Consistent condom use among Chinese, Filipina and White women: The role of culture, sex communication and traditional behavioral theories

Introduction: Current research on sexual behavior has stressed communication about safer sex as a strong predictor of consistent condom use. Asian American and Pacific Islander (AAPI) groups are known to have low comfort levels in communicating about sexual matters, and may thus be at higher risk for inconsistent condom use. Current HIV/STI interventions are largely informed by behavioral theory, including the Theory of Planned Behavior (TPB), which has not been tested on AAPI populations.

Methods: Hierarchical logistic regression analysis of data from a web-based sexual behavior survey of 437 White, Chinese and Filipino women attending 4 Northern California universities.

Results: Multiple logistic regression and ANOVA analyses determined that there were stark differences in consistent condom use rates between ethnic groups (Filipinas 27%, White 43.7%, Chinese 53%). A negative association was found between condom use and comfort discussing sex for both AAPI groups (Chinese: OR=.51 p<.05, Filipinos: OR=.44 p<.10). The TPB model explained consistent condom use well for whites (p<.001), and less well for Filipinos (p<.01) and Chinese (p<.10). Hierarchical logistic regression showed that the addition of comfort discussing sex, a culturally salient variable, improved the fit of the traditional TPB model for the two AAPI groups (Chinese: p<.05, Filipinos: p<.05), but not for Whites.

Conclusions: Culturally salient factors such as comfort discussing sex should be seriously considered as predictors in sexual behavior research. Future research should further examine the relevance of behavioral theories like TPB to disaggregated AAPI populations in attempt to develop culturally appropriate health interventions and policies.