How does Traditional Confucian Culture Influence Adolescents’ Sexual Behavior in Three Asian Cities?

Abstract

Purpose

To investigate whether and how the presence of Confucian cultural norms influences the sexual behaviors of adolescents and young adults in three Asian cities experiencing different levels of economic development.

Methods

Data on this paper were drawn from the international cross-sectional survey on sexual and reproductive health of adolescents and young adults aged 15–24 in three Asian cities (Hanoi, Shanghai and Taipei), conducted in 2006. The original sample consisted of a representative group of 17,016 adolescents, while in this paper, 16,554 never married adolescents were included in the analysis. Both face-to-face interview and Computer Assisted Self-Interview (CASI) approaches were adopted in the survey. Exposure to family concepts, self-cultivation values, gender role concepts and sexual values were the main measures of traditional Confucian cultural influence. Sexual and intimate behaviors were the main outcome measures, multi-Cox regression models were used to assess the association between traditional cultural concepts and values and sexual behavior after adjusting for potentially confounding factors. Data were analyzed with SAS software 9.1.

Results

The traditional Confucian cultural norms were not weakening evenly, with more entrenchment in Hanoi than in Shanghai and Taipei. Prevalences of sexual coitus among adolescent and young adults were lowest in Hanoi and highest in Taipei, while similar profiles of other intimate behaviors were displayed in the three cities. Associations between respondents’ sexual behavior and their cultural concepts and values differed by city. In Hanoi, for all four cultural measures, respondents with more traditional views were less likely to be engaged in sexual activity. This was also true in Shanghai and Taipei with respect to traditional sexual values and self-cultivation values. However, there was an inverse relationship between sexual behavior and traditional family concepts and gender roles in Shanghai and Taipei; those with more traditional values were more likely to have premarital sexual intercourse, except with regard to family values among female youth in Taipei.

Conclusions

The findings suggest that different aspects of Confucian values eroding unevenly in different Asian cities, may have distinct association with adolescent or young adults' sexual behaviors.

Introduction

Confucianism has been the dominant school of ethical and moral thought in traditional Chinese culture for more than two thousand years. Established by Confucius (551~479 BC), it has even been regarded state doctrine in agricultural feudal society, hence has permeated every aspect of Chinese society -- the politics, economy, philosophy, social psychology, social customs, ways of thinking and ways of living. Besides China, the cultures most strongly influenced by Confucianism also include those of Japan, Korea, and Vietnam, as well as various territories including Hong Kong, Macao, Taiwan, and Singapore, where ethnic Chinese are the majority[1].

This ethical-moral system governs all relationship in society and sees the society as hierarchical and vertical structure of superiors and subordinates (typically, ruler and subject, father and son, husband and wife). The main principle of social hierarchy is wisdom, responsibility, and benevolence descending from one’s superiors, while obedience, loyalty and respect from a subordinate. Family is the prototype social organization, and the principles of family living are applied to the larger society [2]. To ensure harmony and order in the family and in society, one must abide by filial piety as the cardinal value. Confucianism also focuses on the cultivation of virtue and maintenance of ethics, based on its core concepts of Humanness (ren), Righteousness (yi) and Propriety (li). That is, one should properly act within a community and place other interests above one’s own personal needs and wishes. To become a moral being is idealized, whereas pursuit of materialistic profit is denounced. In this sense, to be scholars or officials (should be knowledgable and pass harsh examination) is valued while to be merchants is despised.

The guiding principle of gender relations in Confucianism is “male as superior and women as subordinate” (nan zun nv bei). Sons are more valued than daughters, and only production of male progeny is viewed as the continuity of family line [3]. Men and women is expected to have distinct social role that men should go out to work to support family and women stay at home to be caregivers. Besides, a virtuous woman should uphold “three subordinations”: be subordinate to her father before marriage, to her husband after marriage, and to her son in widowhood. Confucianism sees sexuality as taboo and forbid discussion about sex. It advocates sex is regulated by formal arrangements (marriage) and culminates in childbirth, so sex outside of marriage is not condoned. Virtue of chastity is particularly supposed to be abided by women, which means remaining virgin before marriage and fidelity to the husbands, alive or dead. In sexual activity, women are also supposed to keep submissive and less sexually aggressive than men [4, 5].

Cultural environment is an important factor influencing human sexual behaviors. Recently, Hanoi, Shanghai and Taipei have been undergoing marked socio-cultural changes in the wake of modernization, rapid industrialization, and contemporary globalization. Aspects of traditional Confucian values have begun to weaken. The increasing availability of housing has given rise to increases in nuclear families and individual living alone [2]. Dependence and connectedness in the collective family has weakened. Individual needs and rights are emphasized. Industrialization and modernization enable the diversity of careers, and businessmen are not disparaged. Women’s status have been elevated, with the evidence that high percentage of women attaining higher levels of schools and working out in less traditional career. Premarital sex is increasingly accepted by young people and more prevalent among them [6–8]. However, each of the three city has been open to outside influences socially, culturally and economically in different ways for different periods of time, which might cause the shift or erosion of traditional values in different extent.

Over the years, studies have suggested cultural norms may matter in adolescent sex-related behaviors [9–10]. Considering that the relationship between Confucian values and sexual behavior in this rapidly changing socio-cultural environment also deserves exploration, this study will examine and evaluate, in each of the three cities, the extent to which the changes in traditional Confucian values have and will impact the sexual and intimate behaviors of adolescents and young adults.

Methods

Sample and procedures

Data for this article come from a 2006 cross-sectional survey of 17,016 male and female, married and never married youth, aged 15–24, conducted in urban Hanoi, Shanghai and Taipei and rural areas included in their large metropolitan districts by a team of researchers from the Johns Hopkins Bloomberg School of Public Health, the Population and Health Research Center in Taiwan’s Bureau of Health Promotion (BHP), the Shanghai Institute for Planned Parenthood Research (SIPPR) and the Hanoi Institute for Gender and Women’s Studies. In this paper, only the 16,554 never married respondents were included in the analysis.

The sampling methodology has been described in detail in “Levels of Change in Adolescent Sexual Behavior in Three Asian Cities” [11]. Multi-stage sampling methods were used to insure representativeness within each city. In Hanoi and Shanghai, adolescents were recruited from urban household, group living facilities (GLF) and rural household, whether they are married or unmarried. In Taipei, an alternative sampling methods were employed as large proportion of adolescents were continuing their education. Students were interviewed in school with a small non-student sub-sample interviewed at their private residences and GLFs. The questionnaire was developed by the research team, translated, back-translated, and pilot tested in each site. Most of the interview was conducted face-to-face, except that computer-assisted self interview (CASI) was used for sensitive questions. Before the interview, the adolescents signed consent forms guaranteeing confidentiality. All aspects of this study received approval from the Committee on Human Research Office at the Johns Hopkins University as well as the collaborating local organizations.

Measures

Intimate and sexual behaviors

We examined five intimate and sexual behaviors of adolescents and young people: ever having engaged in holding hands, hugging, kissing, intimate fondling and sexual intercourse with a member of the opposite sex. These variables were self-reported (through CASI), and coded as ever/never.

Demographic variables

Demographic characteristics thought to be associated with adolescent and youth sexual behaviors were included in the analysis as potential confounding factors. These variables were: residence (urban/ rural), respondent’s age (integer years of 15–24), gender, whether or not currently a student, household economic status (assessed by the number of listed appliances that the family currently owns, coded as low/middle/high based on tertiles calculated separately for each city), and education level. Education level was classified as “high school or less than high school”, "college”, and “university or higher” based on completed education level for non-students, and current education level for students. Vocational school was collapsed into the college group in Hanoi because it is entered following completion of high school there, but was classified with the high school group for the other two cities where students enroll in it as an alternative to entering high school.

Traditional Confucian cultural variables

Traditional Confucian culture, the common base of social culture in the mainland of China, Taiwan and Vietnam, is a complex system of moral, social, political, and religious thought with regard to individual’s relationships with others and appropriate conduct. Its core concepts advocate filial devotion to family and priority of collective interests, self-cultivation of virtue and unequal gender roles. Accordingly, three scales were created: (a) family concepts, (b) self-cultivation values, and (c) gender role concepts. In addition, we also created a scale to measure Confucian values on sexuality as it could be closely related to adolescent sexual behaviors. Each of the four scales is based on the sum of a different set of questions, coded zero or one according to the score sheet shown in Table 1. Higher sum scores represent more traditional values. Respondents with missing values for the above-mentioned variables were excluded from the analysis.

Table 1.

Score sheet for construction of traditional cultural concept variables (1=more traditional)

Statement	Point
	Agree	Disagree
Family Concepts
1. One’s family must be the main source of trust and dependence.	1	0
2. One need not conform to one’s family’s or society’s expectations.	0	1
3. One’s achievements should be viewed as family’s achievements.	1	0
4. The worst thing one can do is to bring disgrace to one’s family reputation.	1	0
5. Occupational failure does not bring shame to the family.	0	1
6. Regardless of what faults one’s parents may have, one must always respect them.	1	0
7. I had a lot of respect for my parents' ideals and opinions when I was growing up.	1	0
8. Even if one disagrees with one’s parents, one must always do what they suggest.	1	0
9. When choosing husband/wife, who do you think should make decision? (Code as disagree if decision was made by the couple themselves, all else as agree.)	0	1
10. It is important to you that your parents are proud of you.	1	0
11. Children needn’t take care of parents when they are unable to care for themselves.	0	1
Values on Self-Cultivation
1. It is better to be a scholar than the head of a big company or business.	1	0
2. One should be established in their career first and then be married.	1	0
3. One should consider the needs of others before considering one’s own needs.	1	0
Values on Gender Roles
1. A woman should follow her husband no matter what his lot.	1	0
2. Households should be headed by men.	1	0
3. It is acceptable for a husband to beat his wife in some situations.	1	0
4. It is very important to you that you have at least one male heir.	1	0
5. What is the ideal number of boys/girls that a couple should have? How many girls/boys? (Code as agree if number of boys exceeds the number of girls, else as disagree.)	1	0
Sexual Values
1. It is important that (your/your future) spouse is a virgin before marriage.	1	0
2. Women should tell their partners/husbands what they like or don’t like during sex.	0	1

Statistical analyses

Data were analyzed with SAS software 9.1. The sample was weighted before analysis, with weights calculated according to the probability of each respondent being selected from the sample site. Differences in percent distributions of categorical variables between cities were examined by Chi-square tests. Associations between a respondent having experienced sexual intercourse and Confucian cultural concepts/values were analyzed by multi-Cox regression models, adjusted for potential confounding factors.

Results

Table 2 presents the demographic details of the study participants. The three samples were fairly comparable in terms of gender and age, in keeping with the sampling goals of the study. Over 70% of the respondents in each sample lived in urban areas. However, 83% of the Taipei respondents were students, compared to only two-thirds of the Hanoi and Shanghai respondents. About half of the respondents’ education level was college or above. The economic status of respondents was difficult to compare between cities as the criteria for classification differed by city. These factors were controlled in the multivariate analysis.

Table 2.

Distribution of demographic characteristics of respondents by city (%)

Variables	Groups	Hanoi (N=6204)	Shanghai (N=6023)	Taipei (N=4327)
Age	15–17	23.8	32.1	27.5
	18–20	35.9	37.2	33.0
	21–24	40.3	30.7	39.5
Gender	Male	52.5	50.2	51.3
	Female	47.5	49.8	48.7
Residence	Urban	71.8	73.4	87.9
	Rural	28.2	26.6	12.1
Student	Yes	66.3	67.1	82.8
	No	33.7	32.9	17.2
Education	≤ High school	50.3	58.5	47.2
	College	20.4	17.8	5.1
	≥ University	29.3	23.7	47.7
Economic status	Low	31.1	22.0	36.2
	Middle	40.3	38.0	24.1
	High	28.6	40.0	39.7

Initiation of sexual and intimate behaviors

Overall, 15.7% of respondents reported that they had ever engaged in sexual intercourse by the time of the survey, and the proportions who acknowledged they had ever engaged in hand holding, hugging, kissing and fondling were 66.8%, 50.6%, 41.0% and 30.9% respectively. Table 3 shows that there was indeed a difference in the sexual and intimate behaviors between respondents in the three cities. More than half of respondents reported they had ever held hands with a member of the opposite sex, the highest proportion (73.5%) in Hanoi, the lowest (57.2%) in Shanghai and Taipei in between (70.1%). The proportion of respondents who had ever experienced hugging and kissing was higher in Taipei than in Shanghai and Hanoi, while the proportion of respondents who had ever experienced fondling was lower in Shanghai than in the other two cities. For respondents who had ever engaged in coitus, the proportions were highest in Taipei and lowest in Hanoi. Gender differences in sexual behaviors exist in each city; adolescents and youth in Hanoi and Shanghai had the largest gender disparity in reported experience of fondling, while Taipei respondents had the largest gender disparity in coitus. Males had higher reported levels of all sexual behaviors than females except for holding hands, hugging and kissing in Taipei.

Table 3.

Percent having experienced sexual and intimate behaviors by city and gender (%)

Behaviors	Hanoi		Shanghai		Taipei
	Male (n=3095)	Female (n=3109)	Male (n=2983)	Female (n=3040)	Male (n=2168)	Female (n=2159)
Holding hands	75.9	70.9	61.1	53.3	69.6	70.6*
Hugging	52.5	41.5	50.6	43.5	56.6	61.9
Kissing	42.3	34.5	40.8	34.1	46.4	50.9
Fondling	37.7	26.5	32.5	21.4	35.2	32.3
Coitus	7.1	2.2	16.1	8.5	37.7	29.4

^*p>0.05, x² test between the male and female groups in each city (all others p≤.05).

Status of respondents’ concurrence with Confucian concepts and values

As shown in Table 4, in Hanoi and Taipei, over 93% of both males and females reported agreement with five or more statements measuring traditional family concepts (out of 11 items), compared to about 60% in Shanghai. Regarding traditional values in self-cultivation, more than 95% of the adolescents and youth in Hanoi reported agreement with two or more items (out of a total of three), compared to those in Shanghai and Taipei (approximately 80%) and twice as many in Hanoi agreed with all three items compared to either other city. In Hanoi, 86% of the respondents concurred with 2–3 gender role items (out of a total of 5), while in Shanghai and Taipei approximately one third concurred. With respect to traditional sexual values, more than 80% of the respondents in Hanoi agreed with at least 1 item (out of a total of 2), compared to those in Shanghai (70%) and Taipei (45%). In all three cities, males and females are most similar regarding family concepts and personal development, while males are much more likely to adhere to traditional views of gender roles than females.

Table 4.

Distribution of scores for traditional cultural concepts and values by city and by gender (%)

Score		Hanoi		Shanghai		Taipei
		Male	Female	Male	Female	Male	Female
Family Concepts	0–4	2.4	1.3*	40.4	38.4	5.9	6.9*
	5–7	34.5	33.5	56.7	59.2	50.9	57.3
	8–11	63.2	65.2	2.9	2.4	43.2	35.9
Self-cultivation Values	0–1	5.0	4.0*	18.3	18.7	20.4	23.5*
	2	28.8	31.3	45.6	43.6	49.8	47.3
	3	66.3	64.7	36.1	37.7	29.8	29.2
Gender Role Concepts	0–1	5.0	11.9*	48.8	81.5*	51.2	79.8*
	2–3	86.2	84.9	48.2	18.0	45.9	20.0
	4–5	8.7	3.2	3.0	0.5	2.9	0.2
Sexual Values	0	19.9	13.8*	28.9	29.8*	53.3	57.5*
	1	58.8	61.8	51.5	48.1	40.2	37.8
	2	21.4	24.4	19.7	22.1	6.6	4.7

^*p≤0.05, x² test between male and female in each city.

Association between coitus and traditional Confucian concepts and values

Coitus, the most intimate sexual behavior, was chosen as the dependent variable to examine the association between traditional Confucian values and sexual activity. Table 5 presents the adjusted hazard ratios (HR_a) of having had sexual intercourse by these four aspects of traditional concepts controlling for economic status, school status, education level and residence. Male adolescents and young adults in Hanoi with more traditional views on any of the four values are less likely to have engaged in premarital intercourse (HR_a ranging from 0.33~0.76). Females in Hanoi with more traditional attitudes to family concept and sexual values were also less likely to have premarital sex. While in Shanghai and Taipei, the associations between sexual coitus and traditional Confucian values among unmarried adolescents and young adults were more complicated. Same direction of relationship between sexual coitus and values on self-cultivation or sexuality were found among both boys and girls in Taipei and Shanghai. However, inverse relationships between coitus and family or gender role concepts were displayed except the relationship in terms of famliy concepts among females in Taipei; those with highly traditional views regarding family and gender roles are more likely to be the ones who have had sexual intercourse (HR_a ranging from 1.19~4.13).

Table 5.

Adjusted hazard ratio (HR_a) of traditional Confucian variables regressed on sex behavior in the 3 cities by Multi-Cox model (95% CI)

			Hanoi		Shanghai		Taipei
Confucian values	Comp.	Ref.	Male (N=3095)	Female (N=3109)	Male (N=2983)	Female (N=3040)	Male (N=2168)	Female (N=2159)
Family concepts	5–7	0–4	0.41* (0.23–0.70)	0.35 (0.10–1.27)	1.25* (1.03–1.51)	1.51* (1.15–1.99)	1.70* (1.19–2.43)	0.73* (0.55–0.99)
	8–11		0.38* (0.22–0.65)	0.22* (0.06–0.79)	1.45 (0.95–2.23)	1.76* (0.97–3.19)	1.77* (1.23–2.52)	0.83 (0.62–1.13)
Self-cultivation Values	2–3	0–1	0.57* (0.36–0.91)	0.72 (0.27–1.94)	0.79* (0.64–0.98)	0.48* (0.37–0.64)	0.91 (0.78–1.07)	0.97 (0.81–1.16)
	4–5		0.45 * (0.29–0.70)	0.63 (0.24–1.63)	0.58* (0.45–0.74)	0.36* (0.25–0.50)	0.76* (0.63–0.92)	0.78* (0.63–0.97)
Gender role con.	2	0–1	0.61* (0.37–0.99)	0.74 (0.37–1.47)	1.12 (0.93–1.34)	1.21 (0.88–1.65)	1.19* (1.04–1.36)	1.17 (0.98–1.39)
	3		0.76 (0.41–1.40)	0.25 (0.03–2.31)	1.64* (1.06–2.52)	4.13* (1.60–10.61)	1.96* (1.42–2.70)	3.17* (1.13–8.92)
Sexual values	1	0	0.45* (0.34–0.59)	0.21* (0.13–0.35)	0.63* (0.52–0.75)	0.27* (0.21–0.36)	0.70* (0.61–0.80)	0.52* (0.43–0.61)
	2		0.33* (0.20–0.52)	0.08* (0.03–0.22)	0.31* (0.21–0.44)	0.15* (0.09–0.26)	0.61* (0.43–0.88)	0.35* (0.21–0.59)

Adjusted for economic status, school status, education level and residence.

^*p≤ 0.05

Discussion

Traditional values may be viewed as important components of the cultural environment and meaning systems; they are taught by one generation to the next, and internalized into an individual’s values through socialization. Confucianism was the dominant doctrine in the long history of China. It also permeated into the everyday life of Vietnamese in ancient times. So young people's views on the common Confucian values were used as the standpoint to examine the current influence of traditional values in Hanoi, Shanghai and Taipei. China is the cradle of Confucian culture, yet our findings show that any of the four aspects examined in Shanghai and Taipei are now more eroded and less constrained than in Hanoi. Aligned entrenchment of traditional gender role values was displayed in Shanghai and Taipei, while more adherence to filial piety toward family and less embracement on traditional sexual values was found among Taiwanese youth, which suggested the erosion of different dimension of Confucian values were not in paralleling manner. Former studies have suggested that socio-cultural events like migration, industrialization, modernization, and higher education have resulted in challenges to traditional values [12, 13]. Different pathway from tradition to modernization and different stage in modernization of the three cities might possibly explain the different erosion of the Confucian values there. Taiwan is one of the most developed areas in Asia and appears to parallel many other developed areas in several social aspects. China has had a more open policy since the late 1970s; after experiencing dramatic changes in the economy and exposure to global culture, a comprehensive and all-level open policy structure has been established in China. Vietnam has experienced the greater flexibility in economic practice and greater contact of outside since innovative policies implemented in the mid-1980s [5]. However, why youth in Taipei held more filiety to family than their counterparts in Shanghai, or further speaking, the reasons for variant extent in weakening of different dimensions of Confucian values need further research.

The profile of adolescents’ and youth’s intimate and sexual behaviors in the three cities was displayed interestingly. Ordinal ascending was found in prevalences on coitus among female and male respondents in Hanoi, Shanghai and Taipei, which was concordant with the discrepancy of current endorsement of traditional Confucian values there, despite of little difference on the prevalence of other intimate behaviors. This finding implied adolescents and youth in the three cities might face different degree of conflict or torment between their sexual desires or impulses with the actual experiment of sex. As some researchers pointed, in their attempts to construct the meanings of becoming sexual being, youth often look to their social contexts for clues about what constitutes acceptable sexual behavior[9]. Abstinence until marriage and woman’s virginity was considered to be of particular value in Confucianism. Adolescents and youths in Confucian culture might resort to alternative forms like hugging, kissing or foundling to fulfill their sexual desires, but not vaginal sexual intercourse which is overtly inhibited. This arduous process of becoming a sexual being existed more possibly for women in each city, with the evidence that less girls have engaged in sexual coitus than boys.

This study corroborated the association between cultural factors and adolescent sexual behaviors. Those with traditional Confucian values -to be specifically- values on filial piety to family, self-cultivation of virtues, unequal gender roles and restrictions on sexuality, would be less likely to have premarital sexual intercourse in Hanoi. This relationship was also found with regard to values on self-cultivation and sexuality in Shanghai and Taipei. Confucian tradition taught young people with proper conduct and placed great emphasis on spiritual pursuit on morality for young men, rather than asserted the masculinity by overt sexual activity, which is quite different from the contexts of some Latin-American and African areas [14, 15]. Some studies used the vertical and horizontal collectivism to delineate cultural orientation and examined the protective effects of them on sexual risky behaviors [10, 16]. Vertical collectivism emphasizes the interdependence of every human in some collective group and see the group of hierarchy while de-emphasizes self-interests, which is of some similarity in essence with the Confucian family concepts. Confucian constraints on sexuality may serve as buffer against premarital sex as our study indicated. However, on the other hand, these constraints also may evoke stigmatization and self-stigmatization that inhibit sexually active unmarried youth seeking necessary reproductive health counseling and services, which should be paid worthy attention in the context of considerable proportion of youth having had premarital sex.

Unexpectedly, this study found in Shanghai and Taipei those with more traditional values on gender roles and family were more likely to be sexually active, except with regard to family values in female Taiwanese. This puzzling finding might result from several reasons. Family values, once internalized by mechanisms including family discipline and parent-child communication, may serve as a buffer against risk-taking behaviors [10]. Regarding sexuality as taboo in Confucianism restricted the parent-child meaningful communication on sexuality. Youth were inclined to keep secret their own sexual experiences to their parents, even if they felt they needed help or advice and parents adopted a “silencing” approach to sex-talk. In China, a community-based study found only one in five adolescents aged 15–19 years had discussed sexual related information with their parents [17]. The limited parent-child communication on sexuality might block the delivery of family values and expectations, especially related to sexuality. Regarding traditional gender-role values, some scholars suggested that they could lead to risky sexual behavior through hyperfemininity or by discouraging women from successfully negotiating sexual encounters [18]. Young women embracing submissiveness or hyperfemininity in Confucian society might confront with the idea that sex could be used as a tool to gain and maintain relationships and have sex under the partner's dictates; they might have lower self-efficacy in communicating with friends or family because they afraid to be perceived as having two much experience-based knowledge. In addition, young people in Shanghai and Taipei had much contact with Western cultures endorsing more individualism and gender equality which would be related positively with adolescent sexual risk behaviors. The perceived Western cultures and their influence on adolescent sexual behaviors in the three Asian cities needs further research.

This study differs from previous research in that it is a multi-site study, with both urban and rural components, and the sites are at very different points in the processes of modernization, economic development, and outside contact and whose political environments are also distinctly different. This study does, however, have several limitations. First, the data presented here are cross-sectional and thus the direction of influence is uncertain, with the possibility that some of the associations identified here may result from a bi-directional process. Second, different sampling approaches were adopted in Taipei and the other two cities despite obtaining respective representativeness, the different demographic characteristics of respondents, especially education and economic status, could affect their sexual behaviors and perceived cultural norms and thus may increase bias on the results. Third, given the exploratory measurement of Confucian values, we could not ascertained whether it was reliable and nuance in interpretation of a stated issue was possible across cities. The examination of other Confucian-based societies that are also in the process of modernization should shed further light on this issue. Fourth, as self-reporting measures were adopted, there are biases and potential for both underreporting or overreporting.

Despite these limitations, our findings suggest that different aspects of Confucian culture eroded unevenly and might have different association with adolescent and youth's sexual behaviors in Hanoi, Shanghai, and Taipei undergoing rapid socio-economic change. Policy makers and health promotion practitioners should pay more attention to the distinct influence of Confucian cultural values, emphasizing its advantages and eliminating the disadvantages or some impediments (e.g. silencing on sex communication, stigmatization on unmarried women's sexual behaviors) in their efforts to protect adolescents from high-risk sexual behaviors. And some new direction for research, including the moderating effects of individual socioeconomic status and parent-child communication on the relationship between cultural norms and adolescent sexual attitudes and behaviors deserves worthy attention.