Lifetime Sexual Assault, Teen Dating Violence Victimization, and LGBQ-Identity Are Associated with Condomless Sex and Sex Under the Influence Among High School Adolescents in the United States

Background and Purpose: Although teenage pregnancy rates in the United States are dropping, rates of sexually transmitted infection among young people (ages 15-24) remain steady at around 10 million per year. Lesbian, gay, bisexual, and questioning (LGBQ) adolescents remain disproportionately burdened by sexually transmitted infections and unintended pregnancy. A review of health disparities found that LGBQ adolescents in the US are at least twice as likely to either become pregnant or impregnate someone else when compared to their heterosexual peers. Additionally, LGBQ youth experience increased rates of teenage dating violence victimization (TDVV) and lifetime sexual assault (LSA) relative to their heterosexual peers. This study evaluates the contribution of LGBQ-identity and history of lifetime sexual assault, and experiences of sexual or physical teen dating violence victimization, toward sexual behaviors that place adolescents at risk of negative sexual health outcomes: condomless sex and sex under the influence of alcohol or drugs.

Methods: In 2015, 15,624 adolescents participated in the nationally-representative U.S. Youth Risk Behavior Survey. Students reported their demographics (age, sex, sexual identity, race/ethnicity), experiences of past-year physical and sexual teenage dating violence victimization, lifetime history of sexual assault, and recent condomless sex or sex under the influence of drugs or alcohol. Initial multivariate logistic regressions assessed the relationship between LGBQ-identity and each of sexual TDVV, physical TDVV, and LSA. Subsequent multivariate logistic regressions on condomless sex and sex under the influence of alcohol or drugs determined the concurrent influence of LGBQ-identity while accounting for experiences of dating and sexual violence or lifetime history of sexual assault. Separate models were conducted for TDVV and LSA to avoid the lack of disambiguation of those phenomena in the survey design. 

Results: LGBQ adolescents reported significantly higher odds of sexual TDVV (AOR=2.00), physical TDVV (AOR=1.92), and lifetime sexual assault (AOR=2.62). In models of sexual risk accounting for LSA, recent condomless sex was more likely for LGBQ adolescents (AOR=1.35) and those with a history of LSA (AOR=4.06), while sex under the influence was more likely among LGBQ adolescents (AOR=1.33) and adolescents who reported LSA (AOR=4.24), adjusting for age, gender, and race/ethnicity. Comprehensive models accounting for TDVV indicated that LGBQ identity remained significantly associated (AOR=1.49) with condomless sex, as was physical (AOR=3.41) and sexual (AOR=1.35) TDVV, with similar associations found for sex under the influence for LGBQ adolescents (AOR=1.43) and those who reported physical (AOR=2.44) and sexual (AOR=2.43) TDVV adjusting for age, gender, and race/ethnicity.

Conclusions and Implications: LGBQ adolescents report higher rates of sexual risk, lifetime sexual assault, and teenage dating violence victimization. LGBQ-identity, LSA, and TDVV have enduring contributions to negative sexual health outcomes in a representative sample of US high school students. This constellation of phenomena is often clustered together within the LGBQ adolescent population. Early identification and routine screening for history of sexual and relationship victimization is recommended for social workers and other health professionals working to reduce disparate rates of unintended pregnancy and sexually transmitted infection, which have lasting impacts on the health and wellbeing of sexual minority adolescents.