Sexual Behaviors and Partner Characteristics by Sexual Identity Among Adolescent Girls

doi:10.1016/j.jadohealth.2015.11.001

Journal of Adolescent Health

Volume 58, Issue 3, March 2016, Pages 310-316

https://doi.org/10.1016/j.jadohealth.2015.11.001 Get rights and content

Abstract

Purpose

Data suggest that lesbian and bisexual adolescents engage in risky sexual behaviors at higher rates than heterosexual girls. Whether these findings also apply to girls of other sexual identities is less well understood. Potential differences in risky sexual behaviors reported by lesbian versus bisexual adolescents are also underreported in the literature.

Methods

Data were collected online in 2010–2011 among 2,823 girls, aged 13–18 years, in the United States. Multinomial logistic regression was used to quantify comparisons of sexual behaviors between (1) lesbian; (2) bisexual; and (3) questioning, unsure, or other (QUO) identity; and (0) heterosexual girls. Logistic regression compared lesbian and bisexual adolescents.

Results

Lesbian and bisexual adolescents reported significantly more lifetime and past-year sexual partners than heterosexual girls. Bisexual girls were also more likely to report penile-anal and penile-vaginal sex, whereas lesbians were more likely to report earlier sexual debut for almost all types of sex, as compared to heterosexual girls. Lesbians also were more likely to report infrequent condom use and less likely to have conversations with partners about the use of barriers (e.g., dental dams) before first sex. Relative to lesbians, bisexual girls reported older age at first sex for almost all sexual behaviors and higher lifetime prevalence of recent male partners, penile-vaginal, and penile-anal sex. Few differences were noted between QUO and heterosexual girls.

Conclusions

Sexual minority adolescents are not identical in terms of sexual risk. Providers need to be sensitive to these differences and their implications for health and counseling of patients.

Section snippets

Methods

Data are from the Teen Health and Technology Study, an online, national survey of LGB and transgender (LGBT) and non-LGBT adolescents, aged 13–18 years, in the United States. The protocol was reviewed and approved by the Chesapeake Institutional Review Board (IRB), the University of New Hampshire IRB, and the Gay, Lesbian & Straight Education Network (GLSEN) Research Ethics Review Committee. Minors provided informed assent, and 18-year-olds provided consent. The IRBs granted a waiver of

Results

Most participants identified as heterosexual (65%, n = 1,842; note: all percentages in this paragraph are unweighted). Reflective of the recruitment strategy to oversample sexual minority youth, over a third identified as lesbian (13%, n = 364), bisexual (16%, n = 456), queer (.5%, n = 13), and QUO (5%, n = 148; numbers sum greater than 100% due to rounding).

Demographic characteristics were mostly similar across sexual identities (Table 1; note: all percentages forward in the Results section

Discussion

In this large national study detailing the sexual behaviors of lesbian, bisexual, QUO, and heterosexually identified girls aged 13–18 years, findings indicate that sexual behaviors and experiences vary by sexual identity. Lesbian and bisexual adolescents both report more lifetime and past-year sexual partners than heterosexual girls. Similar to previous literature [3], [24], one in five lesbians' most recent sexual partner was male, as is true for four in five bisexual girls. As perhaps might

Acknowledgments

The authors thank the entire study team from the Center for Innovative Public Health Research (formerly Internet Solutions for Kids), the University of New Hampshire, the Gay, Lesbian & Straight Education Network (GLSEN), La Trobe University, and Harris Interactive, who contributed to the planning and implementation of the study. The authors also thank the study participants for their time and willingness to participate in this study. Authors are listed in order of contribution.

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Cited by (36)

“Even if you think you can trust them, don't trust them”: An exploratory analysis of the lived experiences of sexual health among sexual minority girls in foster care
2020, Children and Youth Services Review
Citation Excerpt :
For instance, National Youth Risk Behavior Survey (YRBS) data indicate that sexual minority girls are significantly more likely to ever have had sex, have had sexual intercourse for the first time before age 13, have had lifetime sexual intercourse with four or more persons, be currently sexually active, and not have used a condom during last sexual intercourse, compared to heterosexual girls (Kann et al., 2018). These findings are in line with previous research that highlights elevated rates of risky sexual practices among sexual minority girls compared to heterosexual girls (Everett et al., 2019; Goodenow, Szalacha, Robin, & Westheimer, 2008; Poteat, Russell, & Dewaele, 2019; Rasberry et al., 2018; Ybarra, Rosario, Saewyc, & Goodenow, 2016). Elevated sexual health risk behaviors among sexual minority girls have been attributed to increased rates of childhood sexual and physical abuse (Saewyc, Poon, Homma, & Skay, 2008; Scheer, McConocha, Behari, & Pachankis, 2019).
Girls in foster care are at heightened risk for poor sexual health outcomes compared to their general population counterparts. Sexual minority girls are also at greater risk for poor sexual health compared to their heterosexual counterparts. Yet, little is known about the sexual health of sexual minority girls in foster care. This study aims to provide a preliminary understanding of how sexual minority girls in foster care experience the phenomenon of sexual health. Using a single-case interpretative phenomenological analysis (IPA) design, we interviewed five sexual minority girls in foster care using a single in-depth focus group discussion and analyzed the data using a series of IPA steps. Analysis revealed three major themes about the lived experiences of sexual health among sexual minority girls in foster care: fear of being victimized and distrust within sexual relationships, self-protection from sexual relationship harm, and sexual health communication. Further research is warranted to investigate the sexual health experiences and needs of sexual minority girls in foster care, with particular sensitivity to the potential impact of past sexual victimization and abuse on their sexual health and wellbeing.
A Cross-sectional Study Examining the (In)congruency of Sexual Identity, Sexual Behavior, and Romantic Attraction among Adolescents in the US
2019, Journal of Pediatrics
Citation Excerpt :
It is important to note that the meaning of identity labels may be different for different youth. For example, the meaning of “queer” has been noted for its ambiguity in the scientific literature.47,48 Findings here suggest that it may be different for boys and girls; for girls, it seems to most often connote dual romantic attraction, whereas for boys it seems to connote same-sex romantic attraction.
To examine how sexual identity, romantic attraction, and sexual behavior co-relate for cisgender adolescents.
The Teen Health and Technology survey was a cross-sectional, self-report online survey. More than 5000 youth between 13 and 18 years of age were randomly recruited through Harris Panel OnLine's panel as well as outreach by GLSEN to over-recruit lesbian, gay, bisexual, and other sexual minority youth. Data were collected between 2010 and 2011. Analyses were conducted in 2018 and restricted to cisgender youth.
Overall, romantic attraction and sexual behavior most closely mapped each other. The greatest discordance was noted between sexual identity and romantic attraction. For example, 59% of girls and 16% of boys who identified with a nonheterosexual identity reported that at least 1 of their 2 most recent sexual partners was a different gender. Nine percent of heterosexually-identified girls and 3% of heterosexually-identified boys reported romantic attraction to the same sex, and 6% and 7% of heterosexually-identified girls and boys, respectively, reported that at least 1 of their 2 most recent sexual partners was the same gender.
Treating romantic attraction, sexual identity, and sexual behavior as synonymous assumes a unidimensionality that is unsupported by the data. Pediatricians and others working with youth, including researchers, should be mindful not to assume identity on the basis of behavior. Researchers should be clear and purposeful about how they are operationalizing “sexual minority” and how it may affect the composition of their study population. Healthy sexuality and risk reduction programs need to acknowledge that adolescents with a particular sexual identity may have romantic attractions, and even sexual encounters, with people who fall outside of that identity.
Emotional and behavioral problems among sexual minority youth in Thailand
2019, Asian Journal of Psychiatry
Citation Excerpt :
Students who were not sure or questioning regarding their own gender identity reported significantly lower behavioral problem scores than the lesbian/gay and the bisexual groups without statistically significant differences compared to the straight group. The finding was consistent with a recent study that reported similar rates of risky sexual behaviors for questioning girls to those of heterosexual girls (Ybarra et al., 2016). This may be because questioning youth are still considering their gender identity and therefore are not yet “coming out” on their gender role, resulting in less discrimination from straight communities and less emotional and behavioral problems than other sexual minority subgroups.
Sexual minority youth (SMY) had more risk behaviors and mental health problems than heterosexual youth. Relatively little research has differentiated among lesbian/gay, bisexual, and questioning (LGBQ) youth.
To examine the differences in emotional and behavioral problems between LGBQ youth in the city of Northern Thailand.
Data were from a school-based, cross-sectional study of grade 7–12 students in secondary and vocational schools. Five hundred and forty-three students who identified themselves as LGBQ and 3829 heterosexual peers completed the Youth Self-Report (YSR).
Of 12.4% of LGBQ participants, 4.1% identified themselves as lesbian/gay, 4.8% as bisexual, and 3.5% were unsure. SMY had significantly higher scores in internalizing problems (16.84 VS 13.99, 95% confidence interval [CI] 1.94–3.77, P < 0.001), externalizing problems (15.23 VS 13.51, 95% CI 0.97–2.45, P < 0.001), and total behavioral scores (55.26 VS 47.16, 95% CI 5.55–10.63, P < 0.001) than their heterosexual peers. In sexual minority subgroup analyses, all syndrome subscales were highest in the bisexual group followed by the lesbian/gay group, and the questioning group, respectively.
LGBQ high school students had greater psychosocial problems than their heterosexual counterparts. Bisexual students were at the greatest risks of emotional and behavioral problems. Pediatricians and school mental health providers should be aware of emotional and behavioral problems among LGBQ students.
A scoping review of sexual minority women's health in Latin America and the Caribbean
2019, International Journal of Nursing Studies
Despite research documenting significant health disparities among sexual minority women (lesbian, bisexual, and other non-heterosexual women) in high-income countries, few studies of sexual minority women’s health have been conducted in low- and middle-income countries. The purpose of this scoping review was to examine the empirical literature related to the health disparities and health needs of sexual minority women in Latin America and the Caribbean (LAC), and to identify research gaps and priorities.
A scoping review methodology was used.
We conducted a comprehensive search of seven electronic databases. The search strategy combined keywords in three areas: sexual minority women, health, and LAC. English, Spanish, and Portuguese language studies published through 2017 in peer-reviewed journals were included.
A total 1471 articles were retrieved. An additional 5 articles were identified following descendancy search; 3 of these met inclusion criteria. After removal of duplicates and title and abstract screening, we screened the full text of 37 articles, of which 22 (representing 18 distinct studies) met inclusion criteria. At least two authors independently reviewed and abstracted data from all articles.
More than half of the studies were conducted in Brazil (n = 9) and Mexico (n = 5). Sexual health was the most studied health issue (n = 11). Sexual minority women were at elevated risk for sexually transmitted infections related to low use of barrier contraceptive methods during sexual encounters with men. Findings suggest that sexual minority women are generally distrustful of healthcare providers and view the healthcare system as heteronormative. Providers are believed to lack the knowledge and skills to provide culturally competent care to sexual minority women. Sexual minority women generally reported low levels of sexual health education and reluctance in seeking preventive screenings due to fear of mistreatment from healthcare providers. Sexual minority women also reported higher rates of poor mental health, disordered eating, and substance use (current tobacco and alcohol use) than heterosexual women. Gender-based violence was identified as a significant concern for sexual minority women in LAC.
Significant knowledge gaps regarding sexual minority women’s health in LAC were identified. Additional investigation of understudied areas where health disparities have been observed in other global regions is needed. Future research should explore how the unique social stressors sexual minority women experience impact their health. Nurses and other healthcare providers in the region need training in providing culturally appropriate care for this population.
African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional study
2019, Journal of the National Medical Association
Citation Excerpt :
First, by operationalizing vaginal and anal sexual acts as penile-vaginal or penile-anal acts, we provided a definition to participants to guide interpretability; however, this might have led to an underestimate of SMA, particularly those with only same-sex experience, who were excluded from analyses. For example, lesbian-identified girls are less likely to have engaged in penile sex acts.33 Further, it is possible that we classified some youth as heterosexual who held non-heterosexual attractions or identities but had not acted on them.
To better understand sexual health disparities among African-American sexual minority adolescents.
African-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history.
Compared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV.
African-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.
Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014
2019, Journal of Sexual Medicine
Citation Excerpt :
1 study that included countries with varying degrees of economic development in Asia, Africa, the Americas, Europe, and Oceania found that sexual debut occurred between the ages of 15–19, sexual activity among young people was sporadic (<50% had had sex in the previous month), monogamy was widespread, and boys were more likely than girls to initiate their sexual lives early and report multiple sexual partners.9 In recent years, the association between sexual debut and substance use has gained prominence,2,15,16,18–20 as has the need to consider sexual preference as a relevant variable.12,21,22 In a long-term study in the United States on middle school students aged 11–14, researchers highlighted the association between substance use and early sexual debut and proposed that this association could be explained by the disinhibiting effects of substance use (tobacco, alcohol, or other drugs) and the context, such as nightlife, which is more appropriate for adults, where substance use is common.15
Although first sexual experience (understood as first sexual intercourse) is one of the most commonly assessed characteristics of adolescents, recent research emphasizes the importance of understanding other related social factors. This study highlights factors associated with first sexual experience in a nationally representative sample of adolescent students in Mexico.
The goals of this study were (i) to determine the proportion of adolescents aged 12–17 who had had their first sexual experience; (ii) to identify the factors associated with first sexual experience; and (iii) to analyze the conditions (condom use, substance use) in which first sexual experience takes place.
The data presented in this study are drawn from the 2014 National Survey on Drug Use in Students (Spanish acronym ENCODE), undertaken with the purpose of identifying the prevalence of drug use and associated variables, including sexual activity, in Mexican students. Kaplan-Meier analysis was used to estimate the probability of first sexual experience at a given age, taking sex as an outcome variable and age as a follow-up period. Logistic regression was used to assess possible factors for sexual initiation.
Validated standard questionnaires were used to assess sociodemographic characteristics, first sexual experience (framed as first sexual intercourse), frequency of sexual relations, sexual partners, sexual preference (framed as preferred sex of partners), substance use, having a physical illness or a behavioral problem, condom or other contraceptive use, as well as the absence or presence of parents, parents’ educational attainment, and parents’ substance use.
A total of 26,187 students aged 12–17 participated. Of this total, 14.8% had already had their first sexual experience, at a median age of 15; 64.5% used some type of contraceptive, and 53.2% used condoms. Proportional probabilities for having first sexual experience using age as a follow-up period showed that the probability of having sex earlier was higher among boys than girls: the probability of having sex at age of 15 was 26.5% for boys and 13.9% for girls. Predictors of first sexual experience included substance use (alcohol OR = 2.5, tobacco OR = 2.6, and other drugs OR = 2.3), having a mother who used drugs (OR= 2.2), sexual preference (female homosexual, OR = 2.2), and sex (male, OR = 2.1).
Boys are more likely to have had a first sexual experience than girls. Future strategies should incorporate specifically targeted elements with different messages that consider adolescents’ sex and age.
Barragán V, Berenzon S, Tiburcio M, et al. Factors Associated with Sexual Debut in Mexican Adolescents: Results of the National Survey on Drug Use among Students in 2014. J Sex Med 2019;16:418–426.

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Original articleSexual Behaviors and Partner Characteristics by Sexual Identity Among Adolescent Girls

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

J Adolesc Health

J Adolesc Health

Child Adolesc Psychiatr Clin N Am

Child Abuse Negl

Child Abuse Negl

J Adolesc Health

J Appl Dev Psychol

Sexual orientation, sexual abuse, and HIV-risk behaviors among adolescents in the Pacific Northwest

Am J Public Health

Unseen risks: HIV-related risk behaviors among ethnically diverse sexual minority adolescent females

AIDS Educ Prev

Dimensions of sexual orientation and HIV-related risk among adolescent females: Evidence from a statewide survey

Am J Public Health

Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia

Can J Hum Sex

Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12–Youth Risk Behavior Surveillance, selected sites, United States, 2001-2009

MMWR Surveill Summ

Sexual-orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: Pooled Youth Risk Behavior Surveys

Am J Public Health

Prevalence of unprotected sex and HIV-antibody testing among gay, lesbian, and bisexual youth

J Sex Res

Sexual risk behavior of gay, lesbian, and bisexual youths in New York City: Prevalence and correlates

AIDS Educ Prev

Sexual intercourse, abuse and pregnancy among adolescent women: Does sexual orientation make a difference?

Fam Plann Perspect

Adolescent pregnancy among lesbian, gay and bisexual teens

Chlamydia trachomatis infection among women reporting sexual activity with women screened in Family Planning Clinics in the Pacific Northwest, 1997 to 2005

Am J Public Health

Assessing the representativeness of public opinion surveys

Teens and mobile apps privacy

A national study of lesbian, gay, bisexual (LGB), and non-LGB youth sexual behavior online and in-person

Arch Sex Behav

Teen health and technology

Original article
Sexual Behaviors and Partner Characteristics by Sexual Identity Among Adolescent Girls