Jane S. T. Woo

Reproductive Health Practices Among Indian, Indo-Canadian, Canadian East Asian, and Euro-CanadianWomen: The Role of Acculturation

OBJECTIVE Lower rates of cervical cancer screening in Indian women have been consistently reported, and this has been attributed to cultural barriers. In Canada, the fastest-growing and largest immigrant groups are South Asian and East Asian. Since traditional values are largely retained in Indo-Canadian immigrants and their children, identifying reproductive health behaviours among these ethnic minority groups is important. Our goal was to compare reproductive health knowledge and behaviours of Indian women living in India and in Canada, East Asian women in Canada, and Euro-Canadian women. We also explored the level of acculturation in the two immigrant groups in order to understand the extent to which affiliation with Western culture may improve reproductive health knowledge. METHODS We recruited 663 women of reproductive age from India and from a Canadian university for assessment. These women completed the Health Beliefs Questionnaire, which measures reproductive health behaviours and knowledge, and the Vancouver Index of Acculturation, which measures the level of mainstream and heritage acculturation. RESULTS Euro-Canadian women were most likely to have ever had a Papanicolaou (Pap) test and to perform breast self-examination (BSE). There was no difference between the two Indian groups in the proportion who had ever had a Pap test, but Indo-Canadian women were more likely to have performed BSE. All women showed knowledge of reproductive health, but the three Canadian groups consistently had more accurate knowledge than the Indian group. Among the two immigrant groups, the level of acculturation was associated with reproductive health knowledge. CONCLUSION Canadian women show reproductive health behaviours and knowledge that is superior to Indian women. Moving to a western culture did not influence Indian womens Pap testing behaviour; however, the fact that the reproductive health knowledge of Indian women who moved to Canada was better than that of women in India suggests that there may be a knowledge-behaviour desynchrony in this group of women. Efforts targeted at ethnic minority groups that aim to improve reproductive health knowledge and behaviours are greatly needed.

ORIGINAL RESEARCH—PSYCHOLOGY: Age of First Sexual Intercourse and Acculturation: Effects on Adult Sexual Responding

INTRODUCTION Although age of first intercourse and the emotional aspects of that experience are often a target in assessment because they are thought to contribute to later sexual functioning, research to date on how sexual debut relates to adult sexual functioning has been limited and contradictory. AIM The goal of this study was to explore the association between age of first intercourse and adult sexual function in a sample of Euro-Canadian and Asian Canadian university students. In addition, culture-based comparisons of sexual complaints were made to clarify the role of culture in sexual response. METHODS Euro-Canadian (N = 299) and Asian Canadian (N = 329) university students completed the Golombok-Rust Inventory of Sexual Satisfaction and the Vancouver Index of Acculturation. MAIN OUTCOME MEASURES Self-reported sexual problems and bidimensional acculturation. RESULTS Ethnic group comparisons revealed that Asians reported more sexual complaints including sexual avoidance, dissatisfaction and non-sensuality. Among the women, Asians reported higher scores on the Vaginismus and Anorgasmia subscales whereas the ethnic groups did not differ on the male-specific measures of sexual complaints. In the overall sample, older age of first intercourse was associated with more sexual problems as an adult, including more sexual infrequency, sexual avoidance, and non-sensuality. Among the Asian Canadians, less identification with Western culture was predictive of more sexual complaints overall, more sexual noncommunication, more sexual avoidance, and more non-sensuality. For Asian women, acculturation interacted with age of first intercourse to predict Vaginismus scores. CONCLUSIONS Overall, these data replicate prior research that found that a university sample of individuals of Asian descent have higher rates of sexual problems and that this effect can be explained by acculturation. Earlier sexual debut was associated with fewer sexual complaints in adulthood.

ORIGINAL RESEARCH—PSYCHOLOGY: Acculturation and Sexual Function in Canadian East Asian Men

INTRODUCTION Recent studies have demonstrated the importance of considering acculturation when investigating the sexuality of East Asian women in North America. Moreover, bidimensional assessment of both heritage and mainstream cultural affiliations provides significantly more information about sexual attitudes than simple unidimensional measures, such as length of residency in the Western culture. AIM The goal of this study was to extend the findings in women to a sample of East Asian men. MAIN OUTCOME MEASURES Self-report measures of sexual behaviors, sexual responses, and sexual satisfaction. METHODS Euro-Canadian (N = 124) and East Asian (N = 137) male university students privately completed a battery of questionnaires in exchange for course credit. Results. Group comparisons revealed East Asian men to have significantly lower liberal sexual attitudes and experiences, and a significantly lower proportion had engaged in sexual intercourse compared with the Euro-Canadian sample. In addition, the East Asian men had significantly higher Impotence and Avoidance subscale scores on the Golombok Rust Inventory of Sexual Satisfaction, a measure of sexual dysfunction. Focusing on East Asian men alone, mainstream acculturation, but not length of residency in Canada, was significantly related to sexual attitudes, experiences, and responses. CONCLUSIONS Overall, these data replicate the findings in women and suggest that specific acculturation effects over and above length of residency should be included in the cultural assessment of mens sexual health.

The Role of Sexuality in Cervical Cancer Screening Among Chinese Women

OBJECTIVE Chinese women have significantly lower rates of Papanicolaou (Pap) testing than Euro-Canadian women despite efforts to promote testing. Evidence suggests that Chinese womens reluctance to undergo Pap testing may be related to culture-linked discomfort with sexuality. The purpose of this study was to explore the role of sexuality in the interaction between acculturation and Pap testing. DESIGN Euro-Canadian (n = 213) and Chinese (n = 260) female university students completed a battery of questionnaires. MAIN OUTCOME MEASURES Questionnaires assessing sexual knowledge, sexual function, acculturation, and Pap testing frequency. RESULTS Euro-Canadian women had significantly more accurate sexual knowledge, higher levels of sexual functioning, a broader repertoire of sexual activities, and higher Pap testing rates. Chinese women were more likely to cite embarrassment as a barrier to Pap testing. Heritage acculturation, but not mainstream acculturation, predicted Chinese womens Pap testing behavior. Mainstream acculturation was associated with more accurate sexual knowledge and greater sexual desire and satisfaction. CONCLUSION The findings provide support for the hypothesis that low Pap testing rates in Chinese women may be associated with heritage acculturation, although the hypothesis that sexual function would predict Pap testing behavior was not supported.

The Relationship between Sex Guilt and Sexual Desire in a Community Sample of Chinese and Euro-Canadian Women

Many studies have documented significant differences in sexual desire between individuals of European and Chinese descent, but few have examined the mechanisms that underlie these differences. A recent study of university students found that sex guilt is one mechanism by which culture influences sexual desire among Chinese and Euro-Canadian women. The goal of this study was to examine whether sex guilt also mediates the relationship between ethnicity and sexual desire in a sample that is more representative of women in the general population. Euro-Canadian (n = 78; mean age = 42.1 years) and Chinese (n = 87; mean age = 42.8 years) women were recruited from the community. Euro-Canadian women reported greater sexual desire and less sex guilt. In the entire sample, sex guilt mediated the relationship between ethnicity and sexual desire such that the Chinese women reported greater sex guilt, which, in turn, was associated with lower sexual desire. Among the Chinese women, sex guilt mediated the relationship between mainstream acculturation (degree of Westernization) and sexual desire such that more Westernized Chinese women reported less sex guilt, which, in turn, was associated with greater sexual desire. These results support recent findings and further suggest that sex guilt may be one mechanism by which ethnicity affects sexual desire.

ORIGINAL RESEARCH—PSYCHOLOGYORIGINAL RESEARCH—PSYCHOLOGY: Acculturation and Sexual Function in Canadian East Asian Men

INTRODUCTION Recent studies have demonstrated the importance of considering acculturation when investigating the sexuality of East Asian women in North America. Moreover, bidimensional assessment of both heritage and mainstream cultural affiliations provides significantly more information about sexual attitudes than simple unidimensional measures, such as length of residency in the Western culture. AIM The goal of this study was to extend the findings in women to a sample of East Asian men. MAIN OUTCOME MEASURES Self-report measures of sexual behaviors, sexual responses, and sexual satisfaction. METHODS Euro-Canadian (N = 124) and East Asian (N = 137) male university students privately completed a battery of questionnaires in exchange for course credit. Results. Group comparisons revealed East Asian men to have significantly lower liberal sexual attitudes and experiences, and a significantly lower proportion had engaged in sexual intercourse compared with the Euro-Canadian sample. In addition, the East Asian men had significantly higher Impotence and Avoidance subscale scores on the Golombok Rust Inventory of Sexual Satisfaction, a measure of sexual dysfunction. Focusing on East Asian men alone, mainstream acculturation, but not length of residency in Canada, was significantly related to sexual attitudes, experiences, and responses. CONCLUSIONS Overall, these data replicate the findings in women and suggest that specific acculturation effects over and above length of residency should be included in the cultural assessment of mens sexual health.

ORIGINAL RESEARCHORIGINAL RESEARCH—PSYCHOLOGY: Age of First Sexual Intercourse and Acculturation: Effects on Adult Sexual Responding

INTRODUCTION Although age of first intercourse and the emotional aspects of that experience are often a target in assessment because they are thought to contribute to later sexual functioning, research to date on how sexual debut relates to adult sexual functioning has been limited and contradictory. AIM The goal of this study was to explore the association between age of first intercourse and adult sexual function in a sample of Euro-Canadian and Asian Canadian university students. In addition, culture-based comparisons of sexual complaints were made to clarify the role of culture in sexual response. METHODS Euro-Canadian (N = 299) and Asian Canadian (N = 329) university students completed the Golombok-Rust Inventory of Sexual Satisfaction and the Vancouver Index of Acculturation. MAIN OUTCOME MEASURES Self-reported sexual problems and bidimensional acculturation. RESULTS Ethnic group comparisons revealed that Asians reported more sexual complaints including sexual avoidance, dissatisfaction and non-sensuality. Among the women, Asians reported higher scores on the Vaginismus and Anorgasmia subscales whereas the ethnic groups did not differ on the male-specific measures of sexual complaints. In the overall sample, older age of first intercourse was associated with more sexual problems as an adult, including more sexual infrequency, sexual avoidance, and non-sensuality. Among the Asian Canadians, less identification with Western culture was predictive of more sexual complaints overall, more sexual noncommunication, more sexual avoidance, and more non-sensuality. For Asian women, acculturation interacted with age of first intercourse to predict Vaginismus scores. CONCLUSIONS Overall, these data replicate prior research that found that a university sample of individuals of Asian descent have higher rates of sexual problems and that this effect can be explained by acculturation. Earlier sexual debut was associated with fewer sexual complaints in adulthood.

Cervical cancer screening and Chinese women: insights from focus groups

Objective: Despite extensive efforts to raise awareness, Papanicolaou (Pap) testing rates among Chinese women living in North America remain low compared with Euro-American women. Although the lower Pap testing rate and ensuing health repercussions among Chinese women are well characterized, mechanisms underlying such health disparities are not. The aim of this study was to use a qualitative approach to delineate such mechanisms. Qualitative approaches to understand constructs within the domain of sexual and reproductive health have been shown to be particularly appropriate, and offer a nuanced view of sexuality that is not afforded by traditional quantitative methods. Method: We carried out two focus groups aimed at exploring how Mandarin-speaking and English-speaking Chinese women experience Pap testing (N = 12). The women were invited to partake in the focus groups from having participated in a large-scale quantitative study. Participants were all first-generation immigrants and their average age was 53-years-old. We used content analyses to analyze transcripts and extract themes. Results and Discussion: The women heavily endorsed traditional Chinese medicine philosophy, conceptualizing physical health holistically, and valuing preventative measures over screening and interceptive measures. Pap testing was described as qualitatively different from other screening procedures, such that women assigned a sexually charged meaning to Pap testing, often discussing it in relation to sexual activity and promiscuity. Women expressed their preference for the compulsory and depersonalized manner that Pap tests are performed in their home country of China, as this lessens the embarrassment associated with undergoing Pap testing. Conclusion: Three mechanisms may contribute to lower Pap testing among middle-aged first-generation Chinese immigrants: preference for Chinese medicine philosophy, perceived sexualization of Pap testing, and the institutionalization of medical care. Implications for improving the reproductive health of Chinese women are discussed.

Do East Asian and Euro-Canadian women differ in sexual psychophysiology research participation?

Evidence from studies of ethnic differences in sexual conservativeness and Papanicolaou (Pap) testing behaviors suggests that there may be culture-linked differences in rates of participation in physically invasive sexuality studies, resulting in volunteer bias. The effects of ethnicity and acculturation on participation in female psychophysiological sexual arousal research were investigated in a sample of Euro-Canadian (n = 50) and East Asian (n = 58) women. Participants completed a battery of questionnaires and were given either course credits or

Sex Guilt and Culture-Linked Barriers to Testicular Examinations

10 for their participation. Participants were then informed about the opportunity to participate in a second phase of the study, which involved psychophysiological sexual arousal testing and which was completely optional. Contrary to expectations, the results showed that the East Asian women were more likely to participate in Phase 2 than the Euro-Canadian women. Among the East Asian women, greater heritage acculturation and lower mainstream acculturation predicted a lower likelihood of Phase 2 participation. The findings suggest the need to be wary of overgeneralizing female psychophysiological sexual arousal research results and may have implications for improving Pap testing behaviors in East Asian women.