Exploring the Q in LGBTQ: Demographic characteristic and sexuality of Queer people in a U.S. representative sample of sexual minorities.

Although queer identity has been used among sexual minorities for decades, little is known about the population of queer-identified people in the U.S. We compared people who identify as queer (unweighted n = 88; weighted % = 5.8%) with those who identify as lesbian/gay (n = 833; 46.9%), bisexual (n = 493; 40.6%) or other sexual minority identities (n = 93; 6.7%), in order to describe queer-identified people as a distinct sexual minority group. The study is the first to estimate demographic characteristics and sexuality of queer-identified people using a U.S. nationally representative sample. We found that queer people are overwhelmingly cisgender women and genderqueer/ nonbinary (GQNB), younger, and more highly educated than other groups. After stratifying by gender identity (cisgender women; cisgender men; GQNB), survey-weighted descriptive differences in attraction, sexual partnering, and relationship patterns show that queer individuals are more likely to report attraction to, and sexual relationships with, transgender and GQNB people, though differences by respondent gender identity were noted: The majority of queer women are attracted to and partnered with both women and men, and were more likely than other groups to be attracted to and partnered with cisgender and transgender people. In contrast, queer men are split in their attractions-about half were attracted exclusively to men, and half to men and women-but the majority partnered with men only. Of all groups, queer men are the most likely to partner with transgender men, but none had partnered with transgender women. GQNB people are more likely than cisgender people to identify as queer (25.9%) and are attracted to both cisgender and transgender women and men, yet predominantly partnered with cisgender people. The results provide support for queer as a distinct sexual identity.

Metabolic Syndrome and Economic Strain Among Sexual Minority Young Adults.

PURPOSE: The study tested if sexual orientation is associated with metabolic syndrome (MetS) in young adulthood (ages 24-32), and if economic strain impacts associations. METHODS: Gender-stratified logistic regressions were fit among 11,575 young adults (1644 sexual minority [SM]) in Wave IV of The National Longitudinal Study of Adolescent to Adult Health. RESULTS: MetS was not associated with sexual orientation for either gender, yet economic strain was more prevalent among both SM males and females. Additional MetS risk factors (smoking, binge drinking, and lower education) emerged for SM females. CONCLUSION: Although MetS did not differ by sexual orientation, emergent sexual orientation disparities among females suggest increased future risk.

Sexual orientation and sex differences in socioeconomic status: a population-based investigation in the National Longitudinal Study of Adolescent to Adult Health.

BACKGROUND: Socioeconomic status (SES) is a fundamental contributor to health; however, limited research has examined sexual orientation differences in SES. METHODS: 2008-2009 data from 14 051 participants (ages 24-32 years) in the US-based, representative, National Longitudinal Study of Adolescent to Adult Health were analysed using multivariable regressions that adjusted for age, race-ethnicity, childhood SES, urbanicity and Census region, separately for females and males. Modification by racial minority status (black or Latino vs white, non-Hispanic) was also explored. RESULTS: Among females, sexual minorities (SM) (10.5% of females) were less likely to graduate college, and were more likely to be unemployed, poor/near poor, to receive public assistance and to report economic hardship and lower social status than heterosexuals. Adjusting for education attenuated many of these differences. Among males, SM (4.2% of males) were more likely than heterosexuals to be college graduates; however, they also had lower personal incomes. Lower rates of homeownership were observed among SM, particularly racial minority SM females. For males, household poverty patterns differed by race-ethnicity: among racial minority males, SM were more likely than heterosexuals to be living at >400% federal poverty level), whereas the pattern was reversed among whites. CONCLUSIONS: Sexual minorities, especially females, are of lower SES than their heterosexual counterparts. SES should be considered a potential mediator of SM stigma on health. Studies of public policies that may produce, as well as mitigate, observed SES inequities, are warranted.

Acceptability of multipurpose human papillomavirus vaccines among providers and mothers of adolescent girls: A mixed-methods study in five countries.

INTRODUCTION: Multipurpose vaccines (MPVs) could be formulated to prevent multiple sexually transmitted infections simultaneously. Little is known about acceptability of MPVs among vaccine health care providers (HCPs) or mothers of adolescent girls. METHODS: 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9-14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)-2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country. RESULTS: Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56-82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs. CONCLUSIONS: Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents.

Sexual Initiation Patterns of U.S. Sexual Minority Youth: A Latent Class Analysis.

CONTEXT: The typical understanding of sexual debut as first vaginal intercourse is often irrelevant to sexual minority youth. Better understanding of sexual initiation patterns among these youth is necessary to inform efforts to safeguard their sexual and reproductive health. METHODS: Early sexual experiences were examined among 1,628 female and 526 male sexual minority participants in Waves 1 (1994-1995) and 4 (2008) of the National Longitudinal Study of Adolescent to Adult Health. Latent class analyses identified initiation patterns distinguished by the timing, sequence and spacing of first experiences of sexual behaviors. Multinomial logistic regression analyses assessed correlates of various patterns. RESULTS: Initiation classes for females were categorized as typical debut (representing 41% of the sample, characterized by vaginal intercourse and short spacing between first two behaviors); dual behavior debut (35%, characterized by vaginal and oral sex in the same year); early sexual debut (17%, characterized by average debut at 13, vaginal intercourse, and anal sex before 18); and delayed debut with oral sex (6%). Male classes were single behavior (50%, characterized by oral sex and longer spacing); multiple behavior (32%, characterized by vaginal and oral sex); early anal sex (11%, characterized by anal intercourse before 18); and very early debut (6%, characterized by oral sex and average debut at 10). Class membership was associated with socioeconomic status for females; age and sexual victimization for males; and race, ethnicity and religiosity for both. CONCLUSIONS: Initiation patterns of sexual minority youth differ between genders and involve noncoital behaviors and characteristics beyond timing.

Teen Pregnancy Among Sexual Minority Women: Results From the National Longitudinal Study of Adolescent to Adult Health.

PURPOSE: The purpose of this study was to explore the association between sexual orientation and teen pregnancy (before age 20 years) in a U.S. nationally representative cohort of young adult females aged 24-32 years. METHODS: A total of 5,972 participants in Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health were included. Self-reported sexual orientation identity was categorized as heterosexual, and three sexual minority (SM) groups: mostly heterosexual, bisexual, and lesbian (combining "mostly homosexual" and "100% homosexual"). Stepwise multivariate regression models were fit to compare odds of teen pregnancy and relative risk ratios of timing of teen pregnancy, between heterosexual and SM groups, adjusting for sociodemographic characteristics, sexual victimization history, and sexual risk behaviors. RESULTS: After adjusting for sociodemographics and sexual victimization, bisexual women had significantly higher odds than heterosexual peers of teen pregnancy (odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.05-2.75); this association was marginally significant after adjusting for sexual risk behaviors. Bisexuals were also more likely to have an early (before age 18 years) teen pregnancy (OR = 2.04; 95% CI = 1.17-3.56). In contrast, lesbian women were significantly less likely to have a teen pregnancy than heterosexual (OR = .47; 95% CI = .23-.97), mostly heterosexual (OR = .46; 95% CI = .21-.99), and bisexual (OR = .29; 95% CI = .12-.71) women in final models. CONCLUSIONS: Expanding on extant literature, we found opposing risk patterns for teen pregnancy between bisexual and lesbian women, likely due to distinct patterns of sexual risk taking. Findings suggest that SM-inclusive teen pregnancy prevention efforts tailored to meet the unique needs of SM young women, particularly bisexuals, are needed.

Demographic and developmental differences in the content and sequence of adolescents' ideal romantic relationship behaviors.

This study utilizes data from 18,392 respondents (aged 12-19) in Wave 1 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) to provide a detailed descriptive analysis of U.S. adolescents' desired behaviors in their ideal romantic relationships. Age, gender, and ethnic group differences in the desire for--and preferred sequence of--a set of activities that could occur in a hypothetical romantic relationship were explored within subsets of heterosexual (n = 17,274) and sexual minority adolescents (n = 1118). Non-sexual behaviors were more commonly desired compared to sexual behaviors. The typical desired behavioral sequence was: holding hands, going out alone, telling others they were a couple, kissing, saying "I love you," sexual touching, and finally having sex. Overall, more similarities than differences emerged across groups, with some notable differences in the percentages who desired sexual behaviors. Results provide a nuanced picture of adolescent relationship scripts, with implications for education and prevention.

Invited commentary: broadening the evidence for adolescent sexual and reproductive health and education in the United States.

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies-particularly sexuality health education policies and programs-have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the "tier 1" funding of the Office of Adolescent Health's Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as "evidence-based" interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.

Longitudinal consistency in self-reported age of first vaginal intercourse among young adults.

We examined consistency in self-reports of age at first vaginal sex among 9,399 male and female respondents who participated in Waves III and IV (separated by approximately seven years) of the National Longitudinal Study of Adolescent Health (Add Health). Respondents were coded as consistent if they reported an age at first vaginal intercourse at Wave IV that was within one year of the age they reported at Wave III. Sociodemographic, behavioral, and cognitive predictors of consistency were examined using bivariate and multivariate logistic regression. Overall, 85.43% of respondents were able to provide consistent reports. Among both males and females, consistency was associated with age, years since first vaginal intercourse, race/ethnicity, and lifetime number of other-sex partners in final multivariate models. Respondents who were older and had more recently had their first sexual experience were more likely to be consistent. For females only, those who reported a history of nonparental, physically forced sex were less likely to be consistent. Most young adults consistently report age at first vaginal intercourse, supporting the credibility of retrospective self-reports about salient sexual events such as timing of first vaginal intercourse.