The Association Between Sexual Relationship Power, Sexual Health, and Mental Health: Findings From Asian-American Women's Sexual Health Initiative Project (AWSHIP)

PURPOSES: Measures of sexual relationship power have previously been used to examine sexual health outcomes of women. To our knowledge, this is the first study to examine the effect of relationship power on sexual health and mental health outcomes among Asian-American women transitioning to young adulthood.

METHODS: This study is based on Wave I data from AWSHIP (2010). This study is part of a larger mixed-method study, designed to describe substance use, mental, physical, and sexual health among Asian American women in the greater Boston area. Computer Assisted Self-Interviewing (CASI) system was used to collect information on sensitive topics such as all questions about sexual behaviors. Those who identified as Chinese (n=120), Korean (n=44), Vietnamese (n=22), or a mix of one these ethnicities (n=24) who were single and children of immigrants were recruited. Women ages 18-28 were selected for this particular study (n=210). Three mental health outcomes (the Center for Epidemiologic Studies Depression Scale, the Rosenberg Self Esteem Scale, and the self-rated mental health status) and 6 sexual health outcomes (alcohol or drug use during sex, forced sex, anal sex, condom use during recent sex, early sexual debut, multiple sexual partners) were examined. The sexual relationship power scale (SRPS) was used to measure the sexual relationship control. Chi-square, multiple regression and logistic regression analyses were used to test the hypotheses.

RESULTS: Approximately one third of Asian-American women reported mild or severe depressive symptoms (35.7%). Sixty one percent (n=128) reported ever having sex. Among these women, high sexual risk behaviors were observed, including alcohol and drug use while having sex (58%), multiple sexual partners in the past 6 months (24%), and early sexual debut (39%). Sixteen percent reported forced sex. Controlling for the place of birth, level of education, association of multi-cultural community, and family communication level, the low sexual relationship control was significantly associated with low self esteem (b = 2.32, model R² = 20), high depression (b= -4.39, R² = 21), and poor self-rated mental health status (b = 0.40, R² =14). Sexual relationship control was significantly associated with forced sex (OR = 0.34) as well as early sexual debut (OR= 0.35).

CONCLUSION: This study shows that sexual relationship control has a unique contribution to all the mental health outcomes. For the sexual health outcomes, sexual relationship control was not associated with condom use and substance use during sex; however, it had a significant impact on report of forced sex as well as early sexual debut. This implies that behaviors such as choosing to use condoms and substances during intercourse may be determined by women's' mutual agreements with the partners rather than a lack of power exerted by women. Further, relationship power does not play a role in safer sex decision making; however, it played a role for coercive sex in this population. When designing intervention program for mental health and sexual health among Asian-American women, the issues of relationship power has to be included.