Teenagers often are not comfortable talking about their sex lives with a doctor, but Asian-American teens might have an especially tough time, a study finds.
They are particularly uncomfortable talking with Asian-American or Asian health care providers and say they would lie to them about sex because they think the provider would breach confidentiality and tell their parents.
"If my mom was even outside this door right now, I would not be saying anything about my sexual activities," an 18-year-old woman told the researchers. "I would just be lying."
The Asian-American teens also believe health care providers stereotype them as not sexually active and less likely to engage in risky behavior.
One 17-year-old boy said: "I'm sure the stereotype is that if they're Asian, they're not gonna do anything, but I mean, the fact of the matter is that there are Asians doing something."
In reality, Asian-Americans' age of sexual debut and their risk of acquiring sexually transmitted infections are exactly the same as for white teenagers, according to Dr. Glenn Flores, distinguished chair of health policy research at Medica Research Institute and senior author of the study, which was published Feb. 29 in the Journal of Adolescent Research.
"They're less likely in fact to report using condoms during their last sexual intercourse," Flores says. "And they're less knowledgeable about HIV transmission and prevention, and they have lower rates of HIV screenings."
The study is just a glimpse at a topic that its authors say has been largely ignored in research on the often-fraught communication between doctors and teenagers.
It surveyed 20 teenagers of various backgrounds, including Vietnamese, Chinese, Filipino, Thai, Korean and Laotian, in the Dallas area.
The sex education program in in Dallas schools emphasizes abstinence and does not have a comprehensive sex ed curriculum, according to Dr. Jessie Zhao, a pediatric resident at the NYU Langone Medical Center and lead author of the study. And conversations around sex are often considered taboo in Asian cultures, she says.
"My household like many other Asian households was very conservative, very modest. We really didn't have discussions about sexual health," Zhao says. "The stance in the household was always, 'You will not get pregnant, you will not date, you will go to college, and then maybe after college you can date.' " Zhao wanted to find out if the teenagers' health care providers were filling in the gaps.
In fact, the teens said that doctors were way down the list of sources for sexual health information. The teens sought information from teachers, friends, the Internet and television more often than their parents and health care providers. Doctors ranked only above magazines as a source.
One reason may be because most of the teens were unaware of provider-patient confidentiality, and that their questions would not be reported to parents. As a result, the teens said they would lie about sexual histories or refuse hormonal contraceptives.
The survey participants said they sincerely wanted more information, and that they would be more comfortable talking about sex if clinicians initiated the conversation and informed them about their right to confidential care. However, the teens say too many providers presume they're not interested in the topic.
"It's well documented both in the media and in the literature that Asian-Americans are viewed as this 'model minority," Zhao says, "and that they're really serious about their education and their jobs, and that they don't participate in things that could be a hazard to their health, including teenage sex."
Zhao says even she has to remind herself not to fall into those assumptions. "Now as a physician when I see Asian-American teens in the clinic I actually have to stop myself from stereotyping them."
Flores says providers can help by thinking of it as a quality of care issue and emphasizing confidentiality.
"When a group of teens tells us they consistently lie because of things that we're not doing," Flores says, "I think that's something that we have to really pay attention to."