*1.2. Cross-Cultural and Intergenerational Understandings of SRH*

These 1.5 generation migrants not only contend with cross-cultural and religious understandings of SRH, but must also navigate intergenerational differences in the midst of cross-cultural parenting. For example, research indicates that in the first few years of arrival, first generation skilled Zimbabwean migrants found the ways in which Australian culture constructed and dealt with sexuality to be confronting and at odds with their beliefs and ways of understanding sexuality [8]. This resulted in increased avoidance of and resistance to Australian constructions of SRH delivered via Australian media and Australian people [8]. As a result, families experienced conflict when trying to educate their 1.5 generation migrant children about SRH from a Shona-Zimbabwean lens within contemporary Australia [8]. This intergenerational discrepancy may exist when the only point of reference that migrant parents have about youth sexual development is from when they themselves were youths in their country of origin. They then draw on these experiences and understandings when it becomes relevant–when they have to raise youths. Until that point, contemporary youth/teenage life in Australia or their country of origin may seem irrelevant. Furthermore, first generation migrant parents and 1.5 generation migrant children indicated that many parents of 1.5 generation children expected these children to comply with constructions of sexuality from their country of origin [8]. In addition, these expectations were more readily expressed and enforced for 1.5 generation migrant children than for second generation children/siblings born in Australia. Notable expectations include avoiding interactions with members of the opposite sex (especially enforced with girls), restrictions on participation in youth peer events (e.g., birthday parties, sleep-overs, or group excursions) and restrictions on engagement with LGBTIQ people, information, or media.

#### *1.3. Exploring SRH with 1.5 Generation Migrants*

Despite the dearth of research in this area evidence indicates that 1.5 generation migrants, especially of non-Western backgrounds, often enter a new (Anglo/Euro-centric) cultural and secular environment when they move to Australia. This environment has its own set of constructs of SRH which 1.5 generation migrants are confronted with at a

crucial time in their psychosexual development–childhood, puberty and adolescence [8]. This may result in having learnt and being expected to uphold (by other members of one's cultural community) particular norms about SRH [9] from their culture of origin while at the same time adopting and enacting Australian secular constructions of SRH contributing to a culture clash [8]. Such a clash may have immediate and far-reaching implications for the SRH of 1.5 generation migrants. For migrants arriving from countries with very different cultural, ethnic and religious values, and beliefs to those in Australia the process of adapting constructions, understandings and experiences of sexuality often results in a number of challenges. This study was therefore designed to investigate the role of culture and religion on sexual and reproductive health indicators and help-seeking amongst 1.5 generation migrants.

#### **2. Methods**

This paper focuses on the results of the quantitative questionnaire portion of a larger project conducted in 2015. The larger project used a mixed methods cross-sectional design (i.e., quantitative questionnaire, qualitative interview and Q Methodology) to explore constructions of SRH and SRH help-seeking amongst 1.5 generation migrants in Greater Western Sydney (see [2] for results of the Q Methodology study). The Q methodology helped us to create conceptual maps of participant perspectives as it allows for the sampling of subjective viewpoints, and assists in identifying patterns, including areas of difference or overlap, across various perspectives on a given phenomenon. The Q methodology combines elements from qualitative and quantitative research traditions to understand and explore the many facets of a range of phenomena simultaneously [10].

Greater Western Sydney was chosen as more than 50% of its approximately 800,000 people are migrants or their descendants [1]. Furthermore, the region has been found to have pockets of cultural concentration which allows migrants to stay connected to key aspects of their culture, such as their ethnicity, community, language, and religion. To that effect, it is likely that the cultural and religious norms of migrants' country of origin remain strong and may therefore have a significant influence on how 1.5 generation migrants in this region construct, experience, and understand various aspects of SRH. The study therefore sought to address the following questions:


#### *2.1. Survey*

The survey (see Supplementary Materials Text S1) was specifically designed for this investigation and began with demographic questions including what year the participant moved to Australia, with whom, and at what age. Participants were also asked about their religious affiliation and ethnicity. With regards to cultural connectedness, participants were asked to rank, on a 5-point Likert scale, how strongly they identified with the culture and values from their country of origin and with Australian culture. They were also asked to rank how strong relationships were with their community based on their culture of origin and the extent that cultural values created strong ties between the participant and their family. Questions on participants' SRH history, safer sex practices, and prospective SRH help-seeking were posed. With regard to their help-seeking attitudes, participants were asked: "If you were having a sexual and reproductive health concern, how likely is it that you would seek help from the following people/places? Please indicate your response by clicking on the number that best describes your intention to seek help from each help source that is listed." Participants then indicated on a 5-point Likert scale the likelihood of them seeking help from an intimate partner, friends, parent, other relative/family member, sexual health clinic, the Internet, a doctor/general practitioner (GP), or community/cultural or religious leader, or alternatively if they would not seek help, or would seek help from another source not listed above. Finally, participants were also asked about barriers and facilitators to seeking SRH support.

#### *2.2. Participant Recruitment*

A cohort of 1.5 generation migrants were recruited via advertisements posted at seven Western Sydney University campuses and surrounding off-campus venues (e.g., major shopping malls). This was done to strategically engage participants from several suburbs within the Greater Western Sydney region to ensure that the data collected were from as many ethnocultural groups as possible. Individuals over 18 years old who indicated that they had migrated as children (under 18 years old) to Australia were included in the study. No upper age limit was set as an exclusion criterion to participation.

#### *2.3. Ethics Approval*

This study is part of a larger research project examining the SRH of 1.5 generation migrants in Australia and ethical approval was received from the Human Research Ethics Committee of Western Sydney University. In addition, informed consent to participate in this study was obtained from all participants (approval date and code: 19 June 2015, H11168).
