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ABSTRACT: Purpose: Despite robust empirical and theoretical evidence for higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and sexual orientation among Asian youths. This study examined differences in prevalence of suicidal ideation and suicide attempts between LGB and heterosexual youths in the cities of Hanoi, Shanghai, and Taipei, China.Methods: The data are from a community-based multi-centre cross-sectional study conducted from 2006 to 2007, with a sample of 17 016 youths aged 15-24 years from Hanoi, Shanghai, and Taipei. Chi-square test and logistic regression were used to evaluate correlates of suicidal ideation and suicide attempts.Results: The overall prevalence of suicidal ideation and suicide attempts in the preceding 12 months in LGB youths were both higher than in heterosexual youth (12.8% vs. 8.1% and 4.0% vs. 2.4%, respectively). Stratified by city, the prevalence of suicidal ideation was lowest in Hanoi (2.2%), followed by Shanghai (8.0%) and Taipei (17.0%). Similar trends were observed in the prevalence of suicide attempts, which was lowest in Hanoi (0.3%), followed by Shanghai (1.2%) and Taipei (2.5%). Of note, however, multivariate logistic regression results revealed that LGB youth were at a higher risk for suicidal ideation than heterosexual youth only in Taipei (odds ratio 1.65).Conclusions: Suicidality is common among Asian youth, with higher prevalence observed in urbanized cities. LGB youths are at greater risk of suicidal ideation than their heterosexual counterparts in Taipei than in the other two examined cities.
Journal of epidemiology / Japan Epidemiological Association. 11/2014;
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ABSTRACT: To investigate whether and how the presence of Confucian cultural norms influences the sexual behaviors of adolescents and young adults in three Asian cities experiencing different levels of economic development.
Data for this article were drawn from the international cross-sectional survey on sexual and reproductive health of adolescents and young adults aged 15-24 years in three Asian cities (Hanoi, Shanghai, and Taipei), conducted in 2006. The original sample consisted of a representative group of 17,016 adolescents; while in this study, 16,554 never-married adolescents were included in the analysis. Both face-to-face interview and computer-assisted self-interview approaches were adopted in the survey. Exposure to family concepts, self-cultivation values, gender role concepts, and sexual values were the main measures of traditional Confucian cultural influence. Sexual and intimate behaviors were the main outcome measures, and multi-Cox regression models were used to assess the association between traditional cultural concepts and values and sexual behavior after adjusting for potentially confounding factors. Data were analyzed with SAS software 9.1.
The traditional Confucian cultural norms were not weakening evenly, with more entrenchment in Hanoi than in Shanghai and Taipei. Prevalence of sexual coitus among adolescent and young adults was lowest in Hanoi and highest in Taipei, while similar profiles of other intimate behaviors were displayed in the three cities. Associations between respondents' sexual behavior and their cultural concepts and values differed by city. In Hanoi, for all four cultural measures, respondents with more traditional views were less likely to engage in sexual activity. This was also true in Shanghai and Taipei with respect to traditional sexual values and self-cultivation values. However, there was an inverse relationship between sexual behavior and traditional family concepts and gender roles in Shanghai and Taipei; those with more traditional values were more likely to have premarital sexual intercourse, except with regard to family values among female youth in Taipei.
The findings suggest that different aspects of Confucian values eroding unevenly in different Asian cities may have distinct association with adolescent or young adults' sexual behaviors.
Journal of Adolescent Health 03/2012; 50(3 Suppl):S12-7. · 2.97 Impact Factor
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ABSTRACT: Evidence in western countries indicates that the media have associations with adolescents' and young people's sexual behavior that may be as important as family, school, and peers. In this new study of Asian adolescents and young adults in the three cities of Hanoi, Shanghai, and Taipei, the associations between exposure to sexual content in the media and adolescents' and young adults' sex-related knowledge, attitudes, and behaviors are explored in societies with traditional Confucian culture, but at different stages in the process of modernization.
The data are from a questionnaire-based cross-sectional study conducted from 2006 to 2007, where a sample of 17,016 adolescents and young adults aged 15-24 years from Shanghai, Hanoi, and Taipei completed face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions. For the objectives of this article, analysis was restricted to the 16,554 unmarried respondents. Exposure to sexual content in the mass media (including the Internet and traditional media), pornographic videos, and a preference for western/Asian movies/videos were the main media influence measures. Sex-related knowledge, premarital sexual permissiveness (PSP), and sex-related behaviors were the main outcome measures. The impact of each of four contexts including family, peer, school, and media on sex-related knowledge, attitudes, and behaviors were assessed using multiple linear regression stratified by gender and city, controlling for age, urban/rural residence, education, and economic status. The change in adjusted R(2) from the multiple linear regression analysis was adopted to indicate the contribution of family, peer, school, and media variables to respondents' sex-related knowledge, attitudes, and behaviors.
The contextual factors, including family, peer, school, and media, explained 30%-50% of the variance in sex-related knowledge, 8%-22% of the variance in PSP, and 32%-41% of the variance in sex-related behaviors. Media variables explained 13%-24% of the variance in sexual knowledge, 3%-13% in PSP, and 3%-13% in sex-related behaviors, which was comparable with that of family, peer, and school variables. These associations differed by city and gender.
Access to and use of mass media and the messages they present are influential factors on sex-related knowledge, attitudes, and behaviors of unmarried Asian adolescents and young adults, and should be considered in future research and intervention programs attempting to improve reproductive health outcomes.
Journal of Adolescent Health 03/2012; 50(3 Suppl):S26-36. · 2.97 Impact Factor
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ABSTRACT: Gender is an important factor in understanding premarital sexual attitudes and behaviors. Many studies indicate that males are more likely to initiate sexual intercourse and have more permissive perceptions about sex than females. Yet few studies have explored possible reasons for these gender differences. With samples of unmarried adolescents in three Asian cities influenced by Confucian cultures, this article investigates the relationship between underlying gender norms and these differences in adolescents' premarital sexual permissiveness (PSP).
In a collaborative survey conducted in 2006-2007 in urban and rural areas of Hanoi, Shanghai, and Taipei, 16,554 unmarried participants aged 15-24 years were recruited in the three-City Asian Study of Adolescents and Youth, with 6,204, 6,023, and 4,327 respondents from each city, respectively. All the adolescents were administered face-to-face interviews, coupled with computer-assisted self-interview for sensitive questions. Scales on gender-role attitudes and on PSP for both male and female respondents were developed and applied to our analysis of the data. Multilinear regression was used to analyze the relationship between gender-role attitudes and sexual permissiveness.
Male respondents in each city held more permissive attitudes toward premarital sex than did females, with both boys and girls expressing greater permissiveness to male premarital sexual behaviors. Boys also expressed more traditional attitudes to gender roles (condoning greater inequality) than did girls in each city. Adolescents' gender-role attitudes and permissiveness to premarital sex varied considerably across the three cities, with the Vietnamese the most traditional, the Taiwanese the least traditional, and the adolescents in Shanghai in the middle. A negative association between traditional gender roles and PSP was only found among girls in Shanghai and Taipei. In Shanghai, female respondents who held more traditional gender-role attitudes were more likely to exercise a double standard with respect to male as opposed to female premarital sex (odds ratio [OR] = 1.18). This relationship also applied to attitudes of both girls and boys in Taipei (OR = 1.20 and OR = 1.22, respectively).
Although with variation across sites, gender differences in PSP and attitudes to gender roles among adolescents were very significant in each of the three Asian cities influenced by Confucian-based values. Traditional gender norms may still be deeply rooted in the three cities, especially among females; while it is important to advocate gender equity in adolescent reproductive health programs, the pathway of traditional gender norms in influencing adolescent reproductive health outcomes must be understood, as must differences and similarities across regions.
Journal of Adolescent Health 03/2012; 50(3 Suppl):S18-25. · 2.97 Impact Factor