158 - Increased Prevalence of Same-Sex Sexual Contact among High School Students in the United States

Publication Number: 158.5478

Eli Rapoport, NYU Grossman School of Medicine, New York, NY, United States; Andrew Adesman, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Roslyn, NY, United States

Background: Although the prevalence of US high school students identifying as non-heterosexual increased between 2015 and 2019, no concurrent change in rates of same-sex sexual contact has been identified.

Objective: To examine trends in prevalence of same-sex sexual contact using a larger, more contemporaneous nationally representative cohort of high school students spanning a broader time period.

Design/Methods: Secondary analysis of the 2015-2021 national YRBS was performed. Non-heterosexual sexual identity was defined as those identifying as gay, lesbian, bisexual, questioning, or “some other [non-heterosexual] way.” Notably, the 2021 YRBS had more inclusive response options, precluding direct comparison between survey years. Same-sex sexual contact was identified using a combination of respondent sex and sex(es) of sexual contacts. Multivariate logistic regressions were used to assess whether prevalence of same-sex sexual contact had changed between survey years, with odds ratios corresponding to changes in odds associated with a one-year interval. Regressions were adjusted for sex, grade, and race/ethnicity. Sex-stratified analyses were also conducted, controlling for grade and race/ethnicity. Analyses accounted for the complex survey design of the YRBS.

Results: Between 2015 and 2021, 61,298 students (50.8% male) responded to the YBRS. In the 2021 cohort, 20.3% of respondents identified as non-heterosexual, representing a qualitative increase in non-heterosexual identity (Table 1). 50,137 students responded to the question assessing lifetime sexual contact (262 were not evaluable secondary to missing data regarding respondent sex). In the full cohort, the prevalence of same-sex sexual contact increased by 33.8% from 6.2% to 8.3% (aOR = 1.06, 95% CI: 1.02-1.09) (Table 2). Among girls, the prevalence of same-sex sexual contact increased by 38.9% from 9.5% to 13.2% (aOR = 1.07, 95% CI: 1.03-1.11). Among boys, no statistically significant change was noted.

Conclusion(s): This study demonstrates a substantial increase in same-sex sexual contact among girls in a nationally representative cohort of US high school students. It is unclear to what extent this increase reflects greater comfort with self-disclosure due to a decrease in social stigma or if this increase can be attributed to the increasing rates of non-heterosexual identity with a corresponding greater prevalence of same-sex sexual contact. This apparent shift in sexual practices calls for changes in clinical approaches to sex education, safe-sex counseling, and screening for sexually transmitted diseases.

Table 1. Sexual identity among US high school students 2015-2021.


Table 2. National trends in same-sex sexual contact among US high school students.