JSPN Vol. 11, No. 1, January, 2006 57 Blackwell Publishing, Ltd. Oxford, UK JSPN Journal for Specialists in Pediatric Nursing 1088-145X © 2005 by Nursecom, Inc. January 2006 11 1 COLUMNS Ask the Expert Ask the Expert Sexual Health Education Disparities in Asian American Adolescents Tsui-Sui Kao Column Editor: Betsy M. McDowell Ask the Expert provides research-based answers to practice questions submitted by JSPN readers. Question: I have noticed that there are increasing numbers of Asian American adolescents in the United States. Even though Asian American youth are doing great academically, their level of sexual health-related knowledge is not explicitly known or understood because of the differences in their cultural backgrounds. What do I need to know in order to ensure that my assess- ment of their sexual health knowledge is culturally responsive? Tsui-Sui Kao responds: Asian Americans comprise close to 4.2% of the total U.S. population. Research on the health status of Asian Pacific Americans (APA) often analyzes the population as one homogeneous group; however, the APA community includes more than 30 diverse ethnic subpopulations that vary by national origin, language, culture, citizenship, and economic status. The main subgroups include Chinese, Japanese, Korean, Filipino, Vietnamese, Asian Indian, and other cultures from Southeast Asia (U.S. Department of Commerce [USDOC], 2000). Even though as a whole, Asian Americans seem to have comparable educational backgrounds and median family incomes with Cauca- sian Americans, Asian Americans tend to have more family members working at the same time to maintain their financial status and lifestyle. It is important to note that 14% of the APA population lives below the poverty line, compared to 13% of the U.S. population, and that Asian Americans are less likely to use federal or state-funded health care programs such as Medicaid (National Asian Pacific American Women’s Forum [NAPAWF], 2005). Asian Americans often are perceived as a model minority, appearing to have abundant resources. In reality, their health is compromised by this misconcep- tion, and their health problems are often blamed on the conservative nature of their cultures. Healthcare disparities exist not only in new immigrants but also in the subsequent generations of Asian American children. Most Asian American children are immigrants them- selves or are children of immigrants who straddle two cultures. Few studies are available to help nurses see some of the problems that Asian American adolescents encounter as a result of this bicultural identification. Nurse professionals confront increasing challenges to care for this vulnerable population, especially with the cultural sensitivity to sexual health issues (Kibria, 2002). Nurses must be cognizant of the importance of Asian Americans’ family-centered cultural values, more specifically the taboo against sex education, and the possible impacts of bicultural straddling. Grunbaum, Lowery, Kann, and Pateman (2000) noted that Asian American adolescents tend to delay sexual intercourse, but that once sexually active, they were as likely to have used alcohol or drugs or fail to use a condom during intercourse as any other ethnic group. These factors put them at greater risk for compromised sexual health; therefore, it is important for pediatric nurses to assess the sexual health of all Asian American adolescents. Asian American Adolescents’ Sexual Health Studies show that Asian American adolescents tend to delay the onset of sexual intercourse compared to other ethnic groups (Grunbaum et al., 2000; Horan & DiClemente, 1993; Schuster, Bell, & Kanouse, 1996; Schuster, Bell, Nakajima, & Kanouse, 1998; Upchurch, Levy-Storms, Sucoff, & Aneshensel, 1998); however, they are less likely to receive sexual health-related services prior to and even after becoming sexually active (National Asian Women’s Health Organization [NAWHO], 1997; Schuster et al., 1996) than other popu- lation groups. As a result, Asian American women tend to be diagnosed with more advanced stages of cervical cancer and breast cancer than Caucasian American women (Frisch & Goodman, 2000; Hedeen, White, & Taylor, 1999), and cervical cancer is the leading cause of death for Vietnamese American women (Ishida, 2001). Furthermore, new technology and research show that cervical cancer is actually caused by the human papillomavirus (HPV) (Ordonez, Espinosa, Sanchez-