller number of children among a sample of Mexican American women aged 18–65.95 Although the three reviewed studies looking at condom use in the last year, condom beliefs and fertility expectations had findings consistent with those of earlier acculturation studies, they were all area- or school-based. Studies using national or regional samples are needed to confirm these findings. Application of Acculturation Theories Future research should emphasize theorydriven empirical analyses that directly investigate the relationships between cultural values and beliefs that are pertinent to sexual and reproductive health. Our second research question asked what theories were employed to explain the possible relationship between acculturation and sexual and reproductive health. A major criticism of the studies reviewed here is their failure to directly test theoretical frameworks that might help explain associations between acculturation and these behaviors and beliefs. For example, do Latina teenagers who are more acculturated place less value on virginity or harmonious family relations? If so, does this shift in values lead to a greater likelihood of sexual initiation? Furthermore, what mechanisms might explain acculturation’s adverse association with sexual activity but protective association with contraceptive use and childbearing expectations? Does less emphasis on marianismo and respeto, which might lead to more sexual risk-taking, accompany a more optimistic orientation toward alternative roles to childbearing, which in turn can lead to a greater desire to delay childbearing and motivation to practice contraception? 215 Acculturation and the Sexual and Reproductive Health of Latino Youth Longitudinal studies that follow multiple generations of immigrants would allow Studies that examine transformations in cultural values and in beliefs about sex, contraception and childbearing that occur with greater acculturation, and how these transformations relate to sexual behavior, would make a valuable contribution to this field. Future research should emphasize theory-driven empirical analyses that directly investigate the relationships between cultural values and beliefs that are pertinent to sexual and reproductive health, and the influence that these values and beliefs may exert on various behaviors. For example, Upchurch et al. discussed how transformations in values such as simpatia and familism among Latino teenagers are central to their acculturation and the formation of sexual beliefs and behavior.96 However, they did not directly measure these values, but instead explored the association between the language of interview and sexual initiation. While the preference to interview in English might be indicative of one’s acculturation level, it does not explain how one’s values and beliefs are changing. A more revealing analysis would focus on how teenagers’ support for simpatia or familism changes according to language of interview, and whether such changes explain variation in sexual initiation. researchers to examine the temporal influences of acculturation on norms, beliefs and behaviors. 216 Quality of Measures and Ideal Study Design Our final research question concerned the range of acculturation measures and which best explained variation in the examined outcomes. We identified 23 measures of acculturation, representing four dimensions—time, language, culture and residence. Findings from the six studies that simultaneously analyzed multiple measures of acculturation were equivocal about the robustness of the measures. In one study, the language of interview explained greater variation in sexual initiation than generation did.97 In two studies, time measures explained greater variation than language measures.98 In another two studies, ethnic identity and biculturalism were more significant in explaining variation in initiation than were time and language measures.99 In the sixth study, generation explained greater variation in family planning visits than did cultural orientation.100 These mixed findings highlight the need for more comprehensive studies that separately analyze each dimension of acculturation, test the relative importance of the different dimensions and examine the possible synergy across dimensions. In addition to examining a measure’s ability to explain variation in a particular outcome, future studies should consider a measure’s meaning and utility. While measures that reflect an ethnic group’s culture—such as language preference, ethnic identity or biculturalism—are possibly more robust, they are also potentially less generalizable. For example, language is a more salient cultural construct among Mexican Americans than among Asian Americans in the United States.101 Studying ethnic identity as a general concept for all ethnic groups has been questioned because its different components (i.e., religious affiliation, political attitudes) have varying importance in different ethnic groups.102 Thus, given the cultural and socioeconomic diversity of the Latino population in the United States, generalizability should be a major consideration when choosing measures of acculturation. Although time measures are not always the most robust, they may be more meaningful and useful than measures of language or ethnic identity. The time measures identified in this review do not have differential meanings across ethnic groups, and thus are generalizable to a variety of populations. Greater exposure to competing values of the host society is expected to diminish the influence of values that are unique to an ethnic culture.103 Generation, in particular, is more informative than nativity alone, because it allows a sample to be differentiated into first-, second- and thirdgeneration respondents. Nativity provides information only on the country of birth and does not allow for differentiation between second- and third-generation respondents. Our findings suggest that the presence and nature of associations between acculturation and sexual and reproductive health are likely to vary by country of origin, gender and acculturation measure. An ideal study would be larger, representative and population-based, would stratify analyses by gender and country of origin (or limit the sample to a single Latino ethnic group), and would include a time measure of acculturation and at least one measure from another dimension. The inclusion of youth from various socioeconomic backgrounds would further strengthen the design. Finally, longitudinal studies that follow multiple generations of immigrants would allow researchers to examine the temporal influences of acculturation on norms, beliefs and behaviors. None of the studies reviewed fits these ideal criteria, yet several made noteworthy contributions to the literature. The study by Ford and Norris was area-based and analyzed males and females separately, finding differential associations of acculturation with having had vaginal intercourse in the last year and with ever having had anal intercourse.104 However, it did not analyze Mexicans and Puerto Ricans separately (possibly because of limited sample size), and analyzed only one acculturation measure— language. The Upchurch et al. study also used an areabased sample, and it analyzed generation and language of interview; however, it did not analyze males and females separately.105 Guilamo-Ramos et al. used data from the National Longitudinal Study of Adolescent Health and analyzed time and language measures of acculturation; they did not separately analyze males and females, or ethnic groups.106 Sorenson included time and residence measures of acculturation, sampled teenagers of Mexican origin, and analyzed males and females separately; yet her study was school-based, and may have underrepresented teenagers who had dropped out, perhaps because they were pregnant.107 Finally, the study by Raffaelli, Zamboanga and Carlo is noteworthy, even with its small convenience sample of university students, because they were exclusively Cuban and female, and the analysis included both time and cultural measures of acculturation.108 Perspectives on Sexual and Reproductive Health CONCLUSIONS Research on the relationship between acculturation and sexual and reproductive health among Latino youth remains in its infancy. In the future, priority should be given to empirical studies that explicitly investigate links between time measures of acculturation, changing beliefs and norms, and sexual and reproductive behaviors, particularly contraceptive use and fertility desires. Such research can build on existing theories that elucidate the role of beliefs and norms pertaining to gender expectations, family formation, contraceptive use and sexual behavior that are unique to Latino culture. The findings would provide policymakers, planners and providers with greater insights into designing programmatic interventions that target diverse Latino populations. REFERENCES 1. Pew Hispanic Center, Trends 2005, Washington, DC: Pew Research Center, 2005, pp. 72–89. 2. Ibid. 3. Martin JA et al., Births: final data for 2002, National Vital Statistics Report, 2003, Vol. 52, No. 10; and Ventura SJ, Mathews TJ and Curtin SC, Declines in teenage birth rates, 1991–1997: national and state patterns, National Vital Statistics Report, 1998, Vol. 47, No. 12. 4. Aneshensel CS et al., Onset of fertility-related events during adolescence: a prospective comparison of Mexican American and nonHispanic white females, American Journal of Public Health, 1990, 80(8): 959–963. 5. Darabi KF and Ortiz V, Childbearing among young Latino women in the United States, American Journal of Public Health, 1987, 77(1):25– 28. 6. Hunt LM, Schneider S and Comer B, Should “acculturation” be a variable in health research? a critical review of research on U.S. Hispanics, Social Science & Medicine, 2004, 59(5):973–986; Lara M et al., Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context, Annual Review of Public Health, 2005, 26:367–397; and Gordon M, Assimilation in American Life: The Role of Race, Religion and National Origins, New York: Oxford University Press, 1964. 7. Berry JW, Acculturation as varieties of adaptation, in: Padilla AM, ed., Acculturation, Theory, Models, and Some New Findings, Boulder, CO: Westview Press, 1980, pp. 9–25; Crul M and Vermeulen H, The second generation in Europe, International Migration Review, 2003, 37(4):965–986; and Portes A and Schauffler R, Language and the second generation: bilingualism yesterday and today, in: Portes A, ed., The New Second Generation, New York: Russell Sage Foundation, 1996, pp. 8–29. 8. Padilla AM, ed., 1980, op. cit. (see reference 7); and Rumbaut RG, The crucible within: ethnic identity, self-esteem, and segmented assimilation among children of immigrants, in: Portes A, 1996, op. cit. (see reference 7), pp. 119–170 . 9. Sabogal F et al., Gender, ethnic, and acculturation differences in sexual behaviors: Hispanic and non-Hispanic white adults, Hispanic Journal of Behavioral Sciences, 1995, 17(2):139–159. 10. Newcomb MD et al., Acculturation, sexual risk-taking, and HIV health promotion among Latinas, Journal of Counseling Psychology, 1998, 45(4):454–467. 11. Marín BV et al., Acculturation and gender differences in sexual attitudes and behaviors: Hispanic vs. non-Hispanic white unmarried adults, American Journal of Public Health, 1993, 83(12):1759–1761; Romo LF, Berenson AB and Segars A, Sociocultural and religious influences on the normative contraceptive practices of Latino women in the United States, Contraception, 2004, 69(3):219–225; and Sabogal F et al., 1995, op. cit. (see reference 9). 12. Driscoll AK et al., Adolescent Latino reproductive health: a review Volume 38, Number 4, December 2006 of literature, Hispanic Journal of Behavioral Sciences, 2001, 23(3): 255–326. 13. Guilamo-Ramos V et al., Acculturation-related variables, sexual initiation, and subsequent sexual behavior among Puerto Rican, Mexican, and Cuban youth, Health Psychology, 2005, 24(1):88–95. 14. Upchurch DM et al., Sociocultural contexts of time to first sex among Hispanic adolescents, Journal of Marriage and Family, 2001, 63(4):1158–1169; Ford K and Norris AE, Urban Hispanic adolescents and young adults: relationship of acculturation to sexual behavior, Journal of Sex Research, 1993, 30(4):316–323; Norris AE and Ford K, Condom beliefs in urban, low income, African American and Hispanic youth, Health Education Quarterly, 1994, 21(1):39–53; and SlonimNevo V, First premarital intercourse among Mexican-American adolescent women: interpreting ethnic differences, Journal of Adolescent Research, 1992, 7(3):332–351. 15. Adam B et al., Acculturation as a predictor of the onset of sexual intercourse among Hispanic and white teens, Archives of Pediatrics & Adolescent Medicine, 2005, 159(3):261–265; and Sorenson AM, Fertility expectations and ethnic identity among Mexican-American adolescents: an expression of cultural ideals, Sociological Perspectives, 1985, 28(3):339–360. 16. Ebin VJ et al., Acculturation and interrelationships between problem and health-promoting behaviors among Latino adolescents, Journal of Adolescent Health, 2001, 28(1):62–72; Fraser D et al., Effects of acculturation and psychopathology on sexual behavior and substance use of suicidal Hispanic adolescents, Hispanic Journal of Behavioral Sciences, 1998, 20(1):83–101; Tschann JM et al., Interparental conflict and risk behaviors among Mexican American adolescents: a cognitive-emotional model, Journal of Abnormal Child Psychology, 2002, 30(4):373–385; Kaplan CP et al., Young Latinas and abortion: the role of cultural factors, reproductive behavior, and alternative roles to motherhood, Health Care for Women International, 2001, 22(7):667–689; Kaplan CP, Erickson PI and Juarez-Reyes M, Acculturation, gender role orientation, and reproductive risk-taking behavior among Latina adolescent family planning clients, Journal of Adolescent Research, 2002, 17(2):103–121; Reynoso T, Felice M and Shragg P, Does American acculturation affect outcome of MexicanAmerican teenage pregnancy? Journal of Adolescent Health, 1993, 14(4):257–261; and Jones ME, Kubelka S and Bond ML, Acculturation status, birth outcomes, and family planning compliance among Hispanic teens, Journal of School Nursing, 2001, 17(2):83–89. 17. Jimenez J, Potts MK and Jimenez D, Reproductive attitudes and behavior among Latina adolescents, Journal of Ethnic & Cultural Diversity in Social Work, 2002, 11(3/4):221–249; Raffaelli M, Zamboanga BL and Carlo G, Acculturation status and sexuality among female Cuban American college students, Journal of American College Health, 2005, 54(1):7–13; and Flores E, Tschann JM and Marín BV, Latina adolescents: predicting intentions to have sex, Adolescence, 2002, 37(148): 659–679. 18. Tschann JM et al., 2002, op. cit. (see reference 16); and Upchurch DM et al., 2001, op. cit. (see reference 14). 19. Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 20. Adam B et al., 2005, op. cit. (see reference 15). 21. Sorenson AM, 1985, op. cit. (see reference 15); Slonim-Nevo V, 1992, op. cit. (see reference 14); Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16); Flores E, Tschann JM and Marín BV, 2002, op. cit. (see reference 17); Tschann JM et al., 2002, op. cit. (see reference 16); Adam B et al., 2005, op. cit. (see reference 15); Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16); Kaplan CP et al., 2001, op. cit. (see reference 16); Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16); Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Upchurch DM et al., 2001, op. cit. (see reference 14); Ford K and Norris AE, 1993, op. cit. (see reference 14); Norris AE and Ford K, 1994, op. cit. (see reference 14); and Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17). 22. Fraser D et al., 1998, op. cit. (see reference 16); and Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 23. Adam B et al., 2005, op. cit. (see reference 15); Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Tschann JM et al., 2002, op. cit. 217 Acculturation and the Sexual and Reproductive Health of Latino Youth (see reference 16); Ebin VJ et al., 2001, op. cit. (see reference 16); Fraser D et al., 1998, op. cit. (see reference 16); Norris AE and Ford K, 1994, op. cit. (see reference 14); Ford K and Norris AE, 1993, op. cit. (see reference 14); Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16); Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16); Kaplan CP et al., 2001, op. cit. (see reference 16); Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17); Flores E, Tschann JM and Marín BV, 2002, op. cit. (see reference 17); and Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16). Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16); and Cuéllar I, Harris LC and Jasso R, 1980, op. cit. (see reference 36). 24. Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); and Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 42. Fraser D et al., 1998, op. cit. (see reference 16). 25. Fraser D et al., 1998, op. cit. (see reference 16); Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16); Kaplan CP et al., 2001, op. cit. (see reference 16); Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); Slonim-Nevo V, 1992, op. cit. (see reference 14); Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17); Flores E, Tschann JM and Marín BV, 2002, op. cit. (see reference 17); and Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16). 26. Sorenson AM, 1985, op. cit. (see reference 15); and Ford K and Norris AE, 1993, op. cit. (see reference 14). 27. Adam B et al., 2005, op. cit. (see reference 15); Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Tschann JM et al., 2002, op. cit. (see reference 16); Ebin VJ et al., 2001, op. cit. (see reference 16); Upchurch DM et al., 2001, op. cit. (see reference 14); and Norris AE and Ford K, 1994, op. cit. (see reference 14). 28. Ebin VJ et al., 2001, op. cit. (see reference 16); and Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16). 29. Adam B et al., 2005, op. cit. (see reference 15). 30. Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Ebin VJ et al., 2001, op. cit. (see reference 16); Fraser D et al., 1998, op. cit. (see reference 16); and Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16). 41. Szapocznik J, Kurtines W and Fernandez T, Bicultural involvement and adjustment in Hispanic-American youths, International Journal of Intercultural Relations, 1980, 4(3/4):353–365; and Szapocznik J and Kurtines W, Acculturation, biculturalism and adjustment among Cuban-Americans, in: Padilla AM, 1980, op. cit., (see reference 7), pp. 139–159. 43. Padilla AM, The role of cultural awareness and ethnic loyalty in acculturation, in: Padilla AM, 1980, op. cit. (see reference 7), pp. 47–84. 44. Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 45. Phinney JS, The Multigroup Ethnic Identity Measure: a new scale for use with diverse groups, Journal of Adolescent Research, 1992, 7(2): 156–176. 46. Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16); and Cuéllar I, Arnold B and Maldonado R, Acculturation Rating Scale for Mexican Americans–II: a revision of the original ARSMA scale, Hispanic Journal of Behavioral Sciences, 1995, 17(3):275–304. 47. Sorenson AM, 1985, op. cit. (see reference 15). 48. Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17). 49. Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16). 50. Slonim-Nevo V, 1992, op. cit. (see reference 14). 51. Flores E, Tschann JM and Marín BV, 2002, op. cit. (see reference 17). 52. Adam B et al., 2005, op. cit. (see reference 15); Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Ebin VJ et al., 2001, op. cit. (see reference 16); Upchurch DM et al., 2001, op. cit. (see reference 14); Fraser D et al., 1998, op. cit. (see reference 16); Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16); and Slonim-Nevo V, 1992, op. cit. (see reference 14). 31. Upchurch DM et al., 2001, op. cit. (see reference 14); Norris AE and Ford K, 1994, op. cit. (see reference 14); Kaplan CP et al., 2001, op. cit. (see reference 16); Sorenson AM, 1985, op. cit. (see reference 15); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16); Ford K and Norris AE, 1993, op. cit. (see reference 14); Slonim-Nevo V, 1992, op. cit. (see reference 14); Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17); Flores E, Tschann JM and Marín BV, 2002, op. cit. (see reference 17); Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16); and Tschann JM et al., 2002, op. cit. (see reference 16). 56. Ford K and Norris AE, 1993, op. cit. (see reference 14); and Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16). 32. Upchurch DM et al., 2001, op. cit. (see reference 14). 57. Ford K and Norris AE, 1993, op. cit. (see reference 14). 33. Tschann JM et al., 2002, op. cit. (see reference 16). 58. Ibid. 34. Upchurch DM et al., 2001, op. cit. (see reference 14). 59. Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16); and Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16). 35. Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Ebin VJ et al., 2001, op. cit. (see reference 16); Upchurch DM et al., 2001, op. cit. (see reference 14); Fraser D et al., 1998, op. cit. (see reference 16); Sorenson AM, 1985, op. cit. (see reference 15); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17); and Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16). 36. Marín G et al., Development of a short acculturation scale for Hispanics, Hispanic Journal of Behavioral Sciences, 1987, 9(2):183–205; and Cuéllar I, Harris LC and Jasso R, An acculturation scale for Mexican-American normal and clinical populations, Hispanic Journal of Behavioral Sciences, 1980, 2(3):199–217. 37. Tschann JM et al., 2002, op. cit. (see reference 16); Norris AE and Ford K, 1994, op. cit. (see reference 14); Ford K and Norris AE, 1993, op. cit. (see reference 14); and Flores E, Tschann JM and Marín BV, 2002, op. cit. (see reference 17). 218 40. Tschann JM et al., 2002, op. cit. (see reference 16). 53. Ford K and Norris AE, 1993, op. cit. (see reference 14). 54. Tschann JM et al., 2002, op. cit. (see reference 16). 55. Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 60. Slonim-Nevo V, 1992, op. cit. (see reference 14). 61. Adam B et al., 2005, op. cit. (see reference 15); Ebin VJ et al., 2001, op. cit. (see reference 16); Fraser D et al., 1998, op. cit. (see reference 16); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); and Tschann JM et al., 2002, op. cit. (see reference 16). 62. Upchurch DM et al., 2001, op. cit. (see reference 14). 63. Tschann JM et al., 2002, op. cit. (see reference 16). 64. Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 65. Norris AE and Ford K, 1994, op. cit. (see reference 14). 66. Sorenson AM, 1985, op. cit. (see reference 15). 38. Marín G et al., 1987, op. cit. (see reference 36). 67. Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17). 39. Kaplan CP et al., 2001, op. cit. (see reference 16); Kaplan CP, 68. Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16). Perspectives on Sexual and Reproductive Health 69. Ford K and Norris AE, 1993, op. cit. (see reference 14). 70. Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17). 71. Kaplan CP et al., 2001, op. cit. (see reference 16). 72. Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16). 73. Ford K and Norris AE, 1993, op. cit. (see reference 14); and Flores E, Tschann JM and Marín BV, 2002, op. cit. (see reference 17). 74. Tschann JM et al., 2002, op. cit. (see reference 16); and Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16). 92. Ford K and Norris AE, 1993, op. cit. (see reference 14); and Norris AE and Ford K, 1994, op. cit. (see reference 14). 93. Sabogal F et al., 1995, op. cit. (see reference 9); Marín BV et al., 1993, op. cit. (see reference 11); and Romo LF, Berenson AB and Segars A, 2004, op. cit. (see reference 11). 94. Sorenson AM, 1985, op. cit. (see reference 15). 95. Amaro H, Women in the Mexican-American community: religion, culture, and reproductive attitudes and experiences, Journal of Community Psychology, 1988, 16(1):6–20. 96. Upchurch DM et al., 2001, op. cit. (see reference 14). 75. Ford K and Norris AE, 1993, op. cit. (see reference 14). 97. Ibid. 76. Adam B et al., 2005, op. cit. (see reference 15); Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Ebin VJ et al., 2001, op. cit. (see reference 16); Upchurch DM et al., 2001, op. cit. (see reference 14); Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16); and Slonim-Nevo V, 1992, op. cit. (see reference 14). 98. Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); and Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17). 77. Norris AE and Ford K, 1994, op. cit. (see reference 14); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); and Sorenson AM, 1985, op. cit. (see reference 15). 78. Ford K and Norris AE, 1993, op. cit. (see reference 14); Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17); and Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16). 99. Fraser D et al., 1998, op. cit. (see reference 16); and Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 100. Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16). 101. Phinney JS, 1992, op. cit. (see reference 44). 102. Ibid. 79. Kaplan CP et al., 2001, op. cit. (see reference 16); and Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16). 103. Bean FD and Swicegood G, Generation, female education, and Mexican-American fertility, Social Science Quarterly, 1982, 63(1):131– 144; and Perez W and Padilla AM, Cultural orientation across three generations of Hispanic adolescents, Hispanic Journal of Behavioral Sciences, 2000, 22(3):390–398. 80. Guilamo-Ramos V et al., 2005, op. cit. (see reference 13). 104. Ford K and Norris AE, 1993, op. cit. (see reference 14). 81. Upchurch DM et al., 2001, op. cit. (see reference 14). 105. Upchurch DM et al., 2001, op. cit. (see reference 14). 82. Fraser D et al., 1998, op. cit. (see reference 16). 106. Guilamo-Ramos V et al., 2005, op. cit. (see reference 13). 83. Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 107. Sorenson AM, 1985, op. cit. (see reference 15). 84. Jones ME, Kubelka S and Bond ML, 2001, op. cit. (see reference 16). 85. Jimenez J, Potts MK and Jimenez D, 2002, op. cit. (see reference 17). 86. Sabogal F et al., 1995, op. cit. (see reference 9); and Newcomb MD et al., 1998, op. cit. (see reference 10). 87. Fraser D et al., 1998, op. cit. (see reference 16); and Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). 88. Szapocznik J and Kurtines W, 1980, op. cit. (see reference 41). 89. Guilamo-Ramos V et al., 2005, op. cit. (see reference 13); Ebin VJ et al., 2001, op. cit. (see reference 16); Fraser D et al., 1998, op. cit. (see reference 16); and Reynoso T, Felice M and Shragg P, 1993, op. cit. (see reference 16). 90. Kaplan CP, Erickson PI and Juarez-Reyes M, 2002, op. cit. (see reference 16). 91. Darabi KF and Ortiz V, 1987, op. cit. (see reference 5). Volume 38, Number 4, December 2006 108. Raffaelli M, Zamboanga BL and Carlo G, 2005, op. cit. (see reference 17). Acknowledgments The authors thank Jeanne Tschann and the postdoctoral fellow writing group at the Institute for Health Policy Studies, University of California, San Francisco, for their careful review of early versions of this article. They also thank Sarah Schwartz for her invaluable research assistance, and the Adolescent Reproductive Health Team, Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), for their role in initiating this review. Funding for this work came from the CDC/Association of Teachers of Preventive Medicine cooperative agreement TS-0842. The conclusions and opinions expressed here are those of the authors and not necessarily those of the funder. Author contact: aafable-munsuz@ucsf.edu 219 Sex Cult (2007) 11:1–17 DOI 10.1007/s12119-007-9006-6 ARTICLES Attitude Towards Premarital Sex among Rural College Youth in Maharashtra, India Mohan Ghule Æ Donta Balaiah Æ Beena Joshi Published online: 11 October 2007
Springer Science+Business Media, LLC 2007 Abstract Little is known about the risky sexual behaviour, misconceptions and attitudes regarding sexuality and sexual health among rural youth in India. In order to understand these aspects, quantitative data were collected among 1,500 rural college students (800 male and 700 female) in the age group 15–24 years in the Thane district of Maharashtra, India, during 2004. Analysis of variance and regression analysis were performed using the total mean score of attitude towards sexuality as the dependent variable to determine the association and relationship, respectively, with background and familial characteristics. The results clearly showed that the majority of the students in the study expressed conservative attitudes towards premarital sexuality. Many students not only disagreed with casual sex but also considered it immoral. Gender bias i.e. permitting premarital sex for males and not for females, was reflected in their attitudes to some extent. Mean score indicated that male students had higher mean scores compared with their female counterparts and senior students compared with junior students, indicating more liberal attitudes towards sexuality. Bivariate analysis showed positive association between age; peer interaction; erotic exposure; habits of gutaka, tobacco, smoking and alcohol consumption; and knowledge about reproductive health issues with attitudes towards various sexuality issues. Multivariate analysis showed that female students studying in the commerce and science faculties were more liberal in attitude towards sexuality when compared with female students from the arts faculty. Male students with high erotic exposure (odds ratio 2.3); habits of gutaka, tobacco, smoking and alcohol consumption (odds ratio 2.7); and high peer interaction (odds ratio 2.3) had higher attitudinal scores indicated more liberal attitudes. Overall, the majority of the students expressed conservative attitudes towards premarital sex. The programme on sexuality education and responsibility for in-school M. Ghule (&)
D. Balaiah
B. Joshi National Institute for Research in Reproductive Health, Indian Council of Medical Research, Jehangir Merwanji Street, Parel, Mumbai 400 012, Maharashtra, India e-mail: m_ghule@hotmail.com 123 2 Sex Cult (2007) 11:1–17 adolescents should be launched early in secondary schools/college at an early stage of the perception process and formulation of attitudes towards sexuality. This would provide students with more scientific information and deter them from gathering incomplete information through sources such as pornography and peers. Keywords Rural India
College youth
Sexuality attitude Introduction Attitudes play an important role in determining a person’s behaviour. The relationship between sexual attitudes and behaviour is a vital linkage for young people to decide whether to engage in premarital sex. Strong evidence shows that adolescents with more liberal attitudes toward sexuality are more likely to experience premarital sex (Rakesh 1992). Among the various definitions of attitude, Shaw and Wright (1967) opined that attitude entails an existing predisposition to respond to social objects, which in interactions with situational and other dispositional variables, guides and directs the overt behaviour of the individual. Males have been found to be more likely to engage in premarital sex and to have more positive attitudes towards premarital sex than do females (Carrol et al. 1985; Hendrick et al. 1985; Cernada et al. 1986; Alexander et al. 1989; Rangaiyan 1996; Abraham 2001). Also, it is widely argued that young people living in urban areas have a more liberal attitude towards sexuality and are more likely to engage in sexual premarital intercourse than are their counterparts living in rural areas (Promote et al. 1987; Orubuloye et al. 1991). This may be because the former have more life advantages and greater opportunity to be exposed to mass media related to sexuality issues. However, due to the influence of socioeconomic development, the sexual attitude of adolescents has become more open and independent from the ties of traditional, cultural and sexual behaviour norms. In Indian society, sexual relations are regulated through the institution of marriage, and hence premarital sex is disapproved of and discouraged, whereas the virtue of virginity is upheld. Social and religious sanctions against premarital sex have traditionally been strong deterrents to its practice. Yet, exposure to Western ways of life and sexual conduct could have an influence on one’s attitudes and behaviour. The Family Planning Association of India has conducted two multicentric surveys among males and females aged 15–29 years (in 1990 and 1993) in 13 and 16 cities, respectively (FPAI 1990; Watsa 1993). While not entirely comparable, the results of these surveys suggest that attitudes towards sexuality have changed to some extent over time. In 1990, for example two thirds of all males and 87% of all females surveyed disapproved of sexual relations. In contrast, the 1993 survey suggested that this proportion has declined, especially among males. There was little change in attitude about the importance of virginity. In both surveys, about half the males and females considered it imperative that a female should remain a virgin before marriage (cited in Rangaiyan 1996). The Operations Research Group (1989) reported that about half the male students approved of kissing and necking with girls. About 30% felt that 123 Sex Cult (2007) 11:1–17 3 there is nothing wrong with visiting a prostitute or having a casual fling outside of marriage. More than half of the male students were ready to marry a girl who had had earlier sexual experience, and an equal number approved of the concept of living together. The majority of students agreed with the statement that an ‘‘unmarried couple should not have sexual intercourse’’, but what is quite unexpected that one quarter of these students agreed with the statement that ‘‘I believe in getting sexual pleasure where and when I get it’’. It is obvious from the responses to all the statements that males were more liberal than the females. Reddy et al. (1993) stated that the views of the students who responded to the questionnaire regarding sexuality education and open discussion of sex were quite liberal. For example, 76% of male students and 60% of female students were in favour of introduction of sexuality education in schools and colleges. However, Rakesh (1992) found that more than 80% of college females in Delhi were against premarital sexual activity. About half of them did not involve in any sexual fantasy. More than two thirds of them admitted to having sexual desire but thought that it must be kept under control. Only one third expressed a desire for sex sometimes. A similar study of 17,185 unmarried adolescents aged 14–17 from 251 schools in Uttar Pradesh, Rajasthan, Haryana and Delhi, India, (Family Planning Foundation 1992) reported that three in four respondents disapproved of premarital sex, i.e. 87% of females and 72% of males. College students reported liberal attitudes to premarital sex; even a majority of those who had not become sexually active approved of premarital sex (Goparaju 1993). The more permissive the attitudes, the more likely that premarital sexual activity will occur earlier. Overall, these studies suggest a large extent of conservatism continues. There is a wide gap between the attitudes of males and females towards premarital sex and related issues. However, some change in the attitude towards relationships with the opposite sex has been noted, particularly among females in recent years. Objectives The study was undertaken primarily to understand the nature and extent of sexuality attitudes among unmarried rural college youth and to examine the relationship between background characteristics and knowledge towards various reproductive health issues. Background of the Study Area Maharashtra encompasses an area of 308,000 km2 (119,000 miles2) and is the third largest state in India after Rajasthan and Madhya Pradesh. As per the 2001 census, Maharashtra has a population of 96,752,247 inhabitants, making it the second most populous and urbanised state in India. Maharashtra is India’s leading industrial state, contributing 13% of national industrial output. Around 64% of the people are employed in agriculture and allied activities. Maharashtra’s urban population stands at 42.4%. Its sex ratio is 922 females to 1,000 males. About 77.2% of its population is literate, of which 86.2% are males and 67.5% females. 123 4 Sex Cult (2007) 11:1–17 Thane is located to the north of Mumbai (Bombay, Maharashtra, India). The total population of the Thane district is 8,131,849, which includes a rural population of 2,229,376. The study area is located around 80 km from the Thane district headquarters. Around 70% of the population is literate. There are different landforms, which include mountainous region, river basins and the coastal region. From the point of view of industries, Thane is an important district of the Maharashtra state. However, these industries are located near district headquarters. There are few small-scale industries in the study area. The modes of transport in the Thane district are roads, railways and waterways. The study area consists of a hilly region consisting of Jawhar, Wada, Shahapur and Murbad talukas; in the north and northeast are taluka headquarters of the Thane district, and they are developing gradually. People mainly work as wage earners, labourers in small-scale industries or farmers. Fishing is carried out along the coast. There are many salt pans. Adivasis (tribals) live in this hilly region, and the total tribal population is 1,199,290. Role of Family, Marriage and Gender Relations In India, sexuality is influenced by the interaction of biological, psychological, social, economical, political, cultural, ethical, legal, historical and religious and spiritual factors. Much of India remains relatively traditional when it comes to sex, especially with regard to premarital sex. In many parts of the country, even talking about sex is still considered taboo (International Herald Tribune, Nov. 2006). Indian youth are torn between crosscurrents of reality, fantasy and dream. Young people are poorly informed about their own bodies and matters related to sexuality and health. The information they have is often incomplete, and they remain confused. A strict moral code at home and the selection of a life partner are in contrast to the visuals a youth is exposed to in day-to-day activities. Moral standards set by societal norms through socialisation processes and prevailing situations in which they live place young people at the crossroad. Because of tremendous societal pressure, trying to define their own sexual identity is a problem for both sexes and severely limits their ability to speak about their need for more information or about their doubts and fear. Such taboos and restrictions are accepted with no questions asked. Some examples are ‘‘The girl must be virgin’’; ‘‘Women are unclean during menstruation’’’; ‘‘Men must be controlling partner in sex’’; ‘‘Sex with more than one partner is wrong’’. All these are just variations of a familiar theme. The socialisation process plays an important role here, where girls are made to think of, and interact with, only the husbands, apart from other male members of her family. Women are not expected to express sex within the ‘‘desire’’ and ‘‘pleasure’’ perspective. Also, there are many restrictions imposed on their movement and socialising. Only in coeducational schools have girls found an opportunity to talk to boys, as in most other environments it is prohibited. The common notion among elders is when a boy and girl are mature enough to reproduce, then they should be married off as soon as possible. Religious beliefs have a significant impact on attitudes towards sexuality. The extent to which religion influences individual attitudes, however, depends on the specific doctrines of each religion. The negative 123 Sex Cult (2007) 11:1–17 5 influence of self-religiosity on attitudes towards sex clearly shows that individuals who perceive themselves as more religious display conservative attitudes towards sex (Rangaiyan 1996). An early marriage is also a strong component in which sex is discussed and practiced within the expected social norms. Today, age of marriage is increasing, as are strong external influences such as mass media etc., which are slowly and steadily bringing about changes in sexual attitude, behaviour and practices. Materials and Methods Selection of the district and colleges was done using purposive sampling. In all these selected taluaks (blocks), there is only one college for higher education. The students were recruited by faculty divisions by random sampling. The sample consisted of 1,500 students (800 male and 700 female) in the age group 15– 24 years—junior-college youth (11th–12th standard) and senior (13th–15th standard) from eight colleges in Shahapur, Wada and Murbad in the Thane district. With the help of a professor, students were asked to sit in a classroom with enough space between them in order to avoid any discussion/copying. The purpose of the study was explained, and the students were told clearly that reliable information on sexuality issues is very much lacking, and the importance of giving honest replies was stressed. Students were also told that the questionnaire did not contain name and address, thereby assuring them complete anonymity and strict confidentiality. They were also told that their participation was voluntary and they could discontinue the interview if they wished to do so. On average, the respondents took almost 45 min–1 h to complete the questionnaire. Students who were younger than 18 years and willing to participate in the study were asked to produce written consent of their parents, and remaining students (18 years and older) were informed orally in regional language (either in English, Hindi or Marathi). Unmarried youth in the age group 15–24 years who did not wish to participate (give interview) or would only partially provide information were not included in the study. Around 5% (49 male and 34 female) students either refused to give information or did not complete the questionnaire. They were not included in the study. The study employed a self-administered questionnaire after pretesting on 50 rural college students. The questionnaire contained questions on sexuality attitudes, such as attitudes towards premarital and extramarital sex, sexual thoughts, sex inhibition, sexual freedom, sex education, role of institutions in influencing sexual behaviour, HIV/AIDS and contraception. The study explored attitudes and views towards premarital sex through personal opinions of college youth and also through the attitudes of friends, as perceived by respondents. Questionnaires were provided in Marathi (local state language) and English. The survey was conducted from January through March 2004. Distributions of students are given according to the three major attitudinal response categories, i.e. agree, neutral and disagree. For every permissive attitude, a score of 3 was given; for every neutral/don’t know answer, a score of 1 was given; for every conservative answer, a score of 0 was given. Bivariate and multivariate analysis was carried out to study significant association/ relationship between individual and family characteristics and sexuality attitude. 123 6 Sex Cult (2007) 11:1–17 Results and Discussion Background Characteristics The mean age of the study population was around 18 years. Of the total students, around 74% belonged to the arts stream and the remaining 36% belonged to the science and commerce disciplines. A vast majority (91.5%) of students were Hindus, and 8.5% had other religious affiliations such as Muslim, Christian, Buddhist and Jain. Around three fifths (59%) belonged to Scheduled Caste (SC), Scheduled Tribe (ST) and Nomadic Tribe (NT), and others (SCs and STs are communities that were considered ‘‘outcastes’’ and were excluded from the Chaturvarna system that was the descriptive social superstructure of Hindu society in the Indian subcontinent for thousands of years. These communities had traditionally been relegated to the most menial labour, with no possibility of upwards mobility, and were subject to extensive social disadvantage and exclusion in comparison with the wider community. SCs/STs together comprise over 24% of India’s population, with SC at more than 16% and ST more than 8% as per 2001 census. Source: Wikipedia, the free encyclopedia). Today, most of these castes enjoy the benefits of reservations and increased opportunities in education, employment and other sectors from the time of independence. Nearly 20% of boys and 6.6% girls are working for an income. The total personal income per month varied from Rs. 50 to Rs. 5,000. About 11% of male students reported that they were habitual to gutaka, tobacco chewing, smoking and alcohol consumption. About 60% of students (53% boys and 69% girls) reported to have cable connection and watch television daily up to 2 h. Overall, there was a higher proportion of students’ fathers (32.9%) with educational level up to higher secondary and above compared with students’ mothers (6.8%). Mother’s occupational status was lower than fathers’, and about 91% of students reported that their mothers were housewives. About 67.5% of students belonged to families with an income up to Rs. 5,000 per month. Attitude Towards Sexuality A total of 23 statements related to attitude towards sexuality were included. Table 1 presents distributions of male and female students according to three major attitudinal response categories, i.e. agree, neutral and disagree. More than three fifths of male and female students agreed with the statement that virginity is a girl’s most valuable possession. Half of the male students and over four fifths of female students disagreed with taking pleasures when they find them. Around three fourths of both male and female students disagreed that if they love a girl/boy, they would have sexual relations with her/him. Students consistently reported disagreement over premarital and extramarital sexual relations. For example, about 85% of male and 90% of female students disagreed with the statement that premarital sexual relations often equip persons for more stable and happier marriage. Around two thirds of male and female students disagreed with the statement that extramarital sexual relations is not bad. Though 123 Sex Cult (2007) 11:1–17 7 Table 1 Percent distribution of students who agree or disagree to the attitudinal statements on sexuality Attitudinal statements on sexuality Male (n = 800) Female (n = 700) Disagree Neutral Agree Disagree Neutral Agree Virginity is a female students’ most valuable possession 21.4 17.3 61.2 17.7 12.7 69.5 If I love a girl/boy, I would do anything with her/him 70.1 17.7 12.2 77.3 19.5 3.3 I believe in taking my pleasures when I find them 50.5 21.2 28.3 82.0 14.7 3.3 I think it is right for a boy to masturbate 62.5 23.1 14.5 40.8 31.5 27.8 While it is natural for men to have multiple sexual relations, it is morally incorrect for women to do so 64.1 18.2 17.7 75.1 18.2 6.7 Premarital sexual relations often equip persons for more stable and happier marriages 85.0 8.6 6.4 90.1 7.7 2.1 Extramarital sexual relations is not bad 65.5 12.5 22.1 66.7 17.3 16.0 Pornographic writing should be allowed to be published 52.0 26.2 21.8 52.9 34.9 12.2 I think about sex almost everyday 55.1 20.8 24.1 68.8 25.0 6.2 I like to look at sexy pictures of naked persons 58.0 18.3 23.7 84.7 12.3 3.0 Sometimes sexual feelings empower me 43.6 18.8 37.5 66.8 22.6 10.6 I am embarrassed to talk about sex with friends 45.8 17.2 37.0 35.5 21.2 43.3 Religious groups shouldn’t attempt to impose their standards on sexual behaviour 41.8 24.2 34.0 46.1 34.3 19.6 My religious beliefs are against sex 39.0 28.2 32.8 30.5 35.5 34.0 My parents influence has inhibited me sexually 28.8 22.4 48.8 28.6 30.3 41.1 Children should be given sex education 18.0 10.1 71.9 22.7 20.5 56.8 Sex education in elementary and high schools is likely to encourage premarital sexual activities 25.4 14.8 59.7 28.9 22.3 48.8 Easy access to birth control information and devices increases premarital sexual activities 43.4 23.6 33.0 39.6 39.2 21.2 I will use condoms only when my sexual partner requests 42.3 22.8 34.9 38.3 39.9 21.7 My friends mostly have sex for recreation/ fun 55.5 26.3 18.2 73.7 24.0 2.3 My friends don’t think safe sex important 64.3 22.3 13.3 61.2 27.5 11.3 My friends believe that a single steady sexual partner relationship is no fun 50.9 24.9 24.2 71.1 26.3 2.6 My friends believe that love is not necessary for sex 48.4 23.9 27.7 55.8 33.5 10.7 123 8 Sex Cult (2007) 11:1–17 there is no denying that youth today is moving towards more liberal sexual attitude and behaviour, it is apparent that the Indian youth still look at sex in the broader framework of relationship (Rangaiyan 1996). The transitory nature of attitude is evident by the fact that easy accessibility to birth control information and devices was believed to increase the risk of premarital sexual activities (40% of males and 42% of females) (Rangaiyan 1996). However, in this study, only around one third of male and one fifth female students felt so. Around two fifths of male and female students disagreed with the statement ‘‘I will use condoms only when my sexual partner requests’’. Sexual thoughts are natural phenomena in the process of maturing. It is reasonable to expect that the nature and frequency of these thoughts will have an important bearing upon sexual attitudes as well as behaviour of youth. In this study, 55% of male and 69% of female students also disagreed that they think about sex almost every day. About 58% of male students and 85% of female students disagreed with the statement that they like to look at sexy pictures of naked persons. About 44% of male and 67% of female students disagreed with the statement that sometimes ‘‘sexual feelings empower them’’. About 37% male and 43% female students agreed with the statement that they feel embarrassed to talk about sex with their friends. More than 64% of male and 75% of female students did not consider it natural for men to have multiple sexual relations but it is morally incorrect for women to do so. In continuation with the above findings, it was observed that more than 52% of both male and female students did not approve of pornographic literature being published. Overall, these statements show an example of conscious control over one’s sexuality. There is evidence of conservatism in students’ attitudes, as one third of male students and one fifth of female students agreed that religious groups should not attempt to impose their standards on sexual behaviour. Around one third of both male and female students agreed that their religious beliefs are against sex. Around half of the male students and two fifths of female students agreed that their parents’ influence had inhibited them from becoming sexually involved. Approximately two thirds of male students and three fifths of female students favoured sex education in schools, and around one fourth of the male and female students disagreed that sex education in elementary and high school is likely to encourage premarital sexual activities. One of the striking features during adolescence is the sudden increase in peer interaction and exploration and experiencing of adult behaviour within the subculture of peer groups. These peer groups consist of male and female students at college, at the residence, at the work place and at the coaching/tuition classes. A little more than half of male students and two thirds of female students disagreed with the statement ‘‘my friends mostly have sex for recreation/fun’’. Around 12% of male and female students agreed that their friends do not think safe sex important, and half of male students and around three fourths of female students agreed with the statement that their friends believe that a single steady sexual partner relation is no fun, whereas around 48% of male students and 56% female students disagreed that their friends believe that love is not necessary for sex. However, about 20–35% of students answered, ‘‘don’t know’’ to responses of various statements on premarital sex. Double standards reflect their gender bias. 123 Sex Cult (2007) 11:1–17 9 Differentials or differences? The second part of this paper describes the association between individual and family characteristics and intervening attitude variables by using mean scores of variables to summarise the data. Quantitative information includes students’ attitudes towards sexuality and its dimensions, such as premarital sex, sexual freedom, sexual thoughts, peer’s attitudes and sex education. The attitudinal dimension was analysed by grouping students as being conservative, moderate or liberal, and this was cross-classified with selected student characteristics. One-way analysis of variance (ANOVA) was applied to see whether the mean scores of attitudes towards sexuality issues differ significantly across the categories of male and female students. Using an attitudinal scale consisting of 23 items, students’ attitudes towards various aspects of sexuality are assessed. For every permissive attitude, a score of 3 was given; for every neutral/don’t know answer, a score of 1 was given; for every conservative attitude, a score of 0 was given. Guttman scaling techniques were applied by using responses to items of attitude towards sexuality to construct students’ attitudes. The scale scores ranged from 25 to 61, with a higher score indicating more liberal attitudes. The overall mean of sexuality attitudes was 40.20, with and standard deviation (SD) of 5.89. Mean score obtained by male students was 42.06 (± 6.21 SD ) and female students 38.06 (± 4.67 SD). Mean score of these students shows that junior and senior male students obtained higher attitudinal scores compared with junior and senior female students. Higher mean scores indicate more liberal attitudes of students on these issues. Senior students obtained higher scores compared with their junior counterparts. One-way ANOVA shows that the mean scores differed significantly across the categories of male and female students and level of education. The differences in attitude among male and female students according to their individual and family characteristics are presented. Individual Characteristics Table 2 presents mean score of attitude towards sexuality, sex inhibitions, institutional control and peers’ attitude among junior and senior male and female students by individual characteristics. The permissive attitude may be related to student age. An association was observed between age and attitude towards sexuality among male students. It was found that average attitudinal score increases with age for male students but not for female students. A review of earlier studies identifies the fact that age is positively related to attitude towards sexuality. The higher the age, the more permissive the attitude towards sexuality (Rakesh 1992; FPAI 1995; Rangaiyan 1996; Abraham 1997, Ghule 2004). Students studying in arts and commerce faculties obtained higher scores on attitudes compared with their science counterparts. All religions maintained explicit statements about the inappropriateness of sex before marriage and emphasised sexual abstinence except within marriage. The extent to which religion influences individual attitudes, however, depends on the specific doctrines of each religion. 123 10 Sex Cult (2007) 11:1–17 Table 2 Mean score of attitudes towards sexuality among male and female students by selected individual characteristics Individual characteristics Mean score of attitudinal statements on sexuality issues Male (n = 800) Female (n = 700) Total (n = 1500) Junior Senior Total Junior Senior Tota...
Purchase answer to see full attachment