Healthy Women, Healthy Communities
“Healthy Women, Healthy Communities” is a project conducted by Asian Women’s Health Initiative Project (AWSHIP).
AWSHIP (Asian Women’s Sexual Health Initiative Project), is a five-year study funded by the National Institute of Mental Health (NIMH). It is directed by Dr. Hyeouk Chris Hahm at the Boston University School of Social Work.
The project will focus on values important to Asian Americans: familial relations, health, and community. Through these lenses, the project will examine the interrelation of mental, sexual, and physical health, and how culture and familial relations affect personal health practices. Specifically, “Healthy Women, Healthy Communities” will focus on factors including acculturation, family relations, depression, sexual risk behaviors, and gender inequities to determine their relation to the different subsets of personal health and risk behaviors. Since there is very little data currently on the health practices of Asian Americans, and Asian American women in particular, this study will help in the development of specific, culturally-competent programs for future generations of Asian American women in regards to mental, physical, and sexual health.
AWSHIP has disseminated 6 journal articles and given over 30 presentations at both national and international conferences. In addition to these publications there are currently 4 other studies in the process of being considered for publication by peer reviewed journals or being prepared by our research team. We would like to extend a special thanks to all the Asian American women who participated in our study, and we are pleased to be able to share our findings with you.
Accepted for Publication in 2013:
Hahm, H.C., Jang, J., Vu, C., Alexander, L.M., Driscoll, K.E., & Lundgren, L.M. (2013). Drug use and suicidality among Asian-American women who are children of immigrants. Substance Use and Misuse, in press.
The published studies used AWSHIP datasets between 2010-2012:
1. Hahm, H.C., Lee, J., Rough, K., & Strathdee, S.A. (2011). Gender power control, sexual experiences, safer sex practices, and potential HIV risk behaviors among young Asian-American women, AIDS and Behavior, 16,1, 179-188. PMCID: PMC3389795
We examined the prevalence of three domains of sexual behaviors among young Asian-American women: sexual experiences, safer sex practices, and potential HIV risk behaviors. We also investigated the impact of gender power control on these domains. Among sexually experienced women, 51% reported using condoms during their most recent sex act, 63% reported inconsistent condom use, and 18% reported ever having forced sex. Multiple logistic regression analyses revealed that women’s perceived lower relationship power control was not associated with vaginal sex or safer sex practices, but it was powerfully associated with forced sex and all three potential HIV risk behaviors. This study demonstrates that control within young Asian-American women’s intimate relationships exerts different associations depending on the type of sexual behavior. The application of the Theory of Gender and Power should be employed with prudence when designing HIV interventions for this population.
2. Hahm, H.C., Kolaczyk, E., Lee, Y., Jang, J., & Ng, L. (2012). Do Asian-American women who were maltreated as children have a higher likelihood for HIV risk behaviors and adverse mental health outcomes?Women’s Health Issues, 22, 1, e35-e45. PMCID: PMC3391312
Objectives: This study is the first to systematically investigate whether multiple child maltreatment is associated with HIV risk behaviors and adverse mental health outcomes among Asian-American women.
Methods: We conducted a cross-sectional study of unmarried Chinese, Korean, and Vietnamese women (n = 400), aged 18 to 35, who are identified as children of immigrants, using computer-assisted survey interviews.
Results: Approximately 7 in 10 women reported having been maltreated as a child and 6.8% reported any type of sexual abuse. Only 15% of our sample reported having sex at age 16 or before, yet almost 60% had ever engaged with potentially risky sexual partners. Contrary to the findings from previous studies of White and Black women, sexual abuse plus other maltreatment was not associated with HIV risk behaviors among Asian-American women. However, it was associated with a marked increase in depression, lifetime suicidal ideation, and suicide attempts. A higher education level was associated with increased odds of HIV risk behaviors, including ever having had anal sex and ever having potentially risky sexual partners.
Conclusion: There was no evidence indicating that multiple child maltreatment was linked with HIV risk behaviors, but it exhibited a robust association with poor mental health outcomes. These empirical patterns of internalizing trauma, suffering alone, and staying silent are in accord with Asian-cultural norms of saving face and maintaining family harmony. The prevention of multiple child maltreatment may reduce high levels of depression and suicidal behaviors in this population. It is urgent to identify victims of multiple child maltreatment and provide culturally appropriate interventions.
3. Hahm, H.C., Lee, C.H, Ja-yoon “Uni”, C., Ward, A., & Lunddren, L. (2012). Sexual attitudes, reasons for forgoing condom use, and the influence of gender power among Asian-American women: a qualitative study. Journal of AIDS & Clinical Research. S1:004. doi:10.4172/2155-6113.S1-004
Background and purpose: HIV/AIDS prevalence among Asian-American Pacific Islanders (APIs) is low yet rapidly increasing. Prior research from other populations indicates that HIV risk behaviors are associated with specific adverse/risk factors including depression, drug use, history of child sexual abuse, and forced sex. However, no studies have explored the attitudes about sexual risk behaviors and condom use between API women with adverse experiences versus women without such experiences. This qualitative study compares descriptions of sexual history and condom use between the two groups of women.
Methods: A random sample of 24 sexually active API women (16 in the adverse group and 8 in the non-adverse group) was selected for in-depth interviews from a larger study, which included 501 Korean, Chinese, and Vietnamese survey participants.
Findings: 14 out of the 16 women in the adverse group described complex sexual histories, with greater number of partners, more casual partners, and the combined use of alcohol/drugs and sex. The 8 women in the non-adverse group had fewer partners who were more long term. However, for both groups of women, condom use was inconsistent. Also, the majority of the women in both groups reported that either they themselves or they together with their partners had decided whether or not to use condoms. Yet 4 women in the adverse group showed lower gender power, with their partners being the primary decision-maker for condom use.
Conclusion: Given the inconsistent condom use for both groups, all women in this study were at risk for HIV/AIDS. Consistent with prior research, a sub-group of the women in the adverse group with lower gender power seemed particularly at higher risk. Future HIV prevention interventions need to target all API women while screening for lower gender power to identify those with the highest risk of HIV.
4. Hahm, H.C.& Kim, A* (2010). In the path of establishing ethnic identity: stories of young Korean-American women. Journal of Korean-American Education, 27, 31-37.
5. Lee, J., & Hahm, H.C. (2012). HIV Risk, Substance Use, and Suicidal Behaviors among Asian American Sexual-Minority Women. AIDS Education and Prevention: An Interdisciplinary Journal.
The authors examined the association between lesbian/bisexual identity and three risky health behaviors (HIV risk, substance abuse, and suicidal behavior) in a sample of Asian American women. This cross-sectional study was designed to investigate the prevalence of HIV behaviors and mental health functioning among unmarried Chinese, Korean, and Vietnamese women ages 18-35 who are children of immigrants (N = 701), using computer-assisted survey interviews (CASI). Approximately one out of five Asian American women in the sample identified themselves as a lesbian and bisexual woman (18%). Overall, Asian American lesbian and bisexual women reported higher proportions of risky health behaviors than did their exclusively heterosexual counterparts. The odds of engaging in HIV risk behaviors, using substances, and experiencing suicidal ideation were two to three times higher for lesbian and bisexual women than for exclusively heterosexual women. These findings suggest that rigorous screening is necessary for identifying women in this lesbian/bisexual subgroup in order to provide them with better assessment and services.
6. Hahm, H.C, Jang, J, Vu, C, Discoll, K, Lundgren, L (under review). Drug use and suicidality among Asian-Pacific Islander (API) women residing in the US.
International Conference Presentations based on AWSHIP data between 2010-2013
*Denotes student participation in project
1. Hahm, H.C. (2013, March). Substance Use, HIV Risk Behaviors, and Health Care Utilization Associated with Forced Sex among Asian-American Women (oral presentation). Scheduled to be presented at the 5th World Congress on Women’s Mental Health, Lima, Peru.
2. Hahm, H.C. (2013, March). Depression among Children of Immigrants: Voices of Asian-Pacific Islander (API) Women(poster presentation). Scheduled to be presented at the 5th World Congress on Women’s Mental Health, Lima, Peru.
3. Hahm, H.C., *Jang, J., Shilling, S. (2012, September). Substance Use and Suicidal Behaviors among Asian-American Women. Poster scheduled to be presented at the 14th European Symposium of Suicide & Suicidal Behavior, Tel-Aviv, Israel.
4. Hahm, H.C., & Lee, J. (2012, April). HIV Risk, Substance Use, and Suicidal Behaviors among Asian American Sexual-Minority Women. Poster presented at the Semi-annual meeting of Korean Academy of Social Welfare (KASW). Osan, South Korea.
National Conference Presentations based on AWSHIP data between 2010-2013
1. Hahm, H.C. (2013, April). The Risk Factors and Expressions of Poor Mental Health among Asian-American Women. Society for Research in Child Development (SRCD) Conference. Seattle, Washington
2. Hahm, H. C. & Lee, J. (2013, January). HIV Risk, Substance Use, and Suicidal Behaviors Among Asian American Sexual-Minority Women. Society for Social Work and Research (SSWR) conference. San Diego, CA.
3. Hahm, H.C., *Jang, J., *Ward, A., & *Driscoll, K. (2012, October). Impact of Different Types of Substance Uses among Asian-American Women: Suicidal Ideation and Suicide Attempt. Poster scheduled to be presented at the 140th American Public Health Association Annual Meeting in San Francisco, CA.
4. Lee, J., & Hahm, H.C. (2012, October). HIV risk, substance use, and suicidal behaviors among Asian American sexual minority women. Poster scheduled to be presented at the 140th American Public Health Association Annual Meeting in San Francisco, CA.
5. Hahm, H.C., Kolaczyk, E., Lee, Y., *Jang, J., & *Ng, L. (2012, January). Are Asian-American Women Who Were Maltreated As Children at Higher Likelihood for HIV Risk Behaviors and Adverse Mental Health Outcomes? Oral presentation will be presented at the annual meeting of the Society for Social Work and Research, Washington, D.C.
6. *Yang, Y., Hahm, H.C., *Kim, A., & *Trinh, T. (2012, January). Recruiting Asian American Women: Tailoring Non-Traditional Strategies to Recruit Chinese, Korean and Vietnamese Women into a Health Survey Study. Oral presentation will be presented at the annual meeting of the Society for Social Work and Research, Washington, D.C.
7. Hahm, H.C., Lundgren, L., *Choe, J.U., & *Lo, V. (2011, November). Suicidal ideation and substance use among Asian-American young women. Oral presentation will be presented at the annual meeting of American Public Health Association, Washington, DC.
8. Hahm, H.C. (2011, November). Child maltreatment among Asian-American women: HIV risk behaviors, depression and suicidality. Oral presentation at the annual meeting of American Public Health Association, Washington, DC.
9. Hahm, H.C., Lee, J., *Rough, K., *Ward, A., & *Yang, Y. (2011, January). The association between sexual relationship power, sexual health, and mental health: Findings from Asian-American Women’s Sexual Health Initiative Project (AWSHIP). Oral presentation at the 2011 Society for Social Work and Research Conference, Tampa, FL.
10. Hahm, H.C., *Chang, S., *Porter, E., & Hamilton-Mason, J. (2010, November). HIV risk behaviors among unmarried Asian American young women in the context of culture and family: A qualitative study. Roundtable presentation at the 138th American Public Health Association Annual Meeting, Denver, CO.
11. Hahm, H.C., *Gaumond, J., *Ward, A., & Lundgren, L. (2010, November). Substance use among young, unmarried, 2ndgeneration Asian American women: Preliminary results from “Healthy Women, Healthy Communities” study. Oral presentation at the 138th American Public Health Association Annual Meeting, Denver, CO.