A Cross-sectional Study Examining the (In)congruency of Sexual Identity, Sexual Behavior, and Romantic Attraction among Adolescents in the US

Prevalence of Technology-Facilitated Abuse Among Sexual and Gender Minority Youths

Importance

Digital communication and imaging technologies have created new opportunities for technology-facilitated abuse (TFA) and necessitate a better understanding of how and why the risk for TFA varies across different groups of youths.

Objectives

To compare the prevalence of TFA among youths across 5 different sexual and gender identity groups, and to identify risk factors that may explain variations in TFA risk.

Design, Setting, and Participants

A US nationally representative online survey was conducted among 2639 young adults recruited from the KnowledgePanel online panel from November 19 to December 29, 2021. Individuals aged 18 to 28 years were asked retrospectively about TFA and a variety of other youth experiences in childhood (aged <18 years).

Main Outcomes and Measures

Participants were asked about their sexual and gender identities, 11 types of TFA occurring before the age of 18 years, and several potential risk factors. Prevalence rates of any TFA were compared across sexual and gender identity groups, and analyses were conducted to identify risk factors that help explain group differences. Weights were developed to compensate for gender, education, race and ethnicity, household income, census region, and metropolitan status disproportions.

Results

Among the 2510 respondents (mean [SD] age, 24.8 [2.8] years) who provided gender and sexual identity information, 46.5% (95% CI, 41.9%-51.1%) were cisgender heterosexual females, 25.2% (95% CI, 21.6%-29.1%) were cisgender sexual minority females, 18.3% (95% CI, 14.4%-22.9%) were cisgender heterosexual males, 6.8% (95% CI, 4.6%-9.9%) were cisgender sexual minority males, and 3.3% (95% CI, 2.0%-5.4%) were gender minority individuals. The prevalence of TFA occurring before the age of 18 years was highest among sexual minority females (55.3%; 95% CI, 48.0%-62.4%) and gender minority individuals (53.4%; 95% CI, 33.5%-72.2%). Rates of sexting were highest among cisgender sexual minority females (38.8%; 95% CI, 19.1%-58.8%) and gender minority individuals (36.7%; 95% CI, 19.1%-58.8%) and represented the strongest risk factor for TFA exposure (odds ratio, 5.7; 95% CI, 4.0-8.0). However, it explained little variation in TFA across groups once early in-person adversity, sexual abuse, bullying, and maltreatment were taken into account.

Conclusions and Relevance

This study demonstrates the risk of TFA among sexual and gender minority youths and the need to target prevention efforts toward these vulnerable groups. In addition to strategies to reduce risky behavior, efforts to lower the risk of early sexual abuse, bullying, and maltreatment are likely to also be effective in decreasing TFA among these marginalized groups.

The Role of Sexual and Romantic Attraction in Human Mate Preferences

Sex differences in mate preferences are ubiquitous, having been evidenced across generations and cultures. Their prevalence and persistence have compellingly placed them in the evolutionarily adaptive context of sexual selection. However, the psycho-biological mechanisms contributing to their generation and maintenance remain poorly understood. As such a mechanism, sexual attraction is assumed to guide interest, desire, and the affinity toward specific partner features. However, whether sexual attraction can indeed explain sex differences in partner preferences has not been explicitly tested. To better understand how sex and sexual attraction shape mate preferences in humans we assessed how partner preferences differed across the spectrum of sexual attraction in a sample of 479 individuals that identified as asexual, gray-sexual, demisexual or allosexual. We further tested whether romantic attraction predicted preference profiles better than sexual attraction. Our results show that sexual attraction accounts for highly replicable sex differences in mate preferences for high social status and financial prospects, conscientiousness, and intelligence; however, it does not account for the enhanced preference for physical attractiveness expressed by men, which persists even in individuals with low sexual attraction. Instead, sex differences in physical attractiveness preference are better explained by the degree of romantic attraction. Furthermore, effects of sexual attraction on sex differences in partner preferences were grounded in current rather than previous experiences of sexual attraction. Taken together, the results support the idea that contemporary sex differences in partner preferences are maintained by several psycho-biological mechanisms that evolved in conjunction, including not only sexual but also romantic attraction.

Motives for desiring children among individuals of different sexual-romantic orientations: a cross-sectional study

PURPOSE

Little is known about the reasoning behind the desire to have children in non-heterosexual individuals. This study compares the motives of different sexual-romantic orientations and their preferred ways of fulfilling this desire.

METHODS

This was a monocentric cross-sectional study. Subjects were recruited via social media, personal contacts and queer organisations in Switzerland. An anonymous questionnaire comprised general questions about the participant's background, a validated survey about the desire to have children and additional non-validated questions addressing the impact of sexual-romantic orientation on the desire to have children. The inclusion criteria were adults without children and a completed questionnaire.

RESULTS

Of 837 participants, 642 were included in the study. Four groups of sexual-romantic orientations consisted of more than 35 participants: bisexual-biromantic (n = 38), heterosexual-heteroromantic (n = 230), homosexual-homoromantic (n = 159) and pansexual-panromantic (n = 55). Subgroups with a positive wish for a child rated all motives in the same order and with minimal numeric difference. The most important aspect seemed to be emotional involvement. Non-heterosexual-heteroromantic showed concerns about adverse reactions regarding their wish for a child. All orientations hoped for a biological child.

CONCLUSION

Our findings about bi-, hetero-, homo- and pansexual people and their motives for a desire to have children agree with the existing literature about hetero, homo and bisexual. The impact of the fear of adverse reaction and discrimination has been discussed before and is supported by our data. We suggest better support before and during the realization of the wish for a child as well as support for non-traditional aspiring parents.

Asexual or not sure: Findings from a probability sample of undergraduate students

OBJECTIVE

Present study aims to: 1) examine demographic correlates of LGB, asexual, or not sure participants 2) describe the prevalence of diverse sexual behaviors, 3) assess the prevalence of event-level sexual behaviors and 4) examine predictors of sexual pleasure.

PARTICIPANTS

761 non-heterosexual undergraduates at a large, public U.S. university.

METHODS

Randomly sampled undergraduate students completed a confidential, cross-sectional online survey.

RESULTS

Of 761 non-heterosexual respondents; 567 identified as LGB, 47 asexual, and 147 not sure. Asexual students, those not sure were less likely to report having engaged in solo and partnered sexual activities and report sexual activities being less pleasurable at most recent sexual event, compared with LGB students. This difference (relative to LGB) became nonsignificant when accounting for reported sexual activities.

CONCLUSIONS

Our findings inform how college students define and experience their sexual identities and assist college health professionals in training on sexuality and prevention of risk factors.

Subgroup Analyses of Girl2Girl, a Text Messaging-Based Teen Pregnancy Prevention Program for Sexual Minority Girls: Results from a National RCT

This study aims to investigate whether Girl2Girl, a text messaging-based pregnancy prevention program for cisgender LGB+ girls, had different effects on subgroups based on age, sexual identity, and experience with penile-vaginal sex. A total of 948 girls, 14-18 years old, were recruited nationally via social media and enrolled over the telephone. Once they completed the baseline, they were randomized to either Girl2Girl or an attention-matched control program that discussed "healthy lifestyle" topics (e.g., self-esteem). Both programs were 5 months long: Girls received daily messages for 8 weeks, and then went through a "latent" period of 3 months, and finished with a 1-week review. Outcome measures included condom-protected sex, uptake of other types of birth control, abstinence, and pregnancy. Measures were collected at baseline; 3-month, 6-month, 9-month, and 12-month post-intervention end, which was 17 months after enrollment. Effect modification was examined using longitudinal mixed effects models. Overall, results suggested significant moderating effects of age, (f2 = .12), sexual identity (f2 < .14), and sexual experience (f2 = .11) on rates of condom use and use of other contraception. Although there were no significant moderating effects on pregnancy, abstinence, or intentions to use condoms, use birth control, or be abstinent, (p's > .16), patterns of effects were in the same direction as for significant findings. For example, at 9-month post-intervention, among those who identified as bisexual, the incidence rate of protected sex events was 39% higher for intervention vs. control (IRR = 1.39, 95% CI: 1.06-2.70), adjusting for baseline rate of condom use and sexual experience. Similarly, at 12 months, among bisexual participants, intervention participants had a significantly higher IRR of condom-protected sexual events (IRR = 2.65, 95% CI: 1.31-5.34). There were also higher odds of uptake of birth control use other than condoms for intervention vs. control at 6- (OR = 1.10, 95% CI: 1.01-1.77), 9 m (OR = 1.11, 95% CI: 1.07-1.89), and 12-month (OR = 1.13, 95% CI: 1.07-1.78) follow-up. Girl2Girl appears to be particularly effective for older adolescents, bisexual girls, and those who have already had penile-vaginal sex. No one single approach is going to affect teen pregnancy. Instead, it is more likely that different intervention content and delivery methods will be more accessible and salient to some but not other youth. Understanding for whom the intervention works is just as important as understanding for whom the intervention does not, as this can inform opportunities for future intervention development.Clinical Trial Registration: ClinicalTrials.gov ID# NCT03029962.

Latinx Sexual Minority Adolescent Substance Use: State of the Science and Call for Intersectional Minority Stressors and Protective Factors

Purpose of review

Latinx sexual minority adolescents (LSMA) are at an intersection of ethnic and sexual minority (SM) status and may experience heighten risk of substance use and related problems. These youth may also hold unique protective factors that help mitigate the effects of minority stress and curb substance use. Little is known, however, about the intersectional minority stressors (i.e., due to ethnicity and SM status) and protective factors related to substance use among this population.

Recent Findings

According to the minority stress model, there are unique minority stressors and resiliency factors that can help explain differences in behavioral health rates between white SM and SM of color. Research supports the notion that minority stressors (e.g., stigma/risk, homophobic bullying, and family rejection of SM status) confer risk for substance use among LSMA. In terms of resilience, less is known, but there may be some protective factors that have not been measured that could explain lower rates in some substances (i.e., club drugs and methamphetamine).

Summary

Little is known about how the intersections of ethnicity and SM status are associated with substance use in adolescence. Future research should assess the temporal relationship of multilevel (i.e., intrapersonal, relational, and system), intersectional (i.e., ethnicity and SM status) minority stressors and protective factors unique to LSMA on substance use. We propose that the findings from these future studies will help to create socioculturally appropriate behavioral health treatments that consider the intersectional risks and strengths within the LSMA population.

Fluidity in Gender Identity and Sexual Orientation Identity in Transgender and Nonbinary Youth

Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SOI across 3 months (T1-T2) and 1.5 years (T1-T4) among 183 TNBY (baseline age 14-17 years; 83.6% White, 16.9% Hispanic/Latinx) who participated in a longitudinal US study. Participants completed online surveys including measures of GI and SOI. The most common gender identity selected at T1 (with or without another gender identity) was nonbinary (56.3%), and more than half (57.4%) of youth identified with a plurisexual identity (e.g., bisexual, pansexual). GI fluidity from T1-T2 was 13.2% and from T1-T4 was 28.9%. It was equally common to move toward a nonbinary gender identity as toward a binary gender identity. SOI fluidity was more common (30.6% from T1-T2; 55.8% from T1-T4) than GI fluidity. Shifts toward plurisexual identities were more common than shifts toward monosexual identities (e.g., straight, gay). Findings highlight the need to assess changes in GI and SOI in research and clinical practice to address the unique needs of TNBY accurately and effectively.

Sexual Fluidity in Identity and Behavior Among Cisgender Youth: Findings from the Longitudinal Growing up with Media Study

OBJECTIVES

To examine fluidity in sexual orientation identity and behavior among cisgender youth.

STUDY DESIGN

Data were analyzed from 5 survey waves of the longitudinal US Growing Up with Media Study (2010-2019). Participants were 989 cisgender youth, aged 13-20 years at baseline, who completed online surveys assessing sexual orientation identity and behavior (gender of sexual partners). Amount of change (mobility) and patterns of change across waves were assessed for identity and behavior.

RESULTS

Consistently heterosexual was the most common sexual orientation identity (89%-97% for boys, 80%-90% for girls), followed by gay (3%) for boys, and bisexual (8%) for girls. Sexual minority identities increased (3%-11% for boys, 10%-20% for girls) over time, same-gender sexual behavior also increased. Girls had more identity mobility than boys; no gender difference was found for behavior mobility. Movement from heterosexual to a sexual minority identity occurred for 9% of girls and 6% of boys; movement from different-gender sexual behavior to same-gender sexual behavior occurred for 2% of girls and boys.

CONCLUSIONS

Findings highlight the need to assess multiple dimensions and patterns of change of youth sexual orientation in research and clinical care. Recognizing and creating space for conversations about changes in sexual identity and behavior over time will help providers accurately and effectively address the health needs of all patients.

Physical Dating Violence Victimization among LGBTQ Youth: Disclosure and Association with Mental Health

Youth dating violence and youth suicide are both major public health concerns. However, little research examines the intersection of these issues among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. The current study examined the association between physical dating violence victimization and mental health using online survey data collected from 39,126 LGBTQ youth of ages 13 to 24 in the United States. Overall, 11% of LGBTQ youth who were in a relationship in the past year experienced physical dating violence victimization, with 4% having experienced it once and 7% having experienced it multiple times. Rates of experiencing physical dating violence victimization varied based on a number of youth characteristics and environmental factors. Past-year physical dating violence victimization was associated with nearly four times the odds of attempting suicide in the past year. Given the intersection of suicide risk and dating violence among LGBTQ youth, dating violence prevention organizations must be LGBTQ-inclusive, and suicide prevention must be equipped to address dating violence victimization. The higher rates of physical dating violence victimization among multiple marginalized and socioeconomically disadvantaged LGBTQ youth suggest the need for an intersectional approach that addresses the structural factors that place LGBTQ youth at risk for physical dating violence.

The current state of sexual fluidity research

Sexual fluidity research (i.e., change over time in one or more sexual orientation dimensions) has grown exponentially, with advancements in conceptual models, measurement, and understanding of sexual orientation as a construct and developmental process that accommodates potential for change. Sexual fluidity research has also moved beyond samples of white cisgender women to consider the experiences of individuals with other sociodemographic characteristics and has examined change across multiple dimensions of sexual orientation, mechanisms of change, and associations with health outcomes. This review provides a brief narrative of historical conceptualizations of sexual orientation and fluidity and the current state of research on sexual fluidity. Finally, we identify opportunities for future research, policy, and clinical practice.

Sexual Orientation and Attraction in a Cohort of Transmasculine Adolescents and Young Adults

As part of an ongoing longitudinal study of transmasculine adolescents and young adults seeking gender-affirming surgery, this analysis examined sexual orientation and attraction in a cohort of 167 binary and nonbinary participants 15-35 years of age. Correlations were analyzed using Pearson's chi square. Binary and nonbinary transmasculine individuals had different patterns of orientation and attraction, with binary males more likely to be heterosexual and less likely to be queer (p<0.003). Nonbinary individuals were more likely to be attracted to and have history with other nonbinary people (p<0.01). Transmasculine sexual identities are variable, complex, and not well described by standard sexual orientation categories.

Association Among Maltreatment, Bullying and Mental Health, Risk Behavior and Sexual Attraction in Chinese Students

OBJECTIVE

To identify the association between sexual attraction, childhood maltreatment and bullying victimization, and mental and behavioral health problems among Chinese adolescents.

METHODS

A cross-sectional study among Chinese high school students by multistage stratified cluster sampling was conducted using a self-reported questionnaire. Participants who were same- or both-sex attracted were identified as sexual minorities, and those who were opposite-sex attracted were identified as heterosexuals. Childhood maltreatment was assessed as physical, emotional, and sexual abuse, and bullying was assessed as traditional and cyberbullying. Psychological distress was assessed as depressive and anxiety symptoms, and self-destructive behavior was assessed as suicidal behavior and nonsuicidal self-injury. Logistic regression and path analysis were conducted to analyze the data.

RESULTS

There were 1360 sexual minority and 15,020 heterosexual respondents. Sexual minority status was associated with increased risk of maltreatment (adjusted odds ratio [AOR] range: 1.25-2.46) and bullying (AOR range: 1.38-1.77) victimization, and a series of health problems (AOR range: 1.85-3.69). Furthermore, childhood maltreatment could partially explain the association of sexual minority status with psychological distress (indirect effect: β = 0.026 for boys; β = 0.086 for girls) and self-destructive behavior (β = 0.056 for boys; β = 0.125 for girls), and bullying could partially explain the association between sexual minority status and psychological distress (β = 0.040 for boys; β = 0.031 for girls).

CONCLUSIONS

Sexual minority adolescents were more likely than heterosexuals to experience different forms of childhood victimization, which may put them at higher risk for mental and behavioral health problems. Interventions based on both family and school are essential.

Risk and Protective Factors for Adolescent Relationship Abuse across Different Sexual and Gender Identities

Little is known about the characteristics and context of adolescent relationship abuse victimization across youth of different sexual and gender minority identities. This study sought to examine this in a national sample of 14-15-year-old youth. The sample comprised 3296 youth who reported having been in a relationship, of which 36% (n = 1197) were exclusively cisgender heterosexual; 41% (n = 1, 349) cisgender sexual minority; and 23% (n = 750) gender minority, the majority of whom were also sexual minority. More than half of all youth who had been in a relationship, dated or hooked up with someone had experienced some form of adolescent relationship abuse victimization. Gender minority youth, in particular transgender boys and non-binary youth assigned female at birth, were more likely to be victims of multiple types of adolescent relationship abuse compared to cisgender youth. Perpetrator gender varied for sexual and gender minorities and was more homogenous for cisgender heterosexual youth. Several factors were associated with adolescent relationship abuse for all youth, although alcohol use, and parental trust and communication emerged as particularly important for sexual and gender minority youth. Overall, findings address multiple gaps in the literature and contribute to the understanding of adolescent relationship abuse across different sexual and gender identities.

Sexual Orientation Demographic Data in a Clinical Cohort of Transgender Patients

BACKGROUND

There are specific issues regarding sexual orientation (SO) collection and analysis among transgender and nonbinary patients. A limitation to meaningful SO and gender identity (GI) data collection is their consideration as a fixed trait or demographic data point.

METHODS

A de-identified patient database from a single electronic health record (EHR) that allows for searching any discrete data point in the EHR was used to query demographic data (sex assigned at birth and current GI) for transgender individuals from January 2011 to March 2020 at a large urban tertiary care academic health center.

RESULTS

A cohort of transgender individuals were identified by using EHR data from a two-step demographic question. Almost half of male identified (46.70%, n = 85) and female identified (47.51%, n = 86) individuals had "heterosexual/straight" input for SO. Overall, male and female identified (i.e., binary) GI aggregate categories had similar SO responses. Assigned male at birth (AMAB) nonbinary individuals (n = 6) had "homosexual/gay" SO data input. Assigned female at birth (AFAB) nonbinary individuals (n = 56) had almost half "something else" SO data input (41.67%, n = 15). Individuals with "choose not to disclose" for GI (n = 249) almost all had "choose not to disclose" SO data (96.27%, n = 232).

CONCLUSION

Current SO categories do not fully capture transgender individuals' identities and experiences, and limit the clinical and epidemiological utility of collecting this data in the current form. Anatomical assumptions based on SO should be seen as a potential shortcoming in over-reliance on SO as an indicator of screening needs and risk factors.

Developmental patterns of sexual identity, romantic attraction, and sexual behavior among adolescents over three years

INTRODUCTION

Adolescents are heterogeneous in how they define and experience their sexual orientation, which can include specific identity labels, romantic attractions, and other- and/or same-sex sexual behavior. These three components of sexual orientation are not always concordant, and studies suggest adolescents-particularly girls-are fluid in these dimensions of orientation over time. The current study examined: 1) fluidity in adolescent girls' and boys' self-labeled identities and romantic attractions over time, and 2) patterns of adolescent girls' and boys' self-labeled identities and romantic attractions as they coincide with sexual behavior.

METHODS

Surveys were administered to adolescents in three low-income high schools in the rural Southeastern U.S. at three yearly intervals (n = 744; M_age = 15.0; 54.3% girls; 48% White, 24% Hispanic/Latinx, 21% Black/African American). Participants reported their self-labeled sexual identity and romantic attraction at each time point and their lifetime sexual behavior with girls and boys at year 3.

RESULTS

Results revealed 26% of girls and 11% of boys reported fluidity in identity and 31% of girls and 10% of boys reported fluidity in attractions. At each time point, up to 20% of girls and 6% of boys reported a sexual minority identity label with concurrent same-sex attraction; the majority of these participants also reported same-sex behavior. Among heterosexual-identified participants reporting some degree of same-sex attraction at year 3, approximately 66% of girls and 10% of boys reported same-sex behavior.

CONCLUSIONS

The findings suggest that many adolescents are nuanced and dynamic in how they identify and experience their developing sexualities.