Influences of culture on Asian Americans' sexuality.

While sharing their Asian ancestry and vestiges of Asian cultural heritage to varying degrees, Asian Americans comprise an ethnic minority group that defies simple characterizations. Consisting of approximately 4% of the total U.S. population, Asian Americans trace their roots to one or more of 28 Asian countries of origin or ethnic groups. The largest proportions of Asian Americans in 1990 were Chinese (24%) and Filipino (20%), followed by Japanese, Korean, and Asian Indian at approximately 11% to 12% each and Vietnamese at 9% (U.S. Bureau of the Census, 1993). However, the continuing influx of new immigrants from Southeast Asia and South Asia as well as from China and Korea provide a backdrop for diversity among Americans of Asian ancestry on important dimensions such as national origin, language, nativity, generational status, religion, acculturation to the mainstream American values and customs, and so on. The majority (66%) of Asian Americans in 1990 were born in foreign countries (U.S. Bureau of the Census, 1993).

The present review concerning the impact of Asian and Asian American cultures on sexuality will first examine aspects of various Asian cultural traditions and values that influence sexual attitudes and behavior among Asian Americans, then examine the available scientific literature in several major areas (but excluding materials related to HIV, other STDs, and safe sex practices). Some topics, namely sexual dysfunction and treatment, are not covered because no data exist. Most studies that are reviewed here do not specifically test the link between aspects of Asian or Asian American culture and sexual variables but instead use Asian American ethnicity as a proxy for culture.

CULTURAL ROOTS

Sexuality is linked to procreation in most Asian cultures. Gupta (1994) argues that sexuality was not a taboo subject in ancient Hindu culture granted that it was discussed within the context of marriage. Rather, sexuality was openly discussed in religious and fictional texts (e.g., the Kama Sutra) and depicted in paintings and sculptures, some with explicit erotic details. Japanese and Chinese erotica also date back to ancient times. On the other hand, sex is a taboo subject in contemporary Chinese culture, where sex education in schools is minimal and parents as well as health professionals are reluctant to discuss sexuality and sexual information (Chan, 1986). Traditional Cambodian society believed that a lack of knowledge regarding sexuality would prevent premarital sexual activity that would tarnish the family honor; consequently, discussions of information regarding sexual intercourse and sexuality were kept to a minimum (Kulig, 1994). Filipino culture, with the strong influence of Catholicism, tends to have a strong moral undercurrent that scorns premarital sex, use of contraceptives, and abortion (Tiongson, 1997).

Regardless of each Asian culture's degree of openness surrounding sexual discourse, expressions of sexuality outside of marriage are considered highly inappropriate in most Asian cultures. Most Asian cultures are highly collectivistic and patriarchical; thus, sexuality that is allowed open expression (particularly among women) would repr sent a threat to the highly interdependent social order as well as to the integrity of the family. Many Asian cultural traditions place emphasis on propriety and the observance of strict moral and social conduct, thus modesty and restrained sexuality are valued (Abraham, 1999). The sexually conservative beliefs and behavior that many Americans of Asian ancestry may exhibit may, in turn, be misinterpreted by the larger American society as asexual (Tsui, 1985).

SEXUAL KNOWLEDGE, ATTITUDES, AND NORMS

Available data regarding the sexual knowledge, attitudes, and norms among Asian Americans reflect relative conservatism. In a 1993 study in British Columbia comparing 346 Asian Canadian and 356 non-Asian Canadian (1) university students enrolled in introductory psychology courses, Meston, Trapnell, and Gorzalka (1998) found that Asian Canadians held more conservative sexual attitudes and demonstrated less sexual knowledge than non-Asian Canadians. Among Asian Canadians, the more acculturated they were to the Canadian culture the more permissive their sexual attitudes. In a survey of 574 girls in sixth through eighth grades at public junior high schools in southern California, East (1998) compared the girls' sexual, marital, and birth expectations across four ethnic groups (White, Black, Hispanic, and Southeast Asians). Southeast Asian American (Vietnamese, Cambodian, Laotian; n = 70) girls reported the oldest "best" age for first intercourse (M = 21.7) and first birth (M = 24.4) and the oldest "desired" age for first birth (M = 26.4) of the four ethnic group girls. Southeast Asian American girls indicated the least desire to have children, the least likelihood of having children out of wedlock, and the least intention of having sexual intercourse in the near future. In a survey of 452 unmarried young adults (ages 18 to 25) attending 2-year community colleges, Feldman, Turner, and Araujo (1999) also found that Asian Americans (n = 104) held significantly later normative and personal sexual timetables for initiating all types of sexual behavior relative to other ethnic groups. In another survey with 474 college students in the Southwest (17 of whom were Asian American) regarding sex education, Asian Americans' reported age at which they understood what sexual intercourse was (M = 15.1) and the age at which they plan to begin their future children's sex education (M = 14.1) were older than those of any other ethnic group (Harman & Johnson, 1995).

There are some data suggesting that Asian Americans' sexually conservative attitude may erode with higher degrees of exposure to the American culture. Abramson and Imai-Marquez (1982) administered a measure of sex guilt to three different generations of Japanese American men and women and matched groups of White Americans in the metropolitan Los Angeles area. The researchers found that each subsequent younger generation of Japanese Americans and White Americans reported less guilty thoughts and feelings concerning sexual matters, although Japanese Americans still reported more sex guilt than White Americans within each age cohort group. However, in a different study of 18 Japanese American, 22 Mexican American, 20 African American, and 27 White American parents in Los Angeles regarding their attitudes toward sex education, the attitudes of Japanese American parents were found not to differ from those of other ethnic group parents once father's education and mother's religiosity were controlled for (Abramson, Moriuchi, Waite, & Perry, 1983). Notably, all of the Japanese American parents were born in the U.S.

SEXUAL BEHAVIOR

Most studies of sexual activity among Asian Americans have been conducted with adolescents and college students. The most comprehensive survey of American adults' sexual behavior, the National Health and Social Life Survey conducted in 1992, did not oversample Asian American individuals (Laumann, Gagnon, Michael, & Michaels, 1994). Consequently, only 2% of the total sample was Asian American, making it difficult to sufficiently characterize the sexual behavior of Asian American (particularly female) adults in the general population.

Adolescents

In a survey of 2,026 high school students in Los Angeles County, Asian American adolescents (n = 186) were more likely to be virgins (73%) than African American (28%), Latino (43%), and White Americans (50%) (Schuster, Bell, & Kanouse, 1996). Further analyses of the same data revealed that Asian American adolescents were less likely to have initiated a vaginal intercourse at an early age and were less likely to report having participated in other heterosexual genital sexual activities during the prior year than their non-Asian counterparts as well (Schuster, Bell, Nakajima, & Kanouse, 1998). The researchers found that Asian American nonvirgins also reported the lowest number of lifetime partners for vaginal intercourse, even though the reported frequency of sexual activity did not differ from those of other ethnic group adolescents. Asian American adolescents in homes where English is the primary language spoken were more likely than other Asian Americans to be nonvirgins and to have engaged in heterosexual genital sexual activities. Asian American adolescents were also more likely than non-Asian Americans to think that their parents and friends would disapprove if they had vaginal intercourse and that people their own age should not have vaginal intercourse.

Another study of an ethnically diverse sample of 877 Los Angeles County youths (Upchurch, Levy-Storms, Sucoff, & Aneshensel, 1998) found that Asian American males had the highest median age of first sex (18.1) and that Asian American females (as well as Hispanic females) had rates of first sex that was about half that of White females. Finally, an analysis of the national Youth Risk Behavior Survey data (total N = 52,985) collected by the Centers for Disease Control and Prevention (Grunbaum, Lowry, Kann, & Pateman, 2000) also found that Asian American high school students were significantly less likely than Black, Hispanic, or White students to have had sexual intercourse or to have had four or more sex partners. Only 28% of Asian American students reported lifetime experience of sexual intercourse compared to 77% of Black, 55% of Hispanic, and 48% of White students. However, among those who were currently sexually active, Asian American students were found to be as likely as other groups to have used alcohol or drags during last sexual intercourse or to have used a condom at last intercourse. It should be noted that there is variability among Asian ethnic groups with respect to sexual behavior. Horan and DiClemente (1993) reported that among 11th and 12th grade students in San Francisco, only 13% of Chinese American students were sexually active but 32% of Filipino students were sexually active.

College Students

The patterns found with Asian American adolescents also extend to college students. In a 1982 survey of 114 Chinese American college students in northern California (60% of whom were U.S.-born), Huang and Uba (1992) found that the majority (over 60%) approved of premarital sexual intercourse when partners are in love or engaged to be married; however, only 37% of the men and 46% of the women surveyed had ever engaged in coitus. In this sample, Chinese American women were generally more sexually experienced than men, with more women having engaged in kissing, necking, and petting, although men (M = 18.5) and women (M = 18.8) did not differ in age of first vaginal intercourse experience. There was a positive correlation between the level of acculturation to the U.S. and engagement in premarital sexual intercourse, and those Chinese Americans dating only White Americans consistently had more sexual experience than those dating only Chinese Americans. Huang and Uba concluded that Chinese American college students were not avoiding premarital sex because they do not find it permissible. Rather, the authors speculated that Chinese Americans' sexual behavior and gender differences may reflect internalized racism (e.g., less positive body images), more conservative standards for engaging in premarital sexual relations, and racialized stereotypes of Asian American men as asexual and undesirable sexual partners.

In a 1987-1988 survey of 153 Asian American college students in Southern California (half of who were born in the U.S.), Cochran, Mays, and Leung (1991) found that 44% of the men and 50% of the women had engaged in heterosexual sexual intercourse at least once. The rate of Asian Americans who were sexually active (47%) was significantly lower than their age cohorts in other ethnic groups. Among those who were sexually active, the rates of engagement in oral sex was high (86% for women, 75% for men). In an analyses of their 1993 data on 346 Asian and 356 non-Asian Canadian college students, Meston, Trapnell, and Gorzalka (1996) found significant and substantive ethnic differences in all measures of interpersonal sexual behavior (i.e., light and heavy petting, oral sex, intercourse) and intrapersonal sexual behavior (i.e., frequency of fantasies, masturbation incidence and frequency, and ideal frequency of intercourse), and all sociosexual restrictiveness measures (e.g., lifetime number of partners, number of partners in the past year, predicted number of partners, lifetime number of one-night stands). Overall, 35% of Asian Canadian college students in this survey reported having experienced intercourse. This study did not find any differences among Asian Canadians in their sexual behavior according to their length of residency in Canada.

A survey of 148 White American and 202 Asian American college students in Southern California (McLaughlin, Chen, Greenberger, & Biermeir, 1997) also found that Asian American men (over 55%) and women (60%) were significantly more likely than White American men (25%) and women (< 30%) to be virgins. Among those who were sexually experienced, Asian American men (M = 2.3) and women (M = 2.2) reported fewer lifetime sexual partners than White American men (M = 5.5) and women (M = 3.5). Within the Asian American sample, women from least acculturated families were more likely to be virgins (77%) than those from moderately or highly acculturated families (52% and 53%, respectively). This pattern did not hold for Asian American men. Of note, Asian Americans and White Americans endorsed casual sex to a similar degree even though the groups differed significantly in the number of partners. McLaughlin et al. interpreted this attitude-behavior inconsistency among Asian American college students as possibly reflecting the larger and more effective role that their parents play in controlling the adolescents' behavior.

In sum, the available data indicate that Asian Americans tend to be more sexually conservative than non-Asian Americans of the same age group, particularly with regard to the older age of initiation of sexual activity. One exception is a study by Sue (1982), who reported in a survey of 36 Asian American college students enrolled in a human sexuality course that rates of premarital sexual behavior did not differ from those of non-Asian students. However, Sue's anomalous data are likely the result of the selective nature of Asian American students who voluntarily enrolled in a human sexuality course.

SEXUAL AND REPRODUCTIVE HEALTH

Almost all studies examining sexual and reproductive health among Asian Americans have been conducted with women. The studies of participation in breast and cervical cancer screening among the Asian American population paint a fragmented picture. Some studies have shown moderate rates of cancer screening among Asian American women. For example, 57% of 189 Chinese American women in Michigan, aged 50 or older, had had mammograms in the past 2 years (Yu, Seetoo, Tsai, & Sun, 1998), and over 70% of the Chinese American women sampled in San Francisco had had a mammogram, Pap test, clinical breast examination (CBE), and breast self examination (BSE) (Lee, 1998).

However, the majority of the studies have found extremely low rates of screening in Asian Americans compared to the non-Asian American population. In a study conducted in the Puget Sound area, Asian American women were found to be less likely than other ethnic group women to enroll in breast cancer screening programs even when out-of-pocket expenses for the screening tests were paid by managed care (Tu, Taplin, Barlow, & Boyko, 1999). In a study of women 18 to 74 years old in the San Francisco Bay Area, Chinese American and Vietnamese American women had the lowest rates of first time utilization and recent utilization of breast and cervical cancer screening among all the ethnic groups (Hiatt et al., 1996). Specifically, 33% of Chinese American women had never obtained a pap test and 30% had never performed BSE, whereas 58% of Vietnamese American women had never had a Pap test and 66% had never performed BSE. An interview study of 332 Chinese American women (ages 40-69) recruited through a two-stage probability sampling method in the Chinatown area of Chicago (Yu, Kim, Chen, & Brintnall, 2001) also found a low level of knowledge of cancer screening tests and low use rates. Only 52% and 54% of the Chinese American women surveyed had ever heard of the CBE and Pap smear test, respectively, for cancer screening purposes, and much lower percentages had actually undergone screenings (35% for CBE, 12% for mammogram, 26% for BSE, and 36% for Pap test). Levels of education, English fluency, and source of health care (Eastern vs. Western medicine) were significant predictors of reproductive health behavior in this population.

The pattern of low use of screening also extends to younger age groups. Only 14.9% of 174 Chinese American students at a midwestern university practiced BSE (Lu, 1995). In a 1996 reproductive and sexual health survey of 674 Asian American women (age 18-35; the majority foreign-born) in California, 67% of the women reported having had at least one sexual partner in their lifetime, yet half of the women (50%) had not received any reproductive or sexual health services within the past year and 25% had never received such services in their lifetime (National Asian Women's Health Organization, 1997). More than one third of the respondents reported that they had never discussed pregnancy, sexually transmitted diseases, birth control, or sexuality in their households. A survey of high school students in Los Angeles County also found that Asian American adolescents reported lower levels of communication with physicians about sexual activity and risk prevention than other ethnic groups (Schuster, Bell, Peterson, & Kanouse, 1996).

In a rare study that specifically examined the role of Asian cultural variables, Tang, Solomon, Yeh, and Worden (1999) studied BSE and cervical cancer screening behavior in 156 Asian American and 50 White American female college students. In this sample, 48% of Asian American and 68% of White American women reported having had sexual intercourse with a male partner. The ethnic differences extended to screening behavior, as only 27% of Asian American women reported performing BSE at least once in their lifetime in contrast to 47% of White American women. Similarly, only 32% of Asian American but 70% of White American women reported having had at least one Pap test in their lifetime. Asian American women were found to have more cultural barriers to screening (more communication barrier with mother surrounding sexual and gynecological issues, less openness around sexuality and more modesty, less prevention orientation in health care, and less utilization of Western medicine). Even after controlling for differences between the two ethnic groups (e.g., mother's education, year in college, family history of breast or cervical cancer, knowing someone with breast cancer, being sexually active, etc.), Asian Americans were still less likely than White Americans to have had BSE and pap test. However, Asian American women who were more acculturated were more likely to participate in these screening behaviors.

Consistent with Tang et al.'s (1999) results, similar cultural reasons for the low utilization of reproductive health services were elucidated through a qualitative analysis of interview data with 9 Asian American health care practitioners and educators who worked with Asian American women and focus group data with 6 second-generation Asian American women (National Asian Women's Health Organization, 1995). This study found that Asian American women's sense of risk regarding reproductive and sexual health appeared to be downplayed, as the women tended to view gynecological services as important and legitimate only when they concerned reproductive functions or when the pain or symptoms of infection became unbearable or interfered with daily functioning. In the interviews, health advocates and practitioners agreed that recent immigrants in particular may perceive gynecological exams such as Pap tests as invasive and inappropriate prior to marriage, and that the perception that gynecological care is only acceptable after marriage likely prevents many Asian American women from accessing appropriate care. Additionally, Mo (1992) argued that the idea of a visit to a medical doctor for a checkup without receiving some form of intervention (namely medication) does not fit immigrant Chinese patients' expectations. Mo explained that a Cantonese term, ham suup, which is a colloquial term for sexuality that is most often used in a derogatory manner, is used to describe anyone who is sexually inappropriate. Talking about or touching one's body and being knowledgeable about the body are considered as ham suup, thus discouraging traditional and immigrant Chinese women from gaining knowledge regarding sexuality and sexual health. In sum, there appears to be a pervasive tendency for Asian American girls and women to be more reluctant than White American girls and women to seek care for their sexual and reproductive health.

As a possible consequence of their relatively low use of screening, Asian American women tend to be diagnosed with more advanced stages of cervical cancer (Frisch & Goodman, 2000) and breast cancer (Jenkins & Kagawa-Singer, 1994) than White American women, thereby increasing the disease burden at diagnosis (Hedeen, White, & Taylor, 1999). Cervical cancer rates among Vietnamese American women was the highest of all ethnic groups in the U.S., with the incidence of 43 per 100,000, a rate that is almost five times that of White American women (Miller et al., 1996). These statistics indicate that there are high health costs associated with Asian American women's reluctance to become knowledgeable about, and to engage in, sexual and reproductive health practices.

One study regarding the sexual and reproductive health issues of Asian American men does exist. A telephone survey of 802 English speaking Asian American men between the ages of 18 and 65 was conducted in Los Angeles, San Francisco, and New York (National Asian Women's Health Organization, 1999). Over half of the respondents (54%) were single and the majority (75%) was foreign-born. Although 87% of the surveyed Asian American men had at least one sexual partner in the past year, the vast majority of the respondents (89%) had never received sexual or reproductive health care services.

SEXUAL ABUSE AND AGGRESSION

The scope of sexual abuse in the Asian American community is unknown, as most state and national agencies that collect such data fail to segregate the data for Asian American victims. Where data are available, the reported incidence among Asian Americans appears relatively low compared to other ethnic groups, possibly due to their lack of access or reluctance to use mental health services and public agencies (Kenny & McEachern, 2000). However, many service providers assert that the actual incidence is much higher than reported (Okamura, Heras, & Wong-Kerberg, 1995). High rates of history of sexual victimization among Cambodian American refugees women and children, which they suffered during the Khmer Rouge reign of terror or at refugee camps, have been extensively documented (e.g., Mollica, Wyshak, & Lavelle, 1987; Roz6e & Van Boemel, 1989; Scully, Kuoch, & Miller, 1995). In a study of abuse history among 102 Vietnamese Amerasian refugee young adults in the Philippine Refugee Processing Center who were awaiting placement in the United States, 12% of men and 9% of women reported having been sexually abused (McKelvey & Webb, 1995).

Those who work with Asian American communities speak of the Asian American victims' extreme reluctance to disclose or report sexual abuse or assault (Okamura et al., 1995; Tsuneyoshi, 1996). For example, most Southeast Asian refugees surveyed by Wong (1987) stated that they would respond to sexual abuse in their own family by keeping it a family secret. Further, sexual abuse within the context of marriage may be fatalistically tolerated among some Asian American communities. As a result, immigrant Asian American women may be at a higher risk of marital sexual abuse than U.S.-born Asian American women because they may have been socialized to believe that they had fewer sexual rights than their husbands (Lum, 1998). An analysis of interviews with 25 South Asian immigrant women who were abused by their spouses found that 60% of the women reported being forced to have sex with their husbands against their will, and sexual abuse took many forms such as marital rape and violence and the husbands' control of women's reproductive choices (e.g., forcing the wife to get an abortion, refusal to allow the use of contraceptives, etc.) (Abraham, 1999). Similarly, an interview study with 150 immigrant Korean American women in Chicago revealed that 60% of the women reported being battered, and 37% of those who were physically abused also reported being forced to have sex by their partners (Song, 1996).

Given the cultural tendency to hide sexual abuse from others, it is difficult to ascertain the accuracy of sexual abuse reports. (2) A review of 158 Asian American cases referred for child maltreatment to a San Diego social service agency serving Asian American immigrants and refugees found that sexual abuse constituted only 5% of the total cases, with most sexual abuse victims being Filipino and female (Ima & Hohm, 1991). Another retrospective chart review study of a child abuse clinic in San Francisco generated 69 substantiated cases of sexual abuse between 1986 and 1988 in which the victims were Asian Americans (Rao, DiClemente, & Ponton, 1992). A comparison of this sample of Asian American child sexual abuse victims with randomly selected samples of other ethnic group counterparts found that Asian American victims tended to be older (M = 11.5 years) and more likely to be living with both parents than other ethnic group victims. Notably, Asian American victims were much less likely to display inappropriate sexual behaviors or express anger and hostility but most likely to express suicidal ideation or attempt suicide. Although Asian American mothers were as likely as White Americans and Hispanic Americans to be the primary caretakers to the child victims, they were much less likely than the other groups to have brought the abuse to the attention of authorities and most likely to disbelieve the report of the abuse. Asian American victims were also the least likely to disclose sexual abuse to their mothers; 61% either never spontaneously disclosed the abuse or disclosed the abuse to someone other than their mothers. Asian American victims were also the most likely group to be abused by a male relative (including the father).

Meston and her colleagues (Meston, Heiman, & Trapnell, 1999; Meston, Heiman, Trapnell, & Carlin, 1999) conducted a survey of 466 Asian Canadian and 566 non-Asian Canadian undergraduates regarding abuse experience before age 18 and their current sexuality. The researchers found that 25% of Asian Canadian women and 11% of Asian Canadian men had at least one experience with sexual abuse (defined here as being involved in some sexual activity against their wishes). In contrast, 40% of non-Asian Canadian women and 11% of non-Asian Canadian men reported at least one experience with sexual abuse. However, associations between early abuse and adult sexual behavior did not differ significantly between Asian and non-Asian Canadians, and reports of sexual abuse were not significantly correlated with socially desirable responding in either group. In another survey of 243 college women (38 of whom were Asian American), rates of reported childhood sexual abuse and being a victim of rape among Asian American college women (21% and 11%, respectively) were lower than those of their White American and African American counterparts (Urquiza & Goodlin-Jones, 1994). The researchers also found that for White and African Americans, women with a history of childhood sexual abuse were three times as likely to be raped as an adult than women without a history of childhood sexual abuse. However, this pattern did not hold for Asian American women.

Hall and Barongan (1997) noted that there appeared to be a lower prevalence of sexual aggression in Asian American communities. A national survey of sexual aggression found that fewer Asian American men perpetrate rape and fewer Asian American women are victims of rape than other ethnic groups (Koss, Gidycz, & Wisniewski, 1987). In their review of risk and protective factors for sexual aggression among Asian Americans, Hall, Windover, and Maramba (1998) argued that the patriarchical aspects of Asian culture, in which women hold subordinate status to men, may create a risk for, and a tolerance of, sexual aggression by Asian American men. On the other hand, Asian cultural emphases on self-control and interpersonal harmony may serve as protective factors for sexual aggressive behavior among Asian Americans. To test culture-specific models of sexual aggression, Hall, Sue, Narang, and Lilly (2000) examined intra- and interpersonal determinants of Asian American and White American men's sexual aggression. In this sample of college students, 33% of Asian American and 38% of White American men reported that they had perpetrated some form of sexual aggression. Whereas a path model for White American men suggested that only an intrapersonal variable (misogynous beliefs) predicted sexual aggression, both interpersonal (concern about social standing) and intrapersonal (misogynous beliefs, alcohol use) variables were predictive of Asian American sexual aggression.

Other studies point to a possible role of Asian cultural factors in the attitudes toward sexual violence. For example, a study of 302 Asian American and White American college students (Mori, Bemat, Glenn, Selle, & Zarate, 1995) found that Asian Americans were more likely to endorse negative attitudes toward rape victims and greater belief in rape myths than their White counterparts. Moreover, less acculturated Asian Americans held more negative attitudes toward rape victims than more acculturated Asian Americans. A telephone survey about domestic violence attitudes with 262 Chinese Americans in Los Angeles County (Yick, 2000) found that although 89% of the respondents agreed that sexual aggression constituted domestic violence, the respondents' gender role beliefs (traditional or egalitarian) emerged as a significant factor that shapes their definitions of abuse. In summary, certain facets of traditional Asian cultures (e.g., traditional gender roles, concerns about loss of face) appear to be implicated in Asian Americans' attitudes toward, reporting of, and perpetration of sexual abuse and aggression.

SEXUAL ORIENTATION

Little empirical research exists concerning sexual orientation and sexual identity among Asian Americans apart from the HIV-risk studies, although a body of scholarly work (largely in the humanities) regarding Asian American gay, lesbian, and bisexual identities and sexual orientation exists (e.g., Leong, 1994, 1996). One study of 13 Japanese American gay men revealed that only half of their respondents were open with their families regarding their gay identity (Wooden, Kawasaki, & Mayeda, 1983). In a survey of 19 women and 16 men (ages 21-36) who identified as both Asian American and lesbian or gay, Chan (1989) found that they tended to be more involved in social and political activities in the lesbian-gay community than in the Asian American community. More than half of the respondents (57%) reported being more comfortable in the lesbian/gay community than in the Asian American community and identified more strongly with the gay or lesbian aspects of their identity, although a minority of the respondents reported a synthesized ethnic and sexual identities. Although the majority (77%) had come out to a family member (e.g., sibling), only 26% had disclosed their gay identity to their parents because of fear of rejection.

Finally, in a study investigating whether cultural backgrounds moderate the relationship between sexual orientation and gender-related personality traits, Lippa and Tan (2001) found that participants from more gender-polarized cultural backgrounds (Hispanics and Asian Americans) showed larger homosexual-heterosexual differences in gender-related traits than White Americans for both men and women. That is, Hispanic and Asian American gay men assumed more feminine roles and Hispanic and Asian American lesbians assumed more masculine roles with respect to occupational and hobby preferences as well as self-ascribed masculinity and femininity. Hispanic and Asian American gays and lesbians were also found to fear social disapproval of their homosexuality more than their White counterparts. Taken together, the findings from the few existing studies on sexual orientation among Asian Americans suggest possible influences of cultural and community factors in their sexual identity, disclosure of homosexuality, and gender-related traits.

CONCLUSION

Although there are significant gaps in the social science literature concerning Asian Americans' sexuality and sexual behavior, the existing data converge on notable differences between Asian Americans and other ethnic groups on major aspects such as sexual timetables and behaviors and attitudes surrounding sexuality, reproductive health, and sexual abuse. Many characteristics of the Asian Americans' sexual attitudes and behavior have significant implications for public health and clinical work. The next generation of empirical work must begin to test specific hypotheses regarding the Asian cultural characteristics as well as the impact of minority status on sexuality of Asian Americans.

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(1) In this and all other studies conducted by Meston et al. (1996, 1997, 1999), individuals born in South Asia (India and Pakistan) were classified as non-Asians rather than Asians. (South Asians are considered in this review as Asians, following the convention in Asian American scholarship and the U.S. Census classification.) However, because South Asian Canadians typically constituted less than 3% of Meston et al.'s (1996, 1997, 1999) non-Asian samples, the results of their ethnic comparisons are likely to be reliable. The Asian Canadian group in their studies consisted primarily (70%) of ethnic Chinese.

(2) For a more in-depth discussion of cultural factors that may influence in the reporting and treatment of child sexual abuse in Asian American communities, see Futa, Hsu, and Hansen (2001).

Preparation of this manuscript was supported in part by a grant from the National Institute of Mental Health (MH-01506). I thank Gordon C. Nagayama Hall for comments on an earlier version of this article.

Sumie Okazaki
University of Illinois at Urbana-Champaign

Address correspondence to Sumie Okazaki, Department of Psychology, University of Illinois at Urbana-Champaign, 603 E. Daniel St., Champaign, IL 61820; e-mail: [e-mail].