Sexual Orientation and Risk of Pregnancy Among New York City High-School Students

Objectives. We examined associations between sexual orientation and pregnancy risk among sexually experienced New York City high-school students.Methods. We analyzed data from 2005, 2007, and 2009 New York City Youth Risk Behavior Surveys. We excluded students who had never engaged in sexual intercourse, only had same-gender sexual partners, or had missing data on variables of interest, resulting in a final sample of 4892 female and 4811 male students. We employed multivariable logistic regression to examine pregnancy risk by sexual orientation, measured as self-reported sexual identity and gender of sexual partners, with adjustment for demographics and sexual behaviors. We stratified analyses by gender.Results. Overall, 14.3% of female and 10.8% of male students had experienced a pregnancy. Students who identified as gay, lesbian, or bisexual or reported both male and female sexual partners had higher odds of pregnancy than heterosexual students or students who only had opposite-gender sexual partners. Sexual behaviors accounted for higher odds of pregnancy among female, but only partially accounted for higher odds of pregnancy involvement among male, sexual-minority students.Conclusions. Sexual orientation should be considered in future adolescent pregnancy-prevention efforts, including the design of pregnancy-prevention interventions.Over the past 2 decades, significant research and programmatic attention has been directed toward understanding and preventing adolescent pregnancy in the United States. As a result, the US adolescent pregnancy, birth, and abortion rates have reached historic lows, with significant downward trends reported among adolescents of all racial/ethnic and age groups.1 In New York City, the adolescent pregnancy rate fell by 30% in just 1 decade (2001–2011).2 Despite these significant improvements, rates of unplanned adolescent pregnancy in the United States have remained largely unchanged3 and US adolescent pregnancy and birth rates remain the highest among all developed countries.4 Moreover, although much adolescent pregnancy prevention research has been conducted over the past 2 decades, notably few studies have explored the risk of pregnancy among sexual-minority (nonheterosexual) adolescents.Among the studies that have explored the association between sexual orientation and adolescent pregnancy risk, adolescents who identified as lesbian, gay, and bisexual (LGB) have had either the same or a significantly (2–7 times) increased likelihood of experiencing a pregnancy compared with their heterosexual peers, despite being as likely to have engaged in vaginal intercourse.5–10 Furthermore, LGB youths are more likely than heterosexual youths to have had their first heterosexual intercourse before age 14 years, to have had more sexual partners, and to have experienced sexual abuse5–10—all factors associated with an increased risk of adolescent pregnancy.11 Bisexual-identified youths in particular report engaging in riskier sexual behaviors at younger ages than their peers.8–10 Moreover, having sexual partners of the same gender or both genders during the past year was a common occurrence among adolescent parents, especially fathers.8Despite the valuable contributions of the aforementioned research, there are some limitations to their applicability today. First, most of these studies analyzed data from the 1980s and early 1990s, before or during the early stages of adolescent pregnancy reductions.5–8 Second, most of these studies examined adolescent pregnancy risk among girls only6,9,10 (1 study combined male and female LGB students in its sample)7 and among predominately White populations,6,7,9 and others explored pregnancy risk beyond adolescence into young adulthood (ages 15–20 years).10 One study of British Columbia students in grades 7 through 12 found that adolescent pregnancy rates declined among all sexual orientation groups between 1992 and 2003, but the trends in pregnancy and related risk behaviors were less consistent for sexual-minority adolescents than for their heterosexual counterparts.8 Thus, to understand the current state of adolescent pregnancy among sexual-minority students, we need more recent data on the risk of adolescent pregnancy across sexual orientation for male and female students, particularly among racially diverse student populations.Furthermore, most of the previous research that explored pregnancy risk among sexual-minority students used either self-reported sexual identity10 (i.e., students identified themselves as heterosexual, gay or lesbian, bisexual, or unsure) or sexual attraction5,6,8 (i.e., students reported their feelings of attraction as 100% heterosexual to 100% homosexual, or “not sure”) as the sole measure of sexual orientation; 2 studies combined LGB self-identity and same-sex behavior into a single measure of sexual orientation.7,9 Few studies have employed more than 1 measure of sexual orientation to assess pregnancy risk. This is potentially problematic, as single-indicator measures do not sufficiently capture the complexities of sexual orientation.12 Increasingly, young people use different labels (such as queer, pansexual, or asexual) or use no label at all when referring to their sexual identity.13–15 Moreover, fear of discovery, stigma, or cultural values surrounding sexual orientation may lead some young people to report a sexual identity that is not in accordance with their sexual behavior or underlying sexual attraction.16–18 Thus, to obtain a more comprehensive understanding of pregnancy risk among sexual minority students, it is important to simultaneously examine multiple dimensions of sexual orientation (i.e., sexual identity, attraction, and behavior).12,17,18Our study addresses these limitations by using New York City’s 2005, 2007, and 2009 Youth Risk Behavior Surveillance System (YRBSS) data. We examined the risk of adolescent pregnancy by sexual orientation by using 2 indicators of sexual orientation—students’ self-reported sexual identity and gender of students’ sexual partners. We hypothesized that (1) sexual-minority students would be more likely to experience an adolescent pregnancy than heterosexual students, (2) this relationship would be found for both female and male students, and (3) sexual risk behaviors would explain the higher risk of adolescent pregnancy among sexual-minority students.