Abstract
To examine whether sexual orientation is associated with disparities in teen pregnancy and hormonal contraception use among adolescent females in 2 intergenerational cohorts. Data were collected from 91,003 women in the Nurses' Health Study II (NHSII), born between 1947-1964, and 6463 of their children, born between 1982-1987, enrolled in the Growing Up Today Study (GUTS). Log-binomial models were used to estimate risk ratios for teen pregnancy and hormonal contraception use in sexual minorities compared with heterosexuals and metaanalysis techniques were used to compare the 2 cohorts. Overall, teen hormonal contraception use was lower and teen pregnancy was higher in NHSII than GUTS. In both cohorts, lesbians were less likely, whereas the other sexual minorities were more likely, to use hormonal contraception as teenagers compared with their heterosexual peers. All sexual minority groups in both cohorts, except NHSII lesbians, were at significantly increased risk for teen pregnancy, with risk ratios ranging from 1.61 (95% confidence interval, 0.40-6.55) to 5.82 (95% confidence interval, 2.89-11.73). Having an NHSII mother who was pregnant as a teen was not associated with teen pregnancy in GUTS participants. Finally, significant heterogeneity was found between the 2 cohorts. Adolescent sexual minorities have been, and continue to be, at increased risk for pregnancy. Public health and clinical efforts are needed to address teen pregnancy in this population.
Highlights
Regardless of intention, teen pregnancy is associated with numerous adverse health and social outcomes
Research examining pregnancy rates by sexual orientation is sparse, prior studies suggest that sexual minority females may be at heightened risk compared to heterosexual peers.[4,5,6] Risk factors for teen pregnancy, such as earlier sexual initiation and more sexual partners[7], are more common in female sexual minorities who report a high proportion of male sexual contacts, a younger age of sexual initiation, and more partners compared to heterosexuals.[4, 8, 9] Sexual minority females at risk for unintended pregnancy may be less likely than heterosexual females to use contraceptives, and, in particular, highly effective hormonal contraceptives
Sex education,(11) contraceptive technology,(12) and attitudes about sexual orientation have changed over time and have affected historical trends in teen pregnancy and contraceptive use.[13]. For example, comprehensive sex education has been shown to reduce teen pregnancy compared to no education or abstinence-only education.[14] an estimated 60% of sexually active teens report using a highly effective form of contraception in 2010, which is an increase from 47% in 1995.(15) Contraception is less stigmatized than it was even one generation ago and physicians are more likely to raise the issue with patients.[16] initial research has been conducted on teen pregnancy among sexual minorities, these studies were of limited power, combined sexual minority groups, and were restricted to a single generation
Summary
Regardless of intention, teen pregnancy is associated with numerous adverse health and social outcomes. Research examining pregnancy rates by sexual orientation is sparse, prior studies suggest that sexual minority females (e.g., bisexuals, lesbians, etc) may be at heightened risk compared to heterosexual peers.[4,5,6] Risk factors for teen pregnancy, such as earlier sexual initiation and more sexual partners[7], are more common in female sexual minorities who report a high proportion of male sexual contacts, a younger age of sexual initiation, and more partners (male or female) compared to heterosexuals.[4, 8, 9] Sexual minority females at risk for unintended pregnancy may be less likely than heterosexual females to use contraceptives, and, in particular, highly effective hormonal contraceptives. We explored 3 aims: 1) sexual minority disparities; 2) intergenerational effects; and 3) historical cohort differences
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