National practice guidelines encourage providers address sexual and reproductive health (SRH) as part of routine adolescent preventative care visits, yet little data address how frequently clinicians actually adhere to these recommendations. We used nationally representative data to examine the prevalence of adolescents who reported discussing SRH topics with their health care provider, and how these experiences differed by sexual orientation, gender, age and race/ethnicity. Data are the 2018 National Survey of Sexual Health and Behavior (NSSHB) – an online, nationally-representative, probability survey of individuals 14-49 years of age in the United States conducted by GfK Research (GfK) (Menlo Park, CA, USA). GfK constructs nationally representative probability research panels using address-based sampling recruitment methodology via the U.S. Postal Service’s Delivery Sequence File (DSF) to cover approximately 98% of all US households, including harder-to-reach individuals, such as young adults and minorities. Design weights adjust for population characteristics and any nonresponse. We have used this methodology for seven waves of the NHSSB, resulting in several dozen publications. The analytic sample for our study included 820 (18.0% of total sample [N=4554]) adolescents who were children of adult household heads who also participated in the survey. Outcome variables were SRH topic addressed with provider (all no/yes: pregnancy prevention, sexual orientation, STD/HIV prevention, sexual difficulties [e.g. painful sex, erectile function or vaginal lubrication], STI testing and being sexually active). We used logistic regression – adjusted for complex sampling design and population weights in Stata (15.0; all p<.05) – to examine differences in the odds of SRH discussion with provider by sexual orientation label (heterosexual/sexual minority [ref: lesbian, gay, bisexual, asexual or something else]), age (14-15 [ref] vs. 16-17), gender (male/female [ref]) and race/ethnicity (majority/minority [ref]). The majority (72.8%) of adolescents reported having a routine care visit in the past year. Half of providers asked about current sexual activity, while only a third talked about pregnancy prevention (30.5%). One fifth conversed with their clinician about STD/HIV prevention (22.0%) or about STI testing (20.7%). About one in ten providers addressed sexual orientation (9.7%) or sexual difficulties (13.3%). Conversations about pregnancy (OR=1.56-2.25), STD/HIV prevention (OR=1.78-2.16) and current sexual activity (OR=1.60-1.99) were more frequent with older and racial minority adolescents as compared to younger and White youth. Females had higher odds that males of talking to their providers about pregnancy prevention (OR=1.51), while a greater percent of older adolescents reported being asked about sexual activity (OR=1.65). Sexual minority youth and adolescents of color had three times higher odds of a provider’s offering them an STI test (OR=2.52-2.83) and about twice the odds of being asked by a provider if they were currently sexually active (OR=1.60-1.99). There were no differences in discussions of sexual difficulties. Despite national guidelines recommending SRH counseling as part of adolescent preventative care visits, health care providers infrequently and inconsistently address topics key to risk and prevention during encounters with young people. Targeted interventions should focus on strengthening the regularity and depth of clinicians’ SRH conversations regardless of adolescent demographic or history.