Brief Report
Early Sexual Debut and Associated Risk Behaviors Among Sexual Minority Youth

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Introduction

Early sexual debut, sexual risk taking, substance use, violent victimization, and suicidal behaviors are more prevalent among sexual minority than sexual nonminority youth. Although associations between early sexual debut and these risk behaviors exist, little is known about such associations among sexual minority youth. This study examined these associations among sexual minority U.S. high school students and their sexual nonminority peers.

Methods

In 2015, the national Youth Risk Behavior Survey included questions assessing sexual orientation for the first time. In 2016, data from this nationally representative sample of 15,624 U.S. high school students were analyzed to determine if associations between early sexual debut and other health risk behaviors varied by sexual orientation, by calculating adjusted (for sex, race/ethnicity, and age) prevalence ratios (APRs).

Results

Associations between early sexual debut and other health risk behaviors did not vary significantly by sexual orientation. Early sexual debut (first sexual intercourse before age 13 years) was associated with sexual risk taking, substance use, violent victimization, and suicidal thoughts/attempts among students identifying as lesbian, gay, or bisexual (LGB) and among students identifying as heterosexual, for example, being currently sexually active (LGB students: APR=1.82, 95% CI=1.35, 2.45; heterosexual students: APR=2.50, 95% CI=2.22, 2.81) and not using a condom at last sexual intercourse (LGB students: APR=1.50, 95% CI=1.18, 1.91; heterosexual students: APR=1.29, 95% CI=1.09, 1.52).

Conclusions

School-based sexual health programs might appropriately utilize strategies that are inclusive of sexual minority students, encourage delay of sexual intercourse, and coordinate with violence and substance use prevention programs.

Introduction

Lesbian, gay, and bisexual (LGB) youth tend to experience earlier sexual debut than heterosexual youth.1, 2, 3 They also exhibit greater prevalence of sexual risk taking, substance use, violent victimization, and suicidal behaviors than heterosexual youth.1, 2, 3, 4, 5 Although previous research has described associations between early sexual debut and other health risk behaviors in a variety of adolescent populations,6, 7 very little is known about these associations among sexual minority youth. One study of HIV-positive young men who have sex with men found that early sexual debut was associated with a greater likelihood of marijuana use, suicide attempts, and exchanging sex for money, food, housing, drugs, and transportation.8 No study, however, has compared these associations between sexual minority youth and their sexual nonminority counterparts.

This study extends the current literature by examining the effect of sexual orientation on associations between early sexual debut and sexual risk taking, substance use, violent victimization, and suicidal thoughts and attempts among a nationally representative sample of U.S. high school students.

Section snippets

Methods

In 2015, the national Youth Risk Behavior Survey (YRBS) collected cross-sectional data on sexual orientation and a wide range of priority health risk behaviors from a nationally representative sample of public and private school students in Grades 9–12 (N=15,624), using a methodology described previously.1 The questionnaire was self-administered in the classroom during a regular class period using trained data collectors. Student participation in the survey was anonymous and voluntary, and

Results

The 2015 national YRBS had an overall response rate of 60% and sample size of 15,624. Sexual minority students were categorized by sexual identity (LGB: 8.0%, 95% CI=7.0, 9.2, n=1,246; heterosexual: 88.8%, 95% CI=87.3, 90.1, n=12,954) and sex of sexual contacts (same sex only or both sexes: 6.3%, 95% CI=5.3, 7.3, n=1,001; opposite sex only: 48.0%, 95% CI=45.6, 50.5, n=6,901).

Early sexual debut (first sexual intercourse before age 13 years) was associated with increased prevalence of sexual risk

Discussion

This study is the first to examine the effect of sexual orientation on associations between early sexual debut and other health risk behaviors among a nationally representative sample of U.S. high school students. The finding that associations between early sexual debut and other health risk behaviors were the same among sexual minority and sexual nonminority students was true whether sexual orientation was measured by sexual identity or sex of sexual contacts. Although the factors underlying

Conclusions

Among both sexual minority and sexual nonminority students, early sexual debut was associated with sexual risk taking, substance use, violent victimization, and suicidal thoughts and attempts. Because these associations did not vary significantly by sexual orientation, school-based sexual health education programs might appropriately address the needs of both sexual minority and sexual nonminority students by utilizing strategies that are inclusive of sexual minority students, encourage delay

Acknowledgments

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This is a work product of the U.S. government.

No financial disclosures were reported by the authors of this paper.

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