Nurses who care for the children of ethnic minority families often need to assess the parent or guardian’s perceptions of cultural and/or social topics to avoid misunderstandings. It’s an essential part of providing culturally competent care and has become a standard nursing practice. As a public health nurse in Fort Lee, New Jersey, where 20% of the population is Korean, I meet my community’s diverse cultural context daily.

During one of my clinic days, I suggested to a Korean mother, who I’ll call Mrs. K, that her 16-year-old daughter should receive the human papillomavirus (HPV) vaccine. I explained that HPV is responsible for most cervical cancers. Mrs. K wanted to know how the disease was transmitted, and I told her—by sexual contact. Mrs. K quickly responded, “What are you trying to say? My daughter does not have sex,” and I knew by her tone she was upset and offended.

According to the Centers for Disease Control, HPV is the most common sexually transmitted infection (STI) in the United States, with approximately 20 million people currently infected and six million new cases each year.1 As HPV is the cause of almost all cases of cervical cancer, it is considered one of the most preventable cancers in women. Currently two vaccines are in the market to prevent HPV: Gardasil® (Merck & Co., Whitehouse Station, New Jersey) and Cervarix® (GlaxoSmithKline, Brentfold, Middlesex, United Kingdom). These vaccines are licensed to be given to females between the ages of nine and 26 years old. However, to maximize the effectiveness of the HPV vaccines, it is important to vaccinate prior to the first sexual experience.2 

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Despite living in a society infused with sexuality, the topic is still considered taboo with my patients, who are predominately Korean. I often encounter Korean parents like Mrs. K who have different perspectives and strong opinions regarding sexuality and communicating with their adolescent children. Korean parents tend to assume full responsibility for their children’s behavior and outcomes, and most are heavily involved in their child’s life, from going through daily routines to deciding on a college to even finding a spouse. Because the parents have that level of influence, it can be devastating to acknowledge that their child would partake in premarital sex.3 The Korean culture follows the ancient Chinese philosophy of Confucianism as well as Christianity, which highly regards family values and sexual innocence until marriage. Additionally, parental and adolescent sexual communication is rarely displayed in Korean families as they discourage premarital sex and it is not an open topic of discussion. Premarital sex among adolescents is stigmatized, unacceptable behavior, according to the cultural norms.4

Having been raised by first-generation Korean parents, I understand these ideas well. My parents still change the television channel when people kiss, and I can sense their discomfort when they see such things.

After speaking with many patients regarding HPV and the vaccine, the parents have expressed concern about the possibility of the vaccine encouraging an increase in risky sexual behaviors. Concerned Women for America (CWFA) says, “Giving the vaccine to young girls before they are sexually active provides them with a false sense of security, possibly leading to risky sexual behavior that would not have occurred had the threat of cervical cancer been present.” 5 When these statements are made to the general public, nurses struggle with the realities of HPV and cervical cancer. Parents will continue to show reluctance in having their elementary- or middle-school-aged daughters vaccinated against STIs. As educators and patient advocates, nurses can emphasize how the HPV vaccines prevent cervical cancer rather than the details of sexual behaviors.

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A number of my patients’ parents have expressed an interest in obtaining more information about the HPV vaccination so that they can make informed decisions. The Centers for Disease Control and Prevention (CDC) has information about HPV, cervical cancer, and the vaccines in multiple languages, including Korean. These customized information campaigns target specific ethnic groups to help raise awareness. Providing these printable educational materials from the CDC made it much easier for me to present the necessary information to the parents without offending them. Although I may have offended Mrs. K initially, she returned with her daughter to get the HPV vaccine series after reading the information in Korean. Korean parents may not be entirely confident about talking to their children about sex, but the parents should still be educated about when and how to talk to their children about sexual issues. Sex will become less of a taboo by simply accepting it as a part of life and talking about it openly in a family setting.

References

  1. Markowitz, L. E. et al, Quadrivalent human papillomavirus vaccine: Recommendations of the advisory committee on immunization practices (ACIP), 2007. MMWR Morbidity and Mortality Weekly Report 56, 1-24.
  2. Saslow, D. et al, “American Cancer Society guidelines for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors,” 2007. CA: A Cancer Journal for Clinicians, 57, 7-28.
  3. McGill, B. (2003, March 14). “Changing attitude toward sex threatens South Korean.” Growing promiscuity, lack of education may lead to increase in AIDS, experts say. The San Francisco Gate. Last modified on March 14, 2003
  4. Cha, E. S., Kim, K. H., & Doswell, W. M. (2007). Influence of the parent-adolescent relationship on condom use among South Korean male college students. Nursing and Health Sciences, 9, 277-283.
  5. Concerned Women for America. (2007). “The truth behind the HPV vaccine: Here’s what you need to know.” Last modified on June 2008
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