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.
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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
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and Cuéllar I, Harris LC and Jasso R, An acculturation scale for
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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,
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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
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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
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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
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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
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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
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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.
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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
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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.
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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
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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
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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.
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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.
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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...
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