Acculturation and Parent-Adolescent Communication about Sex in Filipino-American Families: A Community-Based Participatory Research Study

Article Outline

• Abstract
• Methods
  • Community-Based Participatory Research (CBPR)
  • The sample
  • Measures
    • Acculturation
    • Parent-adolescent communication
    • Other measures
  • Analyses
• Results
  • Frequency of talking about sex with parents
  • Acculturation: use of English
  • Acculturation: disagreement with Asian values
  • Other factors associated with frequency of parent-adolescent communication
• Discussion
  • Adolescent acculturation and parent-adolescent communication about sex
• Conclusion
• Acknowledgments
• References
• Copyright

Abstract 

Purpose

To examine whether acculturation is associated with parent-adolescent communication about sex in Filipino-American families. Filipino-Americans, the United States’ second-largest Asian and Pacific Islander (API) group, have more adolescent pregnancy and HIV infection than other APIs. High-quality parent-adolescent communication about sex has been associated with healthy sexual development, and acculturation has been associated with various increased health risks. Whether acculturation affects parent-adolescent communication is unknown.

Methods

We surveyed 120 pairs of Filipino-American parents and adolescents at a single large high school. We asked adolescents about their frequency of parent-adolescent communication about sex and measured adolescent acculturation in two ways: disagreement with traditional Asian values and preferential use of English. In bivariate and multivariate regressions, we examined whether adolescent acculturation was associated with adolescent reports of parent-adolescent communication.

Results

Few adolescents (22%) reported regularly discussing sex with parents. Although most adolescents (72%) agreed with traditional Asian values, most (63%) preferred using English. In bivariate regressions, less parent-adolescent communication about sex was associated with less adolescent agreement with traditional Asian values (p = .002) and more adolescent English use (p = .009). In multivariate regressions, these associations were largely explained by adolescent perceptions of parent knowledge about their whereabouts and activities.

Conclusions

Acculturation may influence Filipino-American parent-adolescent communication about sex and, consequently, Filipino-American adolescent sexual health. Health care and public health providers may need to tailor adolescent sexual health programs based on acculturation or other immigration-related factors.

Keywords: Acculturation, Adolescent, Asian Americans, Parent-child relations, Sexual behavior

The sexual health of most Asian and Pacific Islander (API) adolescents in the United States appears to equal or exceed that of other adolescents. API adolescents are less likely than non-APIs to have unprotected sex or multiple sex partners, and they are less likely to become pregnant or infected with HIV [1], [2], [3], [4]. APIs are not, however, uniformly at lower risk. API adolescents who have intercourse are as likely as non-APIs to use alcohol or drugs with intercourse and as unlikely to use condoms [1], [4], [5]. API adolescents are less likely than whites to discuss HIV/AIDS with parents and may have less HIV prevention knowledge [5], [6]. Finally, API adolescent rates of birth and alcohol, tobacco, and other drug use vary widely by ethnic subgroup, with rates for individual subgroups often exceeding those of non-APIs. The percentage of births to teens among API subgroups in California ranges from 1% to 19% (vs. 12% for whites) [7]. Likewise, the percentage of API 9th graders in California who have used an illicit substance in the last 30 days ranges from 12% to 37% for alcohol (vs. 36% for whites), 6% to 20% for cigarettes (vs. 16% for whites), and 4% to 20% for marijuana (vs. 15% for whites) [8].

Filipino-Americans are the second-largest API group in the United States [9]. Of California’s six largest groups (Chinese, Filipino, Vietnamese, Korean, Indian, and Japanese), Filipino-Americans have the highest proportion of adolescent births [7]. Filipino-American adolescents and adults also appear to have the largest proportion of HIV/AIDS cases among APIs [10]. The reasons for these disparities are unknown. Some suggest that Filipinos are unique among APIs due to prolonged Spanish and American colonialism [11].

Parent-child communication about sex, especially communication that occurs in the context of a close parent-child bond and an authoritative parenting style, is one factor commonly associated with healthier sexual development and reduced sexual risks [12], [13], [14], [15]. A recent study found that certain high-risk adolescent girls who reported high-quality mother-child communication were 1.6 times as likely as those reporting lower-quality communication to plan on delaying sexual intercourse [16]. Among Filipino-Americans, one qualitative study suggested that parent-child communication, particularly regarding sexual matters, could play a major role in preventing adolescent pregnancy [17]. In a focus group study that we conducted with Filipino-American adolescents, parents, and grandparents, almost all participants described major breakdowns in intergenerational communication about sex, stemming, in large part, from family struggles with acculturation [18]. Parents and grandparents in our study believed that acculturation had destroyed the traditional respect for elders that allowed civil and orderly intergenerational communication to occur, while adolescents believed that acculturation had taught them benefits of open dialogue that their parents refused to accept.

Acculturation has been linked to changes in a number of API health-related behaviors. Cultural factors more often ascribed to API cultures than to western cultures (e.g., respecting authority, valuing harmonious social relations, collectivism) have been theorized as protective against risk behaviors [19]. The most acculturated adolescent girls are five times as likely as the least acculturated to have had sexual intercourse [20]. In a study among young adolescents, each additional point on an eight-point acculturation scale was associated with a decrease in physical activity of .9 times and an increase in fast-food consumption of .8 times per week [21]. Adolescents with less parental attachment and more acculturation are 11 times more likely to drink alcohol than those with greater parental attachment and less acculturation [22]. In California, adolescent girls with high English proficiency are five times as likely to smoke as those with low English proficiency [23]. Similar hypotheses about a potentially corrosive effect of U.S. culture on health and well-being have been suggested for Latino immigrant groups [24], [25]. One study found that U.S. parents and adolescents from East Asian, Filipino, and Latino backgrounds who continued to communicate in their native language reported better relationship quality than those who communicated in English [26].

Based on the findings in our earlier focus group study, we examined whether acculturation or other factors (e.g., adolescent and parent perceptions of parental monitoring, adolescent and parent knowledge of sex-related topics including HIV/AIDS) are associated with frequency of parent-adolescent communication about sex in a sample of Filipino parents and adolescents.

Back to Article Outline

Methods 

Community-Based Participatory Research (CBPR) 

Listed by the Institute of Medicine as a high-priority public health innovation [27], CBPR encourages researchers and community members to collaboratively answer questions posed by the community, collecting data locally and communicating results directly to the community for its use [28], [29], [30]. Involvement of researchers is intended to protect against scientific bias, and investment by community members improves real-world applicability and responsiveness to community needs.

The study was conducted by the UCLA/RAND Center for Adolescent Health Promotion, which partners with community members on CBPR projects. A Filipino-American community representative on the Center’s Community Advisory Board (CAB) proposed to partner with the Center to develop the study described in this paper.

In response to this request, we established a smaller project-specific CAB with 13 local Filipino-American community advocates, parents, and adolescents. The CAB met semi-annually over a 3-year period. Between official meetings, the CAB and other community members frequently and regularly collaborated with investigators on study design, recruitment strategies, and research questions and protocols.

In the first phase, key informant interviews and focus groups were conducted with Filipino-American adolescents, parents, and grandparents to qualitatively explore family communication about sex [18]. In the second phase, which we report on in this article, we conducted surveys to quantitatively examine whether acculturation or other factors were associated with parent-adolescent communication about sex in Filipino-American families. The protocol was approved by UCLA’s Office for the Protection of Research Subjects and the Program and Evaluation Research Branch (PERB) of the Los Angeles Unified School District (LAUSD).

The sample 

Data for this study were gathered from Filipino-American students in grades 9 through 12 and their parents in one large ethnically diverse high school in Los Angeles County. Students’ mean age was 16 years (standard deviation [SD]: 1.2). The school was selected based on school district data of student ethnicity that indicated the school had a large proportion of Filipino students.

LAUSD collects school-specific racial/ethnic information (Filipino is a separate category in California schools) on all enrolled students. The participating high school provided us with the names and addresses of all Filipino-American students in the school. We mailed parent surveys to the parents of all Filipino-American students and asked for written informed consent to contact the students. We mailed adolescent surveys to the students for whom we received parental consent. In families with more than one eligible student, parents received one survey for each student. In families with more than one parent, adolescents were asked to respond separately for each parent (the survey contained separate modules for each parent). This technique allowed us to correctly pair parent and adolescent responses during analyses regardless of which parent responded.

All survey and consent materials were available in both English and Tagalog (by far the most commonly spoken Filipino dialect among Filipino-Americans). Materials were first translated from English to Tagalog by one translator, and then back-translated from Tagalog to English by another translator to check for translation quality.

Of 343 Filipino families in the sample, 196 (57%) returned parent surveys; 160 parents (82%) consented to their adolescents’ participation, and 120 adolescents (75%) representing 102 families returned completed adolescent surveys (see Table 1 for additional details about the sample). Responses of parents who did not consent to their adolescents’ participation were similar to responses of parents who did. We report only the responses from the 120 parent-adolescent pairs.

Table 1. Participant characteristics

	Parent Mean (SD) or %	Adolescent Mean (SD) or %	p-value
Mean age (years)	46(6.1)	16(1.2)
Female (%)	75	49
Born in U.S. (%)	4	48
Catholic (%)	88	84
Religiosity (0 = not religious, 3 = very religious)	2.1(.57)	1.6(.70)	<.001
Disagreement with Asian values (average of 8 questions: 0 = strongly agree, 4 = strongly disagree)	0.74(.51)	1.1(.61)	<.001
Language use (average of 4 questions: 0 = a Filipino language only, 4 = English only)	1.9(.78)	2.6(.89)	<.001
Parent knowledge about adolescent whereabouts and activities (average of 11 questions: 0 = nothing, 2 = a lot)	1.7(.29)	1.5(.42)	<.001
Parent knows enough about sexual topics to give advice (0 = strongly disagree, 3 = strongly agree)	1.9(.95)	1.9(.80)	.34
HIV knowledge (number of correct responses to 6 questions)	3.9(2.0)	3.9(2.1)	.68
Education
Less than college graduate (%)	36
College graduate (%)	50
More than college graduate (%)	14
Employed (%)	88
Married (%)	77
Annual household income
Less than $30,000 (%)	36
$30,000–$50,000 (%)	36
More than $50,000 (%)	18
Grade
9th (%)		13
10th (%)		35
11th (%)		26
12th (%)		26
Has had anal, oral, or vaginal sex (%)		17
Frequency of talking about sex with parent (average of 10 questions: 0 = not at all, 2 = a lot)	1.1(.66)	0.85(.63)
Frequency of talking about sex with friends (average of 10 questions: 0 = not at all, 2 = a lot)		1.0(.63)	<.001

Measures 

The survey instrument covered acculturation, parent-adolescent communication, parent knowledge about adolescent whereabouts and activities, knowledge of HIV, sexual behavior, adolescent communication with friends, and socio-demographic information.

We adapted eight questions from the 36-item Asian Values Scale (AVS) [30]. The AVS aims to be a more comprehensive measure of acculturation than behavioral measures such as language preference. Factors underlying the AVS, while common in many societies, are believed by some researchers to be particularly important in Asian cultures. These factors include collectivism, conformity to norms, emotional self-control, humility, filial piety, and family recognition through achievement. The original AVS had acceptable inter-item (α = .82) and test-retest (α = .83) reliability and was highly correlated with other Asian acculturation scales in validity testing [30]. Our eight questions, selected by consensus among investigators and community members based on relevance and importance, focused most on conformity to norms and filial piety and showed acceptable inter-item correlations (α = .77 for parents, α = .81 for adolescents).

We adapted 4 questions from the 12-item Short Acculturation Scale for Filipino Americans (SASFA) [31] to cover language preference. Because English is an official language in the Philippines, its validity as an acculturation measure might be limited. In factor analyses, however, the SASFA appeared to be valid against an equivalent scale designed for Hispanic populations, suggesting that preference for English may be a reasonable acculturation measure among Filipino Americans [31]. Our four questions, again selected by investigator and community consensus, had acceptable inter-item correlations (α = .85 for parents, α = .83 for adolescents).

We used both value and language measures of acculturation in our analyses, hypothesizing that values and language might reflect acculturation in different ways. Second-generation Filipino Americans, for instance, might strongly prefer English while remaining sympathetic toward Asian values prized by their immigrant parents. Therefore, a shift away from Asian values might be a more stringent measure of acculturation than a shift toward English use.

We measured adolescents’ perceptions of frequency of parent-adolescent discussions about sexual issues. In the parent surveys, parents were also asked about the frequency of discussions; however, these questions were not included as outcomes in analyses because we were most interested in adolescent perceptions of communication. Our frequency scale included 10 items (all rated 0 = not at all, 1 = a little, and 2 = a lot) about preventing pregnancy or STDs, avoiding being physically forced or pressured into having sex, avoiding pressuring someone else into having sex, when or why to start or not start having sex, sexual orientation, and feelings that may occur after sexual experiences (α = .93).

We asked parents and adolescents their perceptions regarding the parent’s knowledge about adolescent whereabouts and activities. Our scale (α = .84 for parents, α = .89 for adolescents) included 11 Likert-type scale questions (e.g., “How much do you know about where your child goes after school?” for parents, and “How much do your parents know about where your child goes after school?” for adolescents) adapted from three existing parental monitoring scales [32], [33], [34]. We also tested parents and adolescents regarding their knowledge of HIV-related issues. Our scale (α = .82 for parents, α = .83 for adolescents) included six true/false questions (e.g., “HIV/AIDS can be caught from sharing a glass of water with a person who has HIV or AIDS”) adapted from a previously validated HIV knowledge scale [35].

Analyses 

We used adolescents’ report of frequency of talking about sex as the dependent variables in two sets of linear regressions, with adolescent acculturation (measured by adolescent disagreement with Asian values and adolescent preference for English) as the main predictor variable. Bivariate regressions were first used to identify potentially important predictors of frequency of talking about sex. Potentially important predictors were then included in multivariate regressions. A common statistical convention is to use p < .20 in bivariate analyses as a cutoff for inclusion of a predictor variable in a single multivariate analysis [36]. The following covariates met the p < .20 cutoff in bivariate analyses: adolescent perceptions of parent knowledge about their whereabouts and activities, parent and adolescent knowledge of sexual topics, parent and adolescent HIV knowledge, adolescent religiosity, and adolescent frequency of talking about sex with friends. Potential covariates that did not meet the cutoff included: parent perceptions of their knowledge about adolescent whereabouts and activities, parent religiosity, adolescent sexual activity, parent and adolescent gender, parent and adolescent age, parent education, and household income.

Back to Article Outline

Results 

Frequency of talking about sex with parents 

On average, adolescents reported intermediate frequency of talking about sex (Table 1). Parents reported, on average, much higher frequency (p < .001) than adolescents. Adolescents reported greater frequency of talking about sex with friends than with parents (p = .02). In all of the analyses that follow, frequency of parent-adolescent communication was measured by adolescent self-report.

Acculturation: use of English 

Parents reported nearly equal use of a Filipino language (e.g., Tagalog) and English (Table 1); adolescents reported more use of English than parents (p < .001). Differences in usage between parents and adolescents were largest for language used “with friends” and “while thinking” and smallest for language used “at home,” suggesting that parents and adolescents tended to use a common language when speaking with each other.

In bivariate regressions (Table 2), greater adolescent use of English was associated with less frequent parent-adolescent communication about sex (b = −.21, p = .009). In the multivariate regression, however, the association between more adolescent English use and less frequent parent-adolescent communication was no longer significant (b = −.08, p = .18, Multivariate Model 1 in Table 2). We hypothesized that the association between adolescent English use and parent-adolescent communication might be mediated by associations between adolescent English use and measures of parent-adolescent closeness, such as adolescent perception of parent knowledge about their whereabouts and activities. We found that more adolescent English use was strongly associated with adolescent perception of less parent knowledge (p = .001, not shown), and that adolescent perception of less parent knowledge was strongly associated with less parent-adolescent communication (p <. 001, Table 2), thus supporting our hypothesis [37]. Moreover, when adolescent perception of parent knowledge was removed from the multivariate regression, the association between more adolescent English use and less frequent parent-adolescent communication regained significance (b = −.14, p = .04, Multivariate Model 2 in Table 2).

Table 2. Factors associated with adolescent reports of frequency of talking about sex with parents

Note: Linear regression b (non-standardized β) interpreted as the change in frequency score (positive change = greater comfort or frequency) for each unit change in the predictor variable.

We defined the parent-adolescent language gap as the absolute value of the difference between parent and adolescent English use. In bivariate regressions, a greater parent-adolescent language gap was also associated with less frequent parent-adolescent communication (b = −.23, p = .01, not shown). To determine whether the association between greater adolescent use of English and less frequent parent-adolescent communication was merely a reflection of a greater parent-adolescent language gap, we repeated Multivariate Model 2 with language gap included as an additional variable. In the multivariate regression, the association between greater language gap and less frequent parent-adolescent communication was no longer significant (b = −.06, p = .41, not shown).

Acculturation: disagreement with Asian values 

Although parents and adolescents both generally agreed with Asian values (Table 1), parents agreed more strongly (p < .001). Parents agreed most with the statement, “Children should receive guidance mostly from family,” and least with the statement, “People should always consider the needs of others before considering their own.” Adolescents agreed most with the statement, “Children should expect to take care of their parents when their parents become unable to take care of themselves,” and least with the statement, “Children should spend most of their free time at home with family.”

In bivariate regressions (Table 2), greater adolescent disagreement with Asian values (i.e., greater acculturation) was associated with less frequent parent-adolescent communication about sex (b = −.33, p = .002). In multivariate regressions, this association was no longer significant (b = −.13, p = .21, see Multivariate Model 1 in Table 2). As with language, we hypothesized that the association between adolescent disagreement with Asian values and parent-adolescent communication might be mediated by adolescent perception of parent knowledge about their whereabouts and activities. We found that greater adolescent disagreement with Asian values was strongly associated with adolescent perception of less parent knowledge (p < .001, not shown), and that adolescent perception of less parent knowledge was strongly associated with less frequent parent-adolescent communication (p < .001, Table 2), again supporting our hypothesis. Moreover, when adolescent perception of parent knowledge was removed from the multivariate regression, the association between greater adolescent disagreement with Asian values and less frequent parent-adolescent communication regained significance (b = −.25, p = .02, Multivariate Model 2 in Table 2).

We defined the parent-adolescent values gap as the absolute value of the difference between parent and adolescent disagreement with Asian values. In bivariate regressions, a greater parent-adolescent values gap was also associated with less frequent parent-adolescent communication (b = −.28, p = .04, not shown). To determine whether the association between greater adolescent disagreement with Asian values and less frequent parent-adolescent communication was merely a reflection of a greater parent-adolescent values gap, we repeated Multivariate Model 2 with values gap included as an additional variable. In the multivariate regression, the association between greater values gap and less frequent parent-adolescent communication was no longer significant (b = −.08, p = .53, not shown).

Other factors associated with frequency of parent-adolescent communication 

As described earlier, adolescent perception of more parent knowledge about their whereabouts and activities was strongly associated with more frequent parent-adolescent communication about sex in bivariate regressions (b = .72, p < .001, Table 2). This association persisted and, in fact, dominated other associations in multivariate regressions (b = .55, p < .001). In multivariate regressions when adolescent perception of parent knowledge was removed, a stronger perception among adolescents that parents knew enough about sexual topics to give advice (b = .13, p = .03), greater adolescent religiosity (b = .17, p = .05), and greater parent HIV knowledge (b = .07, p = 02) were also associated with more frequent parent-adolescent communication.

Back to Article Outline

Discussion 

To our knowledge, this study is the first to identify a strong association between greater adolescent acculturation (measured by both disagreement with Asian values and preferential use of English) and less parent-adolescent communication about sex. Our findings suggest that issues related to immigration may need to be taken into account when devising or implementing clinical or public health screening and guidance strategies intended to promote adolescent sexual health.

Adolescent acculturation and parent-adolescent communication about sex 

Researchers have varied in their measurement of acculturation, from simple measures such as language use to multi-faceted tools that attempt to reflect the cultural complexity of behaviors and values [38]. In this study, both the simpler (preference for English) and the more complex (questions adapted from the Asian Values Scale) measures of acculturation predicted less frequent discussion about sex. Thus, our study was unable to distinguish which measure was more useful in this context. It is interesting to note, however, that both parents and adolescents in our study appeared somewhat more committed to Asian values than to Asian languages. It is unclear whether this finding reflects the common use of English in the Philippines, some degree of cross-cultural universality in the Asian Values Scale, or a real difference in the degrees to which shifts in languages and values reflect acculturation. Future research comparing how languages and values reflect acculturation may be useful.

We also tested the alternative hypothesis that parent-adolescent gaps in language or values rather than acculturation per se were the actual predictors of less frequent discussion. Parents and adolescents who struggle to find common ground with respect to either language or values might be less able to communicate with each other about sensitive issues than other parents and adolescents. If that were the case, however, then we might have expected poor parent-adolescent communication to be more strongly associated with a parent-adolescent language or values gap than with a simple adolescent preference for English or adolescent disagreement with Asian values; that did not occur. In this study, adolescent acculturation in and of itself appeared to be linked with inhibited parent-adolescent communication.

Our findings raise the question of why acculturation among Filipino-Americans is associated with less frequent discussion about sex. Our finding that this association may be largely mediated by adolescent perception of less parent knowledge of their whereabouts and activities may indicate that acculturation in this population is associated with a general weakening of the parent-adolescent relationship. In our earlier focus group study of Filipino-American parents and adolescents, many parents complained that integration into U.S. culture engendered a lack of respect for parents that weakened relationships and made parent-adolescent communication difficult [18]. Adolescents countered that U.S. culture merely encouraged open discussion among equals, which their parents incorrectly perceived as lack of respect, leading to arguments and, ultimately, silence. Either way, parents and adolescents agreed that greater acculturation created relationship strains that hampered parent-adolescent communication. Our survey data may reflect these tensions. Future research should explore mechanisms by which acculturation might affect parent-adolescent relationships in immigrant families.

Although our findings regarding acculturation among Filipino-Americans do not necessarily apply to all immigrants or even all APIs, our study may have important public health and clinical implications.

First, acculturation or other issues related to immigration may be just as important to parent-adolescent communication about sex as more widely acknowledged factors including knowledge about sexual topics and parental monitoring. Health care and public health providers commonly counsel that in order to communicate with their children effectively, parents must become more expert about sexual health and learn more about their adolescents’ whereabouts and activities [39]. For Filipino-American or other immigrant families, however, providers may also need to discuss immigration-related issues such as cultural shifts, language barriers, and maintenance of ethnic identity. The ability to discuss these topics might require that providers learn about not only cultural differences between immigrants and non-immigrants but also acculturative conflicts within immigrant families. Exploring ways in which individual providers and health care systems can effectively address acculturation may deserve heightened attention among researchers.

Second, the associations identified in this study reflect problems that are likely difficult to address once established. Any corrosive effects of acculturation on parent-adolescent communication might take years to develop and years of continuously evolving effort to reverse. If providers are to intervene with respect to acculturation and parent-adolescent communication, intervention may need to occur regularly and target families with pre-adolescents and younger children.

Back to Article Outline

Conclusion 

Given the existing literature linking effective parent-adolescent communication about sex with adolescent sexual health, the results of this study provide additional evidence that acculturation and health may be linked. If acculturation is a major determinant of not only family communication about sex but also family health in general, then health care and public health providers will need to develop vastly transformed models of preventive training and practice. As local populations become increasingly diverse, all providers will need to understand and address the effect of acculturation and other immigration-related issues on the health of the communities they serve.

Back to Article Outline

Acknowledgments 

This study was supported by the University-wide AIDS Research Program (R00-LA-104) and the Centers for Disease Control and Prevention (U48/CCU915773 and U48/DP000056). We thank Jacinta Elijah, B.A., for excellent research assistance.

Back to Article Outline

References 

1. Grunbaum JA, Lowry R, Kann L, et al. Prevalence of health risk behaviors among Asian American/Pacific Islander high school students. J Adolesc Health. 2000;27:322–323
   • View In Article
   • Abstract
   • Full Text
   • Full-Text PDF (191 KB)
   • CrossRef
2. CDC. Racial/ethnic disparities in diagnoses of HIV/AIDS- 33 States, 2001–2004. MMWR Morb Mortal Wkly Rep. 2006;55:121–125
   • View In Article
3. MacDorman MF, Minino AM, Strobino DM, et al. Annual summary of vital statistics—2001. Pediatrics. 2002;110:1037–1052
   • View In Article
   • CrossRef
4. Schuster MA, Bell RM, Nakajima GA, et al. The sexual practices of Asian and Pacific Islander high school students. J Adolesc Health. 1998;23:221–231
   • View In Article
   • Abstract
   • Full Text
   • Full-Text PDF (173 KB)
   • CrossRef
5. Hou SI, Basen-Engquist K. Human immunodeficiency virus risk behavior among white and Asian/Pacific Islander high school students in the United States: Does culture make a difference?. J Adolesc Health. 1997;20:68–74
   • View In Article
   • Abstract
   • Full-Text PDF (644 KB)
   • CrossRef
6. Horan PF, DiClemente RJ. HIV knowledge, communication, and risk behaviors among white, Chinese-, and Filipino-American adolescents in a high-prevalence AIDS epicenter: A comparative analysis. Ethn Dis. 1993;3:97–105
   • View In Article
   • MEDLINE
7. Weitz TA, Harper C, Mohllajee AP. Teen pregnancy among Asians and Pacific Islanders in California: Final report. (Report No.: FHS-2001-002). San Francisco: UCSF Center for Reproductive Health Research and Policy; 2001;
   • View In Article
8. Wong MM, Klingle RS, Price RK. Alcohol, tobacco, and other drug use among Asian American and Pacific Islander adolescents in California and Hawaii. Addict Behav. 2004;29:127–141
   • View In Article
   • MEDLINE
   • CrossRef
9. U.S.Census Bureau. The Asian population: 2000. Available at: http://www.census.gov/prod/2002pubs/c2kbr01-16.pdf. Accessed December 18, 2006.
   • View In Article
10. Quarterly Aids Surveillance Report: HIV Seroepidemiology and Surveillance Section, AIDS Surveillance Unit. San Francisco: San Francisco Department of Public Health; 2005;
    • View In Article
11. Okazaki S. Influences of culture on Asian Americans’ sexuality. J Sex Res. 2002;39:34–41
    • View In Article
    • MEDLINE
    • CrossRef
12. Miller BC. Family influences on adolescent sexual and contraceptive behavior. J Sex Res. 2002;39:22–26
    • View In Article
    • MEDLINE
    • CrossRef
13. Meschke LL, Bartholomae S, Zentall SR. Adolescent sexuality and parent-adolescent processes: Promoting healthy teen choices. J Adolesc Health. 2002;31:264–279
    • View In Article
    • Abstract
    • Full Text
    • Full-Text PDF (160 KB)
    • CrossRef
14. Perrino T, Gonzalez-Soldevilla A, Pantin H, et al. The role of families in adolescent HIV prevention: A review. Clin Child Fam Psychol Rev. 2000;3:81–96
    • View In Article
    • MEDLINE
    • CrossRef
15. Jaccard J, Dodge T, Dittus P. Maternal discussions about pregnancy and adolescents, attitudes toward pregnancy. J Adolesc Health. 2003;33:84–87
    • View In Article
    • Abstract
    • Full Text
    • Full-Text PDF (60 KB)
    • CrossRef
16. Fasula AM, Miller KS. African-American and Hispanic adolescents’ intentions to delay first intercourse: Parental communication as a buffer for sexually active peers. J Adolesc Health. 2006;38:193–20
    • View In Article
17. Khabagnote F. Filipino-Americans and the pregnant adolescent: Family attitudes, cultural values, and acculturation. Diss Abst Int SectB: Sci Engin. 2004;64:4044
    • View In Article
18. Chung PJ, Borneo H, Kilpatrick SD, et al. Parent-adolescent communication about sex in Filipino American families: A demonstration of community-based participatory research. Ambul Pediatr. 2005;5:50–55
    • View In Article
    • Abstract
    • Full Text
    • Full-Text PDF (44 KB)
    • CrossRef
19. DeBaryshe BD, Yuen S, Stern IR. Psychosocial adjustment in Asian American/Pacific Islander youth: The role of coping strategies, parenting practices, and community social support. Adolesc Fam Health. 2001;2:63–71
    • View In Article
20. Hahm H, Lahiff M, Barreto R. Asian American adolescents’ first sexual intercourse: Gender and acculturation difference. Perspect Sex Reprod Health. 2006;38:28–36
    • View In Article
    • MEDLINE
    • CrossRef
21. Unger JB, Reynolds K, Shakib S, et al. Acculturation, physical activity, and fast-food consumption among Asian-American and Hispanic adolescents. J Community Health. 2004;29:427–481
    • View In Article
22. Hahm HC, Lahiff M, Guterman NB. Acculturation and parental attachment in Asian-American adolescents’ alcohol use. J Adolesc Health. 2003;33:119–129
    • View In Article
    • Abstract
    • Full Text
    • Full-Text PDF (111 KB)
    • CrossRef
23. Tang H, Shimizu R, Chen MSJ. English language proficiency and smoking prevalence among California’s Asian Americans. Cancer. 2005;104:2982–2988
    • View In Article
    • MEDLINE
24. Ebin VJ, Sneed CD, Morisky DE, et al. Acculturation and interrelationships between problem and health-promoting behaviors among Latino adolescents. J Adolesc Health. 2001;28:62–72
    • View In Article
    • Abstract
    • Full Text
    • Full-Text PDF (239 KB)
    • CrossRef
25. Cobas JA, Balcazar H, Benin MB, et al. Acculturation and low-birthweight infants among Latino women: A reanalysis of HHANES data with structural equation models. Am J Public Health. 1996;86:394–396
    • View In Article
    • MEDLINE
    • CrossRef
26. Tseng V, Fuligni AJ. Parent-adolescent language use and relationships among immigrant families with East Asian, Filipino, and Latin American backgrounds. J Marriage Fam. 2000;62:465–476
    • View In Article
27. In:  Gebbie K,  Rosenstock L,  Hernandez LM editor. Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century. Washington, DC: National Academies Press; 2002;
    • View In Article
28. In:  Minkler M,  Wallerstein N editor. Community Based Participatory Research for Health. San Francisco: Jossey-Bass; 2003;
    • View In Article
29. Leung MW, Yen IH, Minkler M. Community based participatory research: A promising approach for increasing epidemiology’s relevance in the 21st century. Int J Epidemiol. 2004;33:499–506
    • View In Article
    • MEDLINE
    • CrossRef
30. Kim BSK, Atkinson DR, Yang PH. The Asian Values Scale (AVS): Development, factor analysis, validation, and reliability. J Couns Psychol. 1999;46:342–352
    • View In Article
31. De la Cruz FA, Padilla GV, Agustin EO. Adapting a measure of acculturation for cross-cultural research. J Transcult Nurs. 2000;11:191–198
    • View In Article
    • MEDLINE
    • CrossRef
32. Brown BB, Mounts N, Lamborn SD, et al. Parenting practices and peer group affiliation in adolescence. Child Dev. 1993;64:467–482
    • View In Article
    • MEDLINE
    • CrossRef
33. Jacobson KC, Crockett LJ. Parental monitoring and adolescent adjustment: An ecological perspective. J Res Adolesc. 2000;10:65–97
    • View In Article
34. Fletcher AC, Darling NE, Steinberg L, et al. The company they keep: relation of adolescents’ adjustment and behavior to their friends’ perceptions of authoritative parenting in the social network. Dev Psychol. 1995;31:300–301
    • View In Article
    • CrossRef
35. Lanier MM, Pack RP, DiClemente RJ. Changes in incarcerated adolescents’ human immunodeficiency virus knowledge and selected behaviors from 1988 to 1996. J Adolesc Health. 1999;25:182–186
    • View In Article
    • Abstract
    • Full Text
    • Full-Text PDF (175 KB)
    • CrossRef
36. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley; 1989;
    • View In Article
37. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–1182
    • View In Article
    • MEDLINE
    • CrossRef
38. Chung RH, Kim BS, Abreu JM. Asian American multidimensional acculturation scale: Development, factor analysis, reliability, and validity. Cult Divers Ethnic Minor Psychol. 2004;10:66–68
    • View In Article
39. Sieving RE, Oliphant JA, Blum RW. Adolescent sexual behavior and sexual health. Pediatr Rev. 2002;23:407–416
    • View In Article