Association of gender norms, relationship and intrapersonal variables, and acculturation with sexual communication among young adult Latinos.

Association of Gender Norms, Relationship and Intrapersonal Variables, and Acculturation With Sexual Communication Among Young Adult Latinos Carmen Alvarez, Antonia Villarruel

Correspondence to Carmen Alvarez [email protected] Carmen Alvarez Assistant Professor Johns Hopkins University School of Nursing 525 N. Wolfe St. Baltimore, MD 21231 Antonia Villarruel Professor and Margaret Bond Simon Dean of Nursing University of Pennsylvania School of Nursing Philadelphia, PA

Abstract: Sexual communication is an important strategy in promoting safer sex behavior, but few investigators have explored sexual communication among young adult Latinos. In this cross-sectional study, we examined the role of traditional gender norms, relationship factors (relationship characteristics and relationship power), intrapersonal factors (attitudes and subjective norms), and acculturation as statistical predictors of three different types of sexual communication (sexual health, pleasure discussions, and physical sexual communication) in Latino women and men. The sample was 220 Latinos (111 women and 109 men) ages 18–30 years who were sexually active in heterosexual relationships. In multiple regression, after controlling for relationship power, intrapersonal factors, and acculturation, traditional gender norms did not predict sexual communication for either women or men. For both women and men, pleasure-focused communication (pleasure discussions and physical sexual communication) increased with acculturation. For women, the strongest predictor of all types of sexual communication was their attitudes toward sexual communication. Greater relationship power and lower acculturation were associated with women's sexual health communication. For men, no variables explained sexual health communication or physical sexual communication, and acculturation and attitude toward pleasure discussions predicted pleasure communication. Women who believed they had power in their relationships and had positive attitudes toward pleasure discussions and a high level of acculturation reported more physical sexual communication. Findings suggest the importance of relationship power, attitudes, and acculturation in young adult Latinos' sexual communication. Sexual risk prevention strategies among young adult Latinos should include encouraging sexual communication by supporting positive attitudes toward pleasure-focused communication. ß 2015 Wiley Periodicals, Inc. Keywords: sexual health communication; sexual risk; gender norms; relationship power; Latinos; attitudes; acculturation Research in Nursing & Health, 2015, 38, 121–132 Received 3 April 2014; Revised 15 December 2014; Accepted 21 December 2014 DOI: 10.1002/nur.21645 Published online 3 February 2015 in Wiley Online Library (wileyonlinelibrary.com).

Latinos are the fastest-growing and largest ethnic minority group in the United States, comprising approximately 16% of the population (Ennis, Rios-Vargas, & Albert, 2011) and accounting for almost half of the nation's population growth between 2000 and 2006. Latinos also are younger on average than the general population, with almost 80% of Latinos under the age of 45 (Fry & Center, 2008). Compared

to non-Hispanic Whites, Latinos experience disproportionate rates of unplanned pregnancy (Mosher, Jones, & Abma, 2012), sexually transmitted infections (STIs; Centers for Disease Control and Prevention [CDC], 2012), and HIV/ AIDS (CDC, 2013). These heightened risks warrant proactive attention to promote safer sex behaviors among Latino individuals and communities. C

2015 Wiley Periodicals, Inc.

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Sexual communication, defined as the relaying of information to one's partner- either verbally or non-verbally – about female contraception, condom use, sexual history, and matters of sexual satisfaction and pleasure, is an important contributor to safer sex behaviors (Noar, Carlyle, & Cole, 2006; Rojas-Guyler, Ellis, & Sanders, 2005; Widman, Welsh, McNulty, & Little, 2006). Promoting sexual communication between partners may be an avenue to support safer sex behaviors (e.g., consistent condom use, decreased multiple partners). Latinos have difficulty broaching the subject of sex with members of the opposite gender (Marston, 2004; Noland, 2006, 2008). Social norms (Marín, 2003; Villar-Loubet, Vamos, Jones, Lopez, & Weiss, 2011), cultural beliefs, and perceptions regarding gender roles have a negative influence on sexual communication among Latinos in Puerto Rico (Noland, 2006, 2008) and Mexico (Marston). Similarly, Deardorff and colleagues reported negative relationships between traditional values and comfort with sexual communication among US Latinas (Deardorff, Tschann, & Flores, 2008). In addition to traditional gender norms, other antecedents of sexual communication should be identified to support “a focal point of intervention” (Rakowski, 1999, p. 284). In the current study, we examined whether traditional gender roles were related to three types of sexual communication (communication about sexual health, physical forms of communication, and communication about pleasure) in young adult Latinos, while controlling for relationship power, intrapersonal factors, and acculturation.

Theory of Gender and Power An expanded version of the Theory of Gender and Power (TGP) (Wingood & DiClemente, 2000) supported the potential significance of relationship power to sexual communication. The basic tenets of the TGP are that sexual division of labor, sexual division of power, and cathexis (affective attachments and social norms) act together to create social and economic environments that predispose women to adverse health outcomes. The TGP has been used to explore sexual behavior and HIV/AIDS risk and to inform risk reduction interventions among both heterosexual men (Lesser et al., 2005) and women (Pulerwitz, Amaro, De Jong, Gortmaker, & Rudd, 2002; , 2007; St. Lawrence, Wilson, Eldridge, Brasfield, & O'Bannon, 2001; Teitelman, Tennille, Bohinski, Jemmott, & Jemmott, 2011). Power differentials within relationships influenced sexual communication in several reports. Women who perceived negative reactions from their partners were less likely to discuss sex and contraception than those who did not (Gutierrez, Bertozzi, Conde-Glez, & Sanchez-Aleman, 2006; Marin, 2003; Villasenor-Sierra, Caballero-Hoyos, Hidalgo-San Martin, & Santos-Preciado, 2003; Zellner et al., 2006). Bruhin (2003) found that couples with equal

Research in Nursing & Health

relationship power or female-dominated power used condoms more frequently than those with unequal or maledominated power, provided there was sexual communication. Among couples in which power was male-dominated, condom use was infrequent. Cathexis includes an understanding of the gender roles and cultural values that are socially prescribed for men and women. Traditional gender roles are suggested as barriers to sexual communication among Latinos (Marín, 2003; Villar-Loubet et al., 2011). However, in critical analysis, gender roles are fluid and multi-dimensional concepts influenced by socio-cultural and familial contexts (De la Cancela, 1986; Fiorentino, Berger, & Ramirez, 2007). Given their complexity and variability, we conceptualized traditional gender norms as stereotypes to which young adults may or may not subscribe, depending on their environments.

Theory of Reasoned Action and Planned Behavior Intrapersonal predictors of sexual communication were drawn from the Theory of Reasoned Action and Planned Behavior (TRA/PB; Ajzen & Fishbein, 1980), in which behavior is predicted by attitudes, perceived approval, subjective norms, and behavioral beliefs. In young Latinos, these intrapersonal factors have been explored as predictors of condom use (Jemmott, Jemmott, & Villarruel, 2002; Villarruel, Jemmott, Jemmott, & Ronis, 2004) and sexual behavior (Villarruel et al., 2004). In a qualitative study of young adult Latinos (Alvarez & Villarruel, 2013), intrapersonal factors were relevant to sexual communication with a sexual partner. Most participants avoided initial sexual communication due to negative attitudes. Avoiding verbal sexual communication also was associated with perceived partner approval; men were concerned that their partners would be offended if they were to initiate discussions about sex in the relationship. Beyond concern for a partner's reaction, some participants were also concerned about family approval. Men in particular shared that when a woman came from a traditional or conservative family, her family might consider discussions about sex disrespectful. Based on this preliminary work, we proposed that attitudes (feelings of embarrassment or lack of concern or interest in their partner's sexual past), perceived partner approval (perception of how one's partner may react to sexual communication), and subjective norms (perception of how other significant referents feel about sexual communication) would be associated with sexual communication. Other investigators also have reported that attitudes, perceived partner approval, and subjective norms were antecedents to sexual communication. Mexican women whose partners migrated to the US for work would not inquire about their partners' possible sexual activities while away from home (Hirsch et al., 2007), which was proposed

SEXUAL COMMUNICATION AMONG YOUNG ADULT LATINOS/ ALVAREZ AND VILLARRUEL

as supporting the façade of a faithful and respectful relationship. Latina women indicated that they avoided initiating discussions about sex, particularly regarding condom use, in order not to appear too knowledgeable about sex (Faulkner, 2003; Noland, 2006). The relevance of subjective norms was revealed in a study of young adult Latinos, in which concern about sexual discussions as disrespectful was negatively associated with comfort with sexual communication (Deardorff et al., 2008). We also considered acculturation as a predictor of sexual communication. Among one sample of Latinas, there was no relationship between HIV-related communication and acculturation (Moore, Harrison, Kay, Deren, & Doll, 1995), while in another there was a positive relationship (Rojas-Guyler et al., 2005), and in a sample of Latino men, acculturation was negatively related to discussion of condom use with a sexual partner (Ibanez, Marin, Villareal, & Gomez, 2005). Given these contradictory findings, acculturation was deemed relevant to explore. In summary, sexual communication between young adult Latino sexual partners is multifaceted and complex, and traditional gender norms are the proposed main barriers to sexual communication among Latinos. Verbal sexual health communication has been explored, but the potential influences of relationship and intrapersonal variables on sexual communication have not been explored together with traditional gender norms, and the extant data are mainly representative of Latina women and not of Latino men. We addressed these gaps and built on previous work (Castaneda, 2000; Noland, 2006; Quina, Harlow, Morokoff, Burkholder, & Deiter, 2000) by assessing multiple aspects of sexual communication, examining differences by gender, and going beyond gender norms to give equal consideration to intrapersonal factors, relationship dynamics, and acculturation as predictors of sexual communication. The research questions were: 1) Do traditional gender norms predict sexual communication, when controlling for relationship power, intrapersonal factors, and acculturation? 2) Are there gender differences in the relationships between traditional gender norms and sexual communication, relationship power, intrapersonal factors, and acculturation?

Method Design The procedures for this cross-sectional study have been previously described (Alvarez, Bauermeister, & Villaruel, 2014). Institutional Review Boards of the authors' university and a community health clinic where data collection occurred approved the study. Data collection occurred between May and September, 2011, primarily in a large mid-west urban center where Latinos comprise more than half of the population (US Census Bureau, 2010).


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Recruitment We invited individuals to participate in a study about communication in romantic relationships among Latinos. Eligible individuals included: 18–30-year-olds who self-identified as Latino, reported their current status as in a sexually active heterosexual relationship (sexually active with their partner in the last 3 months), and could speak and write Spanish or English. Recruitment in the clinic included approaching potential participants in the exam room and distributing flyers in the waiting area. We established a private area within the clinic where interested individuals completed the consent process and completed the survey. Data collection consisted of self-administered paper-pencil questionnaires in participants' preferred language of either English or Spanish. We informed all eligible individuals that their decision to participate in the study would not have an impact on their receipt of services at the clinic. Recruitment outside of the clinic involved presentations at multiple venues within the community (Head Start, churches, adult-learning centers, and women's group meetings) and distributing flyers at various community establishments where we believed we would most likely find young adult Latinos. Similar to the clinic procedures, we directed eligible individuals to complete the questionnaire in a pre-determined private area. A power analysis revealed that a sample size of 200 was needed in order to achieve 80% power. We recruited a total of 220 participants, the majority (58.6%, n ¼ 129) of whom completed the questionnaire in English. Participants were compensated $10 for their time.

Measures Translation and pre-testing. For this study we developed all measures for sexual communication and intrapersonal variables. We used the cultural decentering process (Werner & Campbell, 1970) to translate the interview guide and original questionnaires that were not available in Spanish. These new questionnaires were then pretested with a sample of English-speaking-only (n ¼ 3) and Spanish-language-dominant individuals (n ¼ 3) who met the inclusion criteria. We informed this pilot sample about the purpose of the study and the need to review the questionnaires for clarity. These pre-test participants were compensated $10 for their time. We conducted exploratory factor analyses to create subscales and determine the reliability of the intrapersonal, verbal, and physical sexual communication scales. Instrument development and descriptive data for the sexual communication variables have been previously reported (Alvarez et al., 2014). Outcome variables: Sexual health communication. We modified items from the Comfort with Sexual Communication Scale (Deardorff et al., 2008) to measure frequency of talking to one's sexual partner about sexual topics. Two verbal sexual communication subscales

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were identified in exploratory factor analysis: Sexual Health Communication (4 items) addressed discussing pregnancy, condom use, and sexually transmitted infections (afemales ¼ .75, amales ¼ .69); and Pleasure Discussions (4 items) addressed discussing topics or pleasure, such as sharing sexual fantasies and preferred sexual positions (afemales ¼.69, amales ¼.68). We also modified items from a sexual satisfaction scale (Wheeless, Wheeless, & Baus, 1984) to measure nonverbal actions used to relay information about sexual pleasure, discontent, or desire to a sexual partner. A sample item is, “I show my partner what pleases me during sex” (1 ¼ rarely, 4 ¼ always). Higher scores indicate greater frequency of nonverbal communication between the partners. Exploratory factor analysis resulted in the extraction of the 3-item Physical Sexual Communication subscale, which addresses how one demonstrates to a partner when one is sexually satisfied or what is sexually pleasurable (afemales ¼ .81, amales ¼ .85).

Independent variables: Traditional gender norms. These were operationalized as sexual gender stereotypes, or the gender roles and cultural values that frame the gender norms about sexual behavior of men and women. The Sexual Gender Norms Scale (Pérez-Jiménez, Varas-Díaz, Serrano-García et al., unpublished) is a 15item, 5-point Likert scale (1 ¼ strongly agree to 5 ¼ strongly disagree) instrument that was developed to evaluate participants' endorsement of sexual stereotypes for men and women. Statements include: “If a man gets tired of having sex with his partner, it is OK for him to have sex with someone else.” Higher scores indicate greater credence given to sexual gender norm stereotypes. Relationship factors. Relationship power was measured with the Sexual Relationship Power Scale (SRPS), developed to evaluate power and sexual decisionmaking within heterosexual intimate relationships (Pulerwitz, Gortmaker, & DeJong, 2000). The SRPS includes two subscales: Relationship Control—15 items including statements such as, “My partner will not let me wear certain clothes” (5point Likert scale—strongly agree to strongly disagree); and Decision-Making Dominance—seven items including questions such as, “Who usually has more say about whether you have sex?” (3-point ordinal scale, 1 ¼ your partner, 2 ¼ both of you equally, and 3 ¼ you). We rescaled the mean scores of the subscales and the entire SRPS to yield total scores between 1 and 5. Higher scores indicate greater power within the relationship. Other relationship factors included length of time in the relationship, difference in time in the United States, age difference, and relationship status. Relationship status was categorized as married, cohabitating, or living apart, with living apart the reference category in analysis. Length of time in the relationship, difference in age, and difference in length of time in the United States were measured as continuous variables. Intrapersonal factors: Attitudes. Items from the Health Protective Sexual Communication Scale (van der


Straten, Catania, & Pollack, 1998) and The Sexual Attitudes Scale (Villarruel, Zhou, Gallegos, & Ronis, 2010) were combined to develop the Attitudes Toward Sexual Communication scale. The items in this scale were worded to reflect attitudes toward a behavior—for example, “Asking my partner if he/she has ever been tested for HIV is . . .” (1 ¼ a very bad idea to 5 ¼ a very good idea). Two subscales were created: The five items in Attitude toward Sexual Health Communication addressed how one feels about discussing pregnancy prevention, HIV, condom use, and STIs with a sexual partner. The four items for Attitude toward Pleasure Discussions addressed how one feels about talking to a partner about sexual likes and dislikes as well as showing one's partner what feels good sexually. One item was selected to address Attitude toward Physical Sexual Communication (1 ¼ a very bad idea to 5 ¼ a very good idea). Higher scores for each of the subscales indicated more positive attitudes toward sexual health communication and pleasure discussions. Subjective norms. The 15-item Subjective Norms about Sexual Communication scale was modeled after the Sexual Attitudes Scale (Villarruel et al., 2010) and the Social Norms about Preventative Behaviors Scale (Perez-Jimenez et al., unpublished). The items were written to reflect what one perceives his/her social referents believe about a behavior—for example, “People that are important to me think that I should talk to my partner about using condoms before we have sex” (1 ¼ completely disagree to 5 ¼ completely agree). The Subjective Norms about Sexual Communication Scale had two subscales: Perceived Partner Approval about Sexual Communication included items that addressed how one believed his/her partner would feel about discussing issues regarding sex, and Subjective Norms included items that addressed how one believed his/her family and friends would feel about the participant talking to his/her partner about sex or showing one's partner what is sexually pleasurable. Higher scores for these subscales reflected more positive perceived partner approval and more accepting subjective norms about sexual communication. Table 1 presents the scale items for all intrapersonal variable measures. Acculturation. Level of acculturation was assessed with the Short Acculturation Scale (SAS; Marin, Sabogal, Marin, Otero-Sabogal, & Perez-Stable, 1987). One original item of the 5-item scale, “In general, what language do you read or speak?” was separated into two items to address speaking and reading separately, creating a total of six items measured with a 5-point ordinal scale (1¼ Spanish only to 5 ¼ English only). The scores were categorized into low level of acculturation (scores 1.00 to 2.99) and high level of acculturation (scores 3.00–5.00).

Analysis T-tests and chi-square analyses were conducted where appropriate to examine differences between men and women. Multiple regression analyses were used to test whether


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Table 1. Scales and Items for Intrapersonal Variables Scale

Items

Attitudes Toward Sexual Health Communication (SHC)a

1. Asking my partner if he/she has ever had a sexually transmitted infection is... 2. Asking my partner how many people he/she has had sex with is… 3. Asking my partner if he/she has ever been tested for HIV is… 4. Talking my partner about using condoms is… 5. Talking to my partner about using other ways to prevent pregnancy is…

Attitudes Toward Pleasure Discussions (PD)a

1. Talking to my partner about what he/she likes or dislikes sexually is... 2. Talking to my partner about what I like or dislike sexually is… 3. Showing my partner what feels good to me during sex is… 4. Touching my partner to let him/her know I want to have sex is …

Attitude Toward Physical Sexual Communication (PSC)

1. I feel free to show my partner what is a sexual turn-on for me

Perceived Partner Approval for Sexual Communication

1. Talking to him/her about how many partners he/she has had in the past? 2. Talking to him/her about whether he/she has ever been tested of HIV? 3. Talking to him/her about whether he/she has ever had a sexually transmitted infection? 4. Talking to him/her about how you can make sex more enjoyable? 5. Showing him/her what pleases you during sex?

Subjective Norms Toward Sexual Communication

People that are important to me think that I should . . . 1. Talk to my partner about how many people he/she has had sex with before we have sex. 2. Talk to my partner about using condoms before we have sex. 3. Talk to my partner about whether he/she has ever been tested for HIV. 4. Talk to my partner about whether he/she has ever had a sexually transmitted infection. 5. Talk to my partner about how to make sex pleasurable in our relationship. 6. Show my partner what I like during sex. 7. Show my partner when I am sexually satisfied.

Response options: 1 ¼ a very bad idea to 5 ¼ a very good idea

a

traditional gender norms were an independent predictor of sexual communication for men, women, or both, when controlling for relationship, intrapersonal, and acculturation factors. We developed stepwise regression models for each sexual communication outcome (sexual health communication, pleasure discussions, and physical sexual communication) in three stages: the first models included only traditional gender norms; the second models added relationship factors (length of time in the relationship, difference in US residence, age difference, marital status, and relationship power); and the final models added intrapersonal variables (attitudes toward sexual health communication, pleasure discussions, and physical sexual communication; subjective norms toward sexual communication; partner approval for sexual communication) and acculturation. We conducted each set of stepwise analyses separately for each gender.

Results Description of Sample and Responses As a whole, almost half of the participants were either married (27.3%) or cohabitating (24.5%). Most participants' partners were also Latino (84.1%), and the majority (80%) reported having one current sexual partner. Most


participants (48.2%) were born in the continental United States (excluding Puerto Rico) or in Mexico (42.7%). On average, all participants had been in the continental US for 16.51 years (SD ¼ 7.5), and their partners had been in the US for a similar length of time (M ¼ 16.97, SD ¼ 7.35). Table 2 provides participant characteristics for each gender. Male participants' relationship partners were younger than those of female participants. More women than male participants were married or cohabiting, and women had been with their partners for a longer period on average. Based on the Short Acculturation Scale (Marin et al., 1987), 57.3% of the sample had a low level of acculturation. The mean scores for Attitudes toward Sexual Health Communication (M ¼ 4.11, SD ¼.71), Attitudes toward Pleasure Discussions (M ¼ 4.27, SD ¼.58), and Attitudes toward Physical Sexual Communication (M ¼ 3.18, SD ¼.68) indicated that participants had positive attitudes towards these behaviors. Except for attitudes toward physical sexual communication, women had significantly higher average scores compared to men, indicating more positive attitudes about sexual communication (Table 3). Mean scores for perceived partner approval and subjective norms towards sexual communication indicated that participants believed that their partner, family, and friends, would approve of participants' sexual communication (verbal and

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Table 2. Demographic and Relationship Characteristics of Sample Women (n ¼ 111)

Men (n ¼ 109)

Mean (SD)

Mean (SD)

24.28 (3.60) 27.59 (4.97) 3.31 (4.12) 4.84 (3.38) 85.6 42.3 30.6 27.0 36.9 63.1

22.68 (3.40) 21.46 (3.62) 1.21 (2.53) 2.82 (2.28) 82.6 11.9 18.3 69.7 48.6 51.4

Characteristic **

Age Age of partner** Age difference between partners** Number of years with partner** Partner is Latino (%) Married** (%) Living together (not married) (%) Live apart (not married) (%) High acculturation (%) Low acculturation (%) Note. SD, standard deviation. p < .001 in Chi-square analyses.

**

nonverbal) with their partners. However, women had higher scores than men for Perceived Partner Approval for Sexual Communication and for Subjective Norms toward Sexual Communication, indicating that women perceived greater approval for sexual communication from their partner, family, and friends about talking to their partners about sex.

communication. In the third step, intrapersonal variables also significantly contributed to the model and explained the most variance. After controlling for relationship and intrapersonal factors, gender norm stereotypes were no longer associated with sexual health communication. In the final model, women who were in longer relationships, believed they had sexual decision-making power and dominance in their relationships, had positive attitudes toward sexual health communication and pleasure discussions, perceived their family and friends as approving of sexual communication with their partners, had been the United States for more time than their partners, and had low acculturation reported more sexual health communication. The full model accounted for 36% of the variance in sexual health communication. None of the variables explained sexual health communication among men (Table 5). The negative relationship between level of acculturation and sexual health communication for women prompted an exploration of differences between women of low and high acculturation. In independent t-tests, less-acculturated women had been in longer relationships (M ¼ 5.54 years,

Gender Norms as Predictor of Sexual Communication Sexual health communication. Among women, traditional gender norms were associated with sexual health communication when entered alone in the first step of analysis (Table 4). Women who believed in more traditional gender norms were less likely to engage in sexual health communication. In the second step, addition of the relationship factors was significant and increased the amount of variance explained. Gender norm stereotypes remained significant, and both length of time in the relationship and relationship power were associated with sexual health

Table 3. Reliabilities and Means of Measures of Independent Variables in Women and Men Women (n ¼ 111)

Measure Sexual Relationship Power Gender Stereotypes Attitudes toward Sexual Health Communication** Attitudes toward Pleasure Discussions** Attitudes toward Physical Sexual Communication Perceived Partner Approval for Sexual Communication* Subjective Norms toward Sexual Communication**

Number of Items 23 15 5 4 1 5 7

Note: Significance notations refer to gender differences evaluated by t-tests * p < .05 ** p < .001


Cronbach Alpha

.84 .76 .74 .79 .85

Mean (SD) 3.17 (0.59) 2.90 (0.73) 4.30 (0.66) 4.43 (0.51) 4.44 (0.67) 3.96 (0.68) 3.63 (0.74)

Men (n ¼ 109) Cronbach Alpha

.70 .69 .79 .79 .90

Mean (SD) 3.10 (0.53) 3.02 (0.51) 3.90 (0.72) 4.11 (0.60) 4.18 (0.74) 3.76 (0.71) 2.95 (0.92)


**

*

p < .05 p < .001

Note. Stepwise multiple regression analysis.

Gender norm stereotypes R2 F Relationship Factors Relationship length Difference in time in US Age difference Married Cohabiting Living apart Relationship power DR2 R2 F Intrapersonal Factors Attitudes toward: Sexual health communication Pleasure discussions Physical sexual communication Subjective norms toward sexual communication Partner approval toward sexual communication Acculturation D R2 R2 F

Physical .02 .00 .03

Pleasure .14 .00 2.05

Health .30** .08 10.50**

Sexual Communication Outcomes Step 1 (b)

.14

.15 .01 .05 .13 .11 Ref .21 .06 .02 1.32

.22* .19 .02 .00 .10 Ref .28* .13 .16 4.09**

Pleasure

.20*

Health

.10 .02 .02 .13 .08 Ref .30 .11 .05 1.90

.05

Physical


.12 .08 .04 .07 .03 Ref .22*

.04 .41* .25* .07 .03 .21* .36 .41 6.79*

.10 .45* .00 .13 .18 .00 .26 .26 3.93** .32** .29* .16 .28** .00 .29* .21 .36 5.67**

.09

Physical

.14 .04 .00 .25 .19 Ref .12

.08

Pleasure

.21* .18* .02 .08 .00 Ref .27**

.07

Health


Table 4. Traditional Gender Norms, Relationship, and Intrapersonal Factors, and Acculturation as Predictors of Sexual Communication for Women (n ¼ 111)


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**

*

p < .05 p < .001

Gender norm stereotypes R2 F Relationship Factors Length of time in relationship Difference in time in US Age difference Married Cohabitating Living apart Relationship power DR2 R2 F Intrapersonal Factors Attitudes toward: Sexual health communication Pleasure discussions Physical sexual communication Subjective norms toward sexual communication Partner approval towards sexual communication Acculturation DR2 R2 F

.00 .00 .00

Health .01 .02 .00

Pleasure .10 1.01 .00

Physical


.02

.01 .06 .06 .05 .02 Ref .07 .01 .05 .21

.09 .05 .02 .12 .16 Ref .05 .06 .00 .88

Pleasure

.00

Health

.11 .04 .13 .05 .04 Ref .03

.13 .57* .00 .02 .02 .28* .34 .26 3.97**

.14 .00 .01 .08 .20 Ref .09

.03 .29 .11 .11 .09 .00 .12 .07 1.61**

.14 .13 .04 .07 .11 Ref .16 .06 .00 1.12

.03

Pleasure

.01

Health

.14 .29 .27 .12 .04 .12 .21 .18 2.88*

.01 .10 .10 .07 .08 Ref .12

.18

Physical


.12

Physical


Table 5. Traditional Gender Norms, Relationship, and Intrapersonal Factors, and Acculturation as Predictors of Sexual Communication for Men (n ¼ 109)

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SD ¼ 3.25 vs. M ¼ 3.66 years, SD ¼ 3.31, p < .001); were engaged in more sexual health communication (M ¼ 3.05, SD ¼.84 vs. M ¼ 2.47, SD ¼.79, p < .001), and had less acceptance of gender norm stereotypes (M ¼ 2.67, SD ¼.71 vs. M ¼ 3.31, SD ¼.58, p < .001).

Pleasure discussions as sexual communication. Traditional gender norms and relationship factors (the first and second steps in analysis) did not explain pleasure discussions among men or women. Positive attitudes towards pleasure discussions predicted this form of sexual communication for both men and women. In addition, for men, a high level of acculturation predicted more pleasure discussions. The full models explained 26% and 27% of the variance in pleasure discussions among women and men, respectively. Physical sexual communication. As for pleasure discussions, traditional gender norms and relationship factors did not explain physical sexual communication. For women, in the final model, those who believed they had power in their relationships, had positive attitudes toward pleasure discussions, and had a high level of acculturation reported more physical sexual communication (Table 4). The model explained 41% of the variance in physical sexual communication among women. For men, although the model explained 18% of the variance in physical sexual communication, none of the variables was independently associated with this outcome.

Discussion The purpose of this study was to examine whether traditional gender norms were associated with sexual communication (sexual health communication, pleasure discussions, and physical sexual communication) when considering relationship and intrapersonal factors, and acculturation. Traditional gender norms are often suggested as a barrier to sexual communication among Latinos (Noland, 2006, 2008). However, our findings suggest that traditional gender norms are not significant predictors of sexual communication after controlling for relationship and intrapersonal factors. Contrary to previous qualitative and quantitative studies, there was no association between sexual communication and traditional gender norms. It is therefore possible that Latino young adults may have an awareness of social/cultural norms and stereotypes, but do not necessarily allow these stereotypes to dictate their behavior (Carrillo, 2002). Relationship factors, specifically length of time in a relationship and relationship power, were associated with sexual communication among women, but not men. Consistent with another study (Saul et al., 2000), relationship power was positively associated with sexual health communication among women. Women who felt more empowered in their relationships were more likely to engage in sexual health communication; also, women with more positive


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attitudes towards sexual health communication were more likely to engage in sexual health communication. Further, women's belief that their family and friends approved about sexual communication was positively associated with sexual health communication with their partners. However, level of acculturation was a barrier for verbal sexual communication. Highly-acculturated women had a greater belief in traditional gender norms and were more likely to engage in physical communication. This finding may be a testament to how Latinas navigate social expectations when it comes to expressing themselves sexually. Being aware of or having a belief in gender norm stereotypes does not have to mean that Latinas personally ascribe to these social expectations, but rather, they may adjust their behavior to give the illusion that they conform to social expectations (Faulkner, 2003). Overall, these findings suggest that while the cultural environment may influence Latina women engaging in sexual health communication with a partner, proximal factors such as intrapersonal attitudes about sexual communication were more powerful predictors. Contrary to findings from other studies that suggest Latina women avoid sexual communication with a partner for fear of a negative reaction (Davila, 2005; Noland, 2006), perceived partner approval and behavioral beliefs were not significant predictors of sexual health communication in our study. On the other hand, perceived approval of family and friends for sexual health communication and individuals' personal feelings toward sexual health communication were most important. Such findings suggest that efforts directed at promoting sexual communication between couples should extend beyond the individual or dyad to include families and communities. Neither gender norms nor relationship nor intrapersonal factors were associated with sexual health communication among men. Despite having positive attitudes toward sexual health communication, men rarely engaged in sexual health communication with their partners, and attitudes toward sexual health communication did not explain the behavior. It may be that, for men, some other factor needs to be present in order for them to engage in sexual health communication—for instance, their partner initiating the discussion. Male participants from other studies (Faulkner & Lannutti, 2010; Pulerwitz & Dworkin, 2006) have reported being open to discussions about sexual communication. Reassuring Latina women that men are willing to engage in sexual communication may encourage greater sexual communication between partners. To our knowledge, unique to this study was the exploration of pleasure discussions and physical sexual communication. These components of sexual communication are important, given that condom-less sex is often practiced to enhance pleasure. A relationship between these types of communication and acculturation among men and women was also revealed in this study. More acculturated men and women reported more pleasure-

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focused communication. These findings support qualitative work (Alvarez & Villarruel, 2013; Carrillo, 2002; Higgins, Hoffman, & Dworkin, 2010) that suggested that young adults prefer sexual communication that focuses on pleasure rather than health. Given these findings, instead of promoting only sexual health communication, perhaps sexual satisfaction and physical sexual communication can be explored as avenues to encourage safer sex behaviors. The importance of intrapersonal variables to sexual communication in this study raises the question of when attitudes about sexual communication are formed and how malleable they are within a relationship. Understanding how attitudes toward sexual communication may be influenced over time in the context of a relationship can inform interventions to encourage individuals and couples to engage in sexual communication and ultimately safer sex behavior. Findings from this study also challenge the vulnerability paradigm that suggests that women have limited agency regarding their sexuality due to male sexual power and privilege (Higgins et al., 2010). Although we did not explore actual sexual behavior (i.e., condom use), these Latina women reported positive attitudes toward all aspects of sexual communication—particularly pleasure discussions and physical sexual communication. Such positive attitudes coupled with the absence of a relationship between sexual communication and perceived partner approval suggests that young adult Latina women may indeed have the agency to advocate for their sexual desires within their relationships. There were several limitations of this study. Our cross-sectional data limit us to identifying associations and not causal relationships. The cross-sectional design did not enable study of how intrapersonal factors as well as communication change over time in a relationship. Couple-level data would have revealed degree of concordance of both attitudes and sexual communication and provided insight into how differences in attitudes influence sexual communication. Although all measures demonstrated respectable internal consistency (alpha of approximately .70 or greater); the alphas were not very high for sexual health and pleasure discussions, particularly for men. This may explain the few significant relationships among variables for men. Finally, characteristics of respondents and non-respondents were not collected, limiting our ability to determine whether those who participated in the study were different from those who declined. Despite these limitations, this study has several strengths. The combination of variables from the TGP and TRA/PB was beneficial. Analyzing the comparative influence of gender and power variables in relation to intrapersonal variables helped validate the importance of concurrently considering “culture” as well as more proximal variables when exploring behavior. Using both theories provided perspective on the influence of traditional gender roles relative to attitudes towards sexual communication. Including both men and women in the study made it


possible to reveal gender differences, in that relationship factors and subjective norms influenced sexual communication for women but not men. If confirmed, these gender differences should be considered in sexual health promotion interventions for Latinos. Prospective studies are needed to test whether activities geared toward increasing positive attitudes toward sexual health communication with partners result in increased sexual communication as well as safer sex behavior.

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