Trends in Sexual Orientation Missing Data Over a Decade of the California Health Interview Survey

Objectives. We explored changes in sexual orientation question item completion in a large statewide health survey.Methods. We used 2003 to 2011 California Health Interview Survey data to investigate sexual orientation item nonresponse and sexual minority self-identification trends in a cross-sectional sample representing the noninstitutionalized California household population aged 18 to 70 years (n = 182 812 adults).Results. Asians, Hispanics, limited-English-proficient respondents, and those interviewed in non-English languages showed the greatest declines in sexual orientation item nonresponse. Asian women, regardless of English-proficiency status, had the highest odds of item nonresponse. Spanish interviews produced more nonresponse than English interviews and Asian-language interviews produced less nonresponse when we controlled for demographic factors and survey cycle. Sexual minority self-identification increased in concert with the item nonresponse decline.Conclusions. Sexual orientation nonresponse declines and the increase in sexual minority identification suggest greater acceptability of sexual orientation assessment in surveys. Item nonresponse rate convergence among races/ethnicities, language proficiency groups, and interview languages shows that sexual orientation can be measured in surveys of diverse populations.Measuring sexual orientation in health surveys facilitates comprehensive public health surveillance. Accumulating evidence suggests that some lesbians, gay men, and bisexual individuals, compared with heterosexual persons, have higher smoking rates,1,2 greater second-hand smoke exposure,3 more psychological distress4–6 and depression,7 higher suicide attempt rates,8 worse general health status9 and higher disability rates,10 and lower preventive care use.11 As a reflection on these emerging findings, calls for greater collection of sexual orientation data abound,12–17 but the validity of sexual-minority research is threatened if survey respondents cannot or will not provide these data.Several large health surveys now routinely measure sexual orientation. Since 2001, the California Health Interview Survey (CHIS) has included questions assessing self-identified sexual orientation.18 Twelve Behavioral Risk Factor Surveillance System state surveys also asked sexual orientation questions at least once between 2000 and 2014.19 Other large-scale surveys currently asking sexual orientation include the Los Angeles County Health Survey,20 National Health Interview Survey (NHIS),21 National Health and Nutrition Examination Survey,22 and General Social Survey.23Results from these surveys indicate that most respondents provide a codeable sexual orientation response. One percent of NHIS respondents in 2013 did not respond when asked their sexual orientation. “Don’t know” responses comprised 0.4% and refusals made up 0.6%.24 In 2003 to 2010 Washington State Behavioral Risk Factor Surveillance System data, 0.74% responded “don’t know” or “not sure,” and 1.12% refused.25 Yet, African Americans, Asian Americans, and Hispanics in that study had higher odds of nonresponse than Whites. This raises questions about possible sociodemographic differences in sexual orientation measurement, but there have been few assessments of the combined roles of race/ethnicity and language in sexual orientation item nonresponse, and changes in those effects over time.25,26 The independent effects of English proficiency and interview language remain largely unexplored as well. Linguistic and ethnic minorities who are also sexual minorities may be underrepresented in routine public health surveillance efforts if they are differentially likely to answer sexual orientation questions.25 Understanding the relationship among sexual orientation item nonresponse, race/ethnicity, and language proficiency is important because these sociodemographic domains correlate with health disparities.27-29Sexual orientation nonresponse is likely attributable to social stigma of identification and a lack of understanding of the terminology used to discuss the topic.30 Secular trends in lesbian, gay, and bisexual (LGB) social and legal recognition31 may increase LGB individuals’ willingness to disclose their sexual orientation in surveys. The non-LGB public may also become more comfortable with and knowledgeable about the topic as a result. Public opinion surveys now show majority support for gay marriage and LGB people in general.32,33 Sexual orientation item nonresponse should decline, and the percentage of respondents identifying as LGB may increase as stigma recedes and familiarity grows. These potential effects may be more pronounced among racial, ethnic, and linguistic minorities.25,26Two primary research questions guided this study:

• (1) Does the sexual orientation item nonresponse rate change over time?
• a. If so, is this change constant across races/ethnicities, English proficiency levels, and interview languages?
• b. How strongly do race/ethnicity, English proficiency, and interview language predict sexual orientation nonresponse?
• (2) Does LGB identification vary over the same time period?

     

Nonresponse to a Question on Self-Identified Sexual Orientation in a Public Health Survey and Its Relationship to Race and Ethnicity

We examined whether nonresponse to the survey question on self-identified sexual orientation was associated with race and ethnicity, utilizing Washington State Behavioral Risk Factor Surveillance System data. The results of adjusted multinomial logistic regression indicated that the nonresponse rates of Asian Americans, Hispanics, and African Americans are higher than those of non-Hispanic Whites. Innovative ways of measuring sexual orientation to reduce racially and ethnically driven bias need to be developed and integrated into public health surveys.The US Department of Health and Human Services (DHHS) in Healthy People 2020 identifies reducing health disparities among lesbian, gay, and bisexual people as a health improvement priority.1 To achieve the objectives and monitor the progress of Healthy People 2020, nationwide efforts to better understand the health of sexual minorities are required. Measures of self-identified sexual orientation have been included in some national surveys, and studies have found that the inclusion of such measures in population-based health surveys is beneficial in that they provide important information regarding the historically marginalized populations with no detriments to overall response rates.2,3 In addition, there has been research to improve sexual orientation questions by reducing confusion in sexual orientation terminology.4–7Few studies, however, have examined whether estimates of self-identified sexual orientation are biased by racial and ethnic identities. The National Survey of Family Growth revised categories of sexual orientation by adding straight to heterosexual and homosexual to gay and lesbian, and the nonresponse rate dropped from 6.2% to 1.6%; still, the nonresponse rate for Hispanics remained high at about 9%.8 Other studies rarely report information regarding nonresponse rate by race and ethnicity. Some studies suggest that individuals from particular racial and ethnic minority groups may have experienced elevated difficulties in identifying their sexual orientation in many health surveys conducted in the United States because the sexual orientation terms commonly used in the surveys have been constructed in the dominant Euro-American culture.9–11An ongoing population-based health survey measuring sexual orientation is the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS). WA-BRFSS asks participants to identify their sexual orientation from the given categories of “heterosexual, that is straight,” “homosexual, that is gay or lesbian,” “bisexual,” and “other.” Those who answer “not sure or don’t know” or refuse to answer are coded and treated as a nonresponse. Most studies also exclude from analyses those who choose “other.” Utilizing WA-BRFSS data, our objective was to investigate whether race and ethnicity are associated with nonresponses in the measure of self-identified sexual orientation.     

Adding sexual orientation questions to statewide public health surveillance: New Mexico's experience

We examined refusal rates for sensitive demographic questions to determine whether questions on sexual orientation are too sensitive for routine use on public health surveys. We compared the percentage of active refusals in New Mexico for a sexual orientation question and 6 other sensitive demographic questions. In 2007 and 2008, refusal rates for sexual orientation questions were similar to rates for questions on race/ethnicity and weight and significantly lower than rates for questions on household income. Perceptions that sexual orientation is too controversial a topic to be included on state surveys may be unfounded.     

Sexual Behaviors of Middle School Students: 2009 Youth Risk Behavior Survey Results From 16 Locations

BACKGROUND: The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS: In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey‐Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t‐tests were calculated for these 5 items by gender, age, and race for each location. RESULTS: Data show that 5–20% of sixth graders and 14–42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION: Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.     

Examining the Impact of Question Construction on Reporting of Sexual Identity: Survey Experiment Among Young Adults

BackgroundCompared with heterosexuals, sexual minorities in the United States experience a higher incidence of negative physical and mental health outcomes. However, a variety of measurement challenges limit researchers’ ability to conduct meaningful survey research to understand these disparities. Despite the prevalence of additional identities, many national health surveys only offer respondents 3 substantive options for reporting their sexual identities (straight/heterosexual, gay or lesbian, and bisexual), which could lead to measurement error via misreporting and item nonresponse.ObjectiveThis study compared the traditional 3-option approach to measuring sexual identity with an expanded approach that offered respondents 5 additional options.MethodsAn online survey experiment conducted among New Jersey residents between March and June 2021 randomly assigned 1254 young adults (ages 18-21) to answer either the 3-response measure of sexual identity or the expanded item. Response distributions for each measure were compared as were the odds of item nonresponse.ResultsThe expanded version of the question appeared to result in more accurate reporting among some subgroups and induced less item nonresponse; 12% (77/642) of respondents in the expanded version selected a response that was not available in the shorter version. Females answering the expanded item were less likely to identify as gay or lesbian (2.1% [10/467] vs. 6.6% [30/457]). Females and Non-Hispanic Whites were slightly more likely to skip the shorter version than the longer version (1.1% [5/457 for females and 3/264 for Non-Hispanic Whites] vs. 0% [0/467 for females and 0/277 for Non-Hispanic Whites]). About 5% (32/642) of respondents answering the longer item were unsure of their sexual identity (a similar option was not available in the shorter version). Compared with respondents answering the longer version of the question, those answering the shorter version had substantially greater odds of skipping the question altogether (odds ratio 9.57, 95% CI 1.21-75.74; P=.03).ConclusionsResults favor the use of a longer, more detailed approach to measuring sexual identity in epidemiological research. Such a measure will likely allow researchers to produce more accurate estimates of health behaviors and outcomes among sexual minorities.     

Promising to wait: Virginity pledges and adolescent sexual behavior

PurposeThe current study examined the association between formal and non-formal virginity pledges and the initiation of genital play, oral sex, and vaginal intercourse among adolescents.MethodsLogistic regressions controlling for age, gender, race, expectancies, academic achievement, contraceptive education, perceived peer pledging behavior, and parental and peer attitudes were conducted to examine the relationship between pledging behavior and genital play, oral sex, and vaginal intercourse. A total of 870 adolescents aged 12–16 from 10 counties in northern and southern California participated in the current study.ResultsThe findings indicate that making a private pledge or promise to oneself to wait to have sexual intercourse until one is older reduces the likelihood that adolescents will engage in sexual intercourse and oral sex. The effect persists even when controlling for socio-demographic variables. Making a formal pledge did not appear to have an effect on sexual behavior.ConclusionsThe findings raise questions about the effectiveness of formal virginity pledges in preventing adolescent sexual behavior. The findings suggest that sexual health programs may be more effective if they encourage young people to make a personal commitment to delay the onset of sex, foster social norms supportive of delaying sex, and raise awareness of how early sexual initiation may threaten future plans.     

Determinants of Item Nonresponse in a Large National Sex Survey

The study aim was to describe patterns of item nonresponse in a sex survey and identify factors associated with high nonresponse. A random sample of 4548 respondents to the National Survey of Sexual Attitudes and Lifestyles in Britain, 1990-1991 was assessed. Both respondent-wise and variable-wise patterns of incomplete response are described in terms of distinctive characteristics of nonrespondents and questions with a high nonresponse rate. Logistic regression was used to model the determinants of extreme nonresponse. For at least 90% of respondents, the item nonresponse was ignorable for most practical purposes and recall difficulties were indicated as its main cause, while the sensitivity of the questions had a large effect mainly among those in the top 5% of the overall nonresponse distribution. The latter were also distinguishable in terms of refusals to answer some face-to-face questions. Several overlapping indicators of poor educational and social background were associated with elevated overall nonresponse, particularly among the top 5% of the distribution. Thus recall accuracy rather than sensitivity of some sex survey questions was the key difficulty for a majority of the respondents whose overall nonresponse was satisfactorily low. The sensitivity of the topic had a large effect on item nonresponse only for a small group of participants.     

Lifestyle surveys--the complete answer?

STUDY OBJECTIVES: These were as follows: to study incompleteness of data, herein called item non-response, generated by a self completion questionnaire; to identify the characteristics of item non-responders and the types of questions liable to high item non-response rates; and to discuss possible reasons for item non-response. DESIGN: Item non-response patterns in 12,307 responders (62%) to a representative postal survey based on a stratified sample drawn from family health services authorities' (FHSA) registers were investigated. MAIN OUTCOME MEASURES: Data were analysed for item non-response in three groups depending on when the questionnaire was returned (wave analysis). The overall completion rate of the questionnaire was examined and the natural logarithm of the proportion of completed questions was used as an outcome variable in multiple regression analysis. Item nonresponse to key questions and questions of different types was examined. RESULTS: Wave analysis: the overall completion rate of the questionnaire was 86% in questionnaires returned before the first reminder and 83%-84% in those sent back after subsequent reminders. Overall pattern of item non-response; respondents failed to complete a mean of 15% and a median of 10% of the questionnaire. All questions in the questionnaire had some item non-response, ranging from 1% to 85%. Completion rates were associated with gender, age, indicators of lower socioeconomic status, and general health status. Individual questions: particular types of questions were liable to have higher item non-response, for example, linked binary questions. CONCLUSIONS: Item non-response in population postal surveys is likely to present problems in the interpretation of data by introducing bias additional to that of total non-response. Item non-response does not increase greatly with later returns, suggesting that the quality of data across responses generated by two reminders is similar. There are obstacles to reducing item non-response, such as respondent error or socioeconomic and health characteristics of the general population, that cannot be totally overcome. However, the evidence that individuals tend to complete only options within questions that apply to them and their positive behaviour is useful information for those designing questionnaires and interpreting survey data.     

Environmental Influences on Safer Sex in Young Gay Men: A Situational Presentation Approach to Measuring Influences on Sexual Health

Environmental influences on sexual behavior are difficult to examine given their temporal distance from the sexual act and the cost of long-term longitudinal studies. We examined environmental influences on risky sexual behavior in young gay men using the Situational Presentation (Sitpres) methodology, where situations in which relevant environmental variables are presented as computer vignettes with the variables randomly allocated, and participants rate the likelihood of their engaging in unsafe sexual behavior. A total of 100 gay men aged between 18 and 26 years of age completed 20 situational presentations with the outcome being the likelihood of engaging in unprotected anal intercourse. On regression analysis, 3 environmental variables significantly predicted safer sex: perceived gay/bisexual men's norms toward condom use; availability of HIV prevention messages; and what one's religion says about gay sex. Not significant were family, media, legal, and work/school attitudes to homosexuality. Demographic variables that were predictors included education, age, sexual orientation, and degree of being "out" about sexual orientation. These data suggest that environmental factors can be approximated using the Sitpres methodology, and that more proximal environmental variables have a stronger impact than distal ones.     

Survey nonresponse among ethnic minorities in a national health survey – a mixed-method study of participation,barriers, and potentials

Objectives. The participation rate in the Danish National Health Survey (DNHS) 2010 was significantly lower among ethnic minorities than ethnic Danes. The purpose was to characterize nonresponse among ethnic minorities in DNHS, analyze variations in item nonresponse, and investigate barriers and incentives to participation.

Design. This was a mixed-method study. Logistic regression was used to analyze nonresponse using data from DNHS (N = 177,639 and chi-square tests in item nonresponse analyses. We explored barriers and incentives regarding participation through focus groups and cognitive interviews. Informants included immigrants and their descendants of both sexes, with and without higher education.

Results. The highest nonresponse rate was for non-Western descendants (80.0%) and immigrants 25 (72.3%) with basic education. Immigrants and descendants had higher odds ratios (OR = 3.07 and OR = 3.35, respectively) for nonresponse than ethnic Danes when adjusted for sex, age, marital status, and education. Non-Western immigrants had higher item nonresponse in several question categories. Barriers to non-participation related to the content, language, format, and layout of both the questionnaire and the cover letter. The sender and setting in which to receive the questionnaire also influenced answering incentives. We observed differences in barriers and incentives between immigrants and descendants.

Conclusions. Nonresponse appears related to linguistic and/or educational limitations, to alienation generated by the questions' focus on disease and cultural assumptions, or mistrust regarding anonymity. Ethnic minorities seem particularly affected by such barriers. To increase survey participation, questions could be sensitized to reflect multicultural traditions, and the impact of sender and setting considered.     

Nonresponse error in injury-risk surveys

BACKGROUND: Nonresponse is a potentially serious source of error in epidemiologic surveys concerned with injury control and risk. This study presents the findings of a records-matching approach to investigating the degree to which survey nonresponse may bias indicators of violence-related and unintentional injuries in a random-digit-dialed (RDD) telephone survey. METHODS: Data from a statewide RDD survey of 4155 individuals aged 16 years and older conducted in Illinois in 2003 were merged with ZIP code-level data from the 2000 Census. Using hierarchical linear models, ZIP code-level indicators were used to predict survey response propensity at the individual level. Additional models used the same ZIP code measures to predict a set of injury-risk indicators. RESULTS: Several ZIP code measures were found to be predictive of both response propensity and the likelihood of reporting partner violence. For example, people residing in high-income areas were less likely to participate in the survey and less likely to report forced sex by partner, processes that suggest an over-estimation of this form of violence. In contrast, estimates of partner isolation may be under-estimated, as those residing in geographic areas with smaller-sized housing were less likely to participate in the survey but more likely to report partner isolation. No ZIP code-level correlates of survey response propensity, however, were found also to be associated with driving-under-the-influence (DUI) indicators. CONCLUSIONS: There is evidence of a linkage between survey response propensity and one variety of injury prevention measure (partner violence) but not another (DUI). The approach described in this paper provides an effective and inexpensive tool for evaluating nonresponse error in surveys of injury prevention and other health-related conditions.     

Biases in internet sexual health samples: comparison of an internet sexuality survey and a national sexual health survey in Sweden

The internet is becoming a favored technology for carrying out survey research, and particularly sexual health research. However, its utility is limited by unresolved sampling questions such as how biased internet samples may be. This paper addresses this issue through comparison of a 'gold standard' random selection population-based sexual survey (The Swedish Sexual Life Survey) with an internet-based survey in Sweden which used identical demographic, sexual and relationship questions, to ascertain the biases and degree of comparability between the recruitment methods. On the internet questionnaire, there were significant differences between males and females on all the measured indices. There were no significant differences in proportions of males and females, or nationality, between the two samples. However, the internet samples for both males and females were significantly more likely to be younger, originally from and currently living in a major city, better educated, and more likely to be students and less likely to be retired. Relationship variables were less likely to be significantly different between samples: there were no differences for males or females between the SSS and the internet samples on having been in a committed relationship, and how they met their present partner, nor for males in having discussed separation in the past year. However, there was a higher proportion of people attracted to the same sex, and higher numbers of sex partners (as well as a higher proportion of people reporting no sex) in the past year, in the internet sample. These data suggest that apart from the demographics of age, location, and education, currently being in a committed relationship, and the number of sex partners in the past year, internet samples are comparable for relationship characteristics and history with a national sexual life survey. Comparison of internet data with random survey data in other western countries should occur to determine if these patterns are replicated.     

Socioeconomic and Ethnic Inequalities in the Progress of Multimorbidity and the Role of Health Behaviors

ObjectivesTo assess socioeconomic and ethnic inequalities in the progress of multimorbidity and whether behavioral factors explain these inequalities among older Americans.DesignHealth and Retirement Study, a longitudinal survey of older American adults.Setting and ParticipantsData pooled from 2006 to 2018 (waves 8–14), which include 38,061 participants.MethodsWe used 7 waves of the survey from 2006 to 2018. Socioeconomic factors were indicated by education, total wealth, poverty-income ratio (income), and race/ethnicity. Multimorbidity was indicated by self-reported diagnoses of 5 chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioral factors were smoking, excessive alcohol consumption, physical activity, and body mass index (BMI). Multilevel mixed effects generalized linear models were constructed to assess socioeconomic and ethnic inequalities in the progress of multimorbidity and the role of behavior. All variables included in the analysis were time-varying except gender, race/ethnicity, and education.ResultsAfrican American individuals had higher rates of multimorbidity than White individuals; however, after adjusting for income and education, the association was reversed. There were clear income, wealth, and education gradients in the progress of multimorbidity. After adjusting for behavioral factors, the relationships were attenuated. The rate ratio (RR) of multimorbidity attenuated by 9% among participants with the lowest level of education after accounting for behavior (RR 1.21; 95% CI 1.18–1.23 and 1.11; 95% CI 1.17–1.14) in the models unadjusted and adjusted for behaviors, respectively. Similarly, RR for multimorbidity among those in the lowest wealth quartile attenuated from 1.47 (95% CI 1.44–1.51) and 1.31 (95% CI 1.26–1.36) after accounting for behaviors.Conclusion and implicationsEthnic inequalities in the progress of multimorbidity were explained by wealth, income, and education. Behavioral factors partially attenuated socioeconomic inequalities in multimorbidity. The findings are useful in identifying the behaviors that should be included in health promotion programs aiming at tackling inequalities in multimorbidity.     

Prevalence of Same-Sex Behavior and Orientation in England: Results from a National Survey

There are few data sources on the prevalence of same-sex sexual orientation in England. We aimed to measure the prevalence of same-sex orientation and behavior in the English general population and assess the impact of enquiry format on reporting. The Adult Psychiatric Morbidity Survey 2007 used a multi-stage, stratified probability-sampling design (n = 7,403). Two questions addressed sexual orientation and sexual partnership and each had two versions. Version A of the sexual orientation question used “homosexual.” Version B used “gay or lesbian.” Version A of the sexual partnership question required participants who had male and female partners to say which was predominant, while Version B had a midpoint response option: “about equally with men and women.” Participants were randomized between versions. Overall, 5.3% of men and 5.6% of women reported they were not entirely heterosexual. The question using “gay or lesbian” elicited higher (though not statistically significant) reporting of non-heterosexual orientation than the question using “homosexual.” A significantly larger proportion of men and women (96.0 and 96.1%) reported entirely heterosexual partnerships in response to Version A of the partnership question than in response to Version B (94.0 and 92.9%) where Version B asked specifically about “kissing, touching, intercourse, or any other form of sex.” These figures constitute the first national prevalence data on combined sexual orientation and sexual behavior in England, based on a random probability sample of the general population. They demonstrate that people are willing to report their sexual orientation in survey research, but reporting is sensitive to question wording.     

Sexual orientation as a continuous variable: A comparison between the sexes

Sexual orientation was measured as a continuous variable based upon reported percentage of sexual fantasies and percentage of sexual experiences involving members of the same sex. In the present sample (which probably somewhat overrepresented the homosexual end of the continuum) about one-third of both males and females reported at least occasionally fantasizing about sexually interacting with members of the same sex. The survey indicated about one-third of males also reported having had at least one intimate sexual experience with the same sex, whereas only 10% of females did so. Also, virtually all females who sexually fantasized about the same sex only did so occasionally, whereas most of the males who fantasized about the same sex did so much more exclusively. Although these results cannot be considered representative of the distribution of sexual orientation in any natural population, they suggest that there are advantages in measuring sexual orientation as a continuous variable instead of as one with only a few discrete categories. The results also support other studies that have concluded that when deviations from exclusive heterosexuality are present, they are likely to be much more extreme among males than among females.     

Socioeconomic disadvantage and adolescent women's sexual and reproductive behavior: the case of five developed countries.

CONTEXT: Differences among developed countries in teenagers' patterns of sexual and reproductive behavior may partly reflect differences in the extent of disadvantage. However, to date, this potential contribution has received little attention. METHODS: Researchers in Canada, France, Great Britain, Sweden and the United States used the most current survey and other data to study adolescent sexual and reproductive behavior. Comparisons were made within and across countries to assess the relationships between these behaviors and factors that may indicate disadvantage. RESULTS: Adolescent childbearing is more likely among women with low levels of income and education than among their better-off peers. Levels of childbearing are also strongly related to race, ethnicity and immigrant status, but these differences vary across countries. Early sexual activity has little association with income, but young women who have little education are more likely to initiate intercourse during adolescence than those who are better educated. Contraceptive use at first intercourse differs substantially according to socioeconomic status in some countries but not in others. Within countries, current contraceptive use does not differ greatly according to economic status, but at each economic level, use is higher in Great Britain than in the United States. Regardless of their socioeconomic status, U.S. women are the most likely to give birth as adolescents. In addition, larger proportions of adolescents are disadvantaged in the United States than in other developed countries. CONCLUSIONS: Comparatively widespread disadvantage in the United States helps explain why U.S. teenagers have higher birthrates andpregnancy rates than those in other developed countries. Improving U.S. teenagers' sexual and reproductive behavior requires strategies to reduce the numbers of young people growing up in disadvantaged conditions and to help those who are disadvantaged overcome the obstacles they face.     

The effects of race/ethnicity, income, and family structure on adolescent risk behaviors

OBJECTIVES: The study examined the unique and combined contributions of race/ethnicity, income, and family structure to adolescent cigarette smoking, alcohol use, involvement with violence, suicidal thoughts or attempts, and sexual intercourse. METHODS: Analyses were based on the National Longitudinal Study of Adolescent Health. A nationally representative sample of 7th to 12th graders participated in in-home interviews, as did a resident parent for 85.6% of the adolescent subjects. The final sample included 10,803 White, Black, and Hispanic 7th to 12th graders. RESULTS: White adolescents were more likely to smoke cigarettes, drink alcohol, and attempt suicide in the younger years than were Black and Hispanic youths. Black youths were more likely to have had sexual intercourse; both Black and Hispanic youths were more likely than White teens to engage in violence. Controlling for gender, race/ethnicity, income, and family structure together explained no more than 10% of the variance in each of the 5 risk behaviors among younger adolescents and no more than 7% among older youths. CONCLUSIONS: Findings suggest that when taken together, race/ethnicity, income, and family structure provide only limited understanding of adolescent risk behaviors.