Asian and Pacific Islander teenagers are frequently studied as a group, but risk behaviors differ significantly across ethnic subgroups, according to findings from an analysis of Hawaii’s 2003 Youth Risk Behavior Survey (YRBS).1 For example, 47% of Native Hawaiians in the sample were sexually experienced, compared with 20% of their Japanese peers and 32% of Filipinos; 13% of Native Hawaiians, but only 3–6% of others, reported having had at least four partners. Relative to white adolescents, Native Hawaiians had the riskiest profile, and Japanese teenagers the lowest risk.

The YRBS assesses health risk behaviors, including six related to sexual health, among adolescents in grades 9–12. Whereas the national version of the survey groups all Asian and Pacific Islander respondents together, the Hawaii version asks participants, all of whom attend public schools, to specify their ethnic group. The researchers studied Native Hawaiians, Filipinos and Japanese, because these were the largest single-race ethnic groups beside whites participating in the survey; whites served as the reference group in logistic regression analyses. More than 1,000 students in each ethnic group were included in the sample. Each group was roughly evenly divided between males and females; participants were about 15 years old, on average.

Chi-square analyses indicated that the prevalence of risky sexual behaviors generally is higher among Native Hawaiian adolescents than among the other Asian and Pacific Islander groups studied. Some 47% of Native Hawaiians were sexually experienced—a significantly higher proportion than the 32% found among Filipinos or the 20% among Japanese youths. Native Hawaiians also were the most likely to report having had intercourse within the previous three months (32%, compared with 23% of Filipinos and 15% of Japanese), having first had sex before age 13 (10%, compared with 3% and 1%, respectively) and having had four or more partners (13%, compared with 6% and 3%). Among those with sexual experience, the proportion reporting substance use before last intercourse was higher among Native Hawaiians (28%) than among Filipinos (14%) or Japanese (16%). The proportion of sexually active teenagers who said they had used a condom at last intercourse ranged from 41% among Filipinos to 49% among Native Hawaiians and 51% among Japanese.

According to results of the regression analyses, Native Hawaiian adolescents were significantly more likely than whites to report three of the six behaviors studied—ever having had intercourse (odds ratio, 1.8), having recently had sex (1.6) and having first had sex by age 13 (2.3). Japanese youths, by contrast, had reduced odds of five behaviors—having had sex (0.5), having had recent sex (0.6), having had first intercourse before age 13 (0.3), having had at least four partners (0.3) and having used alcohol or drugs before last sex (0.5). Filipinos had an intermediate level of risk; compared with whites, they had lower odds of having had four or more partners, having used substances before last sex and having used condoms at last sex (0.4–0.5).

In the sample overall, males were significantly less likely than females to be sexually experienced (odds ratio, 0.7) and to have had sex recently (0.6); they were more likely than females to have first had intercourse by age 13 (1.9) and, if they were sexually active, to report substance use and condom use at the time of last intercourse (1.8 and 1.7, respectively). Males and females were equally likely to report having had four or more partners. Patterns of gender differences varied among the ethnic subgroups. Japanese males conformed to the overall pattern only in having reduced odds of being sexually experienced and having had recent sex (0.6 and 0.4, respectively); additionally, they were less likely than females to report four or more lifetime partners (0.4). Filipino males were less likely than their female counterparts to have any sexual experience (0.7) or recent sexual experience (0.5), and were more likely to have used substances before last sex (2.2) and to have used condoms at that time (1.7). Compared with Native Hawaiian females, males in this group had reduced odds of having recently had sex (0.7) but elevated odds of every other outcome assessed: early sexual initiation (2.1), four or more partners (1.7), substance use before last sex (2.2) and condom use at last sex (1.8).

The researchers note three key limitations of their study. First, the data are based on self-reported risk behavior and may be affected by social desirability bias. Second, the data set did not include socioeconomic measures, so it was not possible to assess the extent to which socioeconomic characteristics may have accounted for ethnic differences in behavior. Finally, the survey is representative only of public school students in Hawaii.

Despite the study’s shortcomings, the researchers conclude, their findings “underscore the heterogeneity of [Asian and Pacific Islander] subgroups” and the need to study these subgroups separately to find the best approaches to “minimizing the negative consequences of adolescents’ sexual risk behaviors.”

D. Hollander

REFERENCE

1. Sasaki PY and Kameoka VA, Ethnic variations in prevalence of high-risk sexual behaviors among Asian and Pacific Islander adolescents in Hawaii, American Journal of Public Health, 2009, 99(10):1886–1892.