National Survey Of Family Growth Research Articles

Threats to ACA associated with temporary increase in Long-Acting Reversible Contraception

ABSTRACT Long-Acting Reversible Contraception methods (LARCs) have a lower uptake rate than oral contraception, despite being more reliable and potentially cheaper in the long run. Historically, high insertion costs have stunted their uptake. The Affordable Care Act eradicated these costs by classifying contraception as preventative care that insurers must offer at no charge as of late 2012. Additionally, the ACA required that all employer-provided insurance plans have contraceptive coverage. After four years of coverage, the 2016 national election represented a credible threat to the ACA and contraceptive coverage and access. Utilizing the National Survey of Family Growth, I estimate how LARC uptake changed during and after 2016 using data from 2011 to 2019. I find that use of LARCs spiked in 2016 and 2017 for Medicaid users and 2017 and 2019 for women with private insurance.

Racial/Ethnic and Sexual Orientation Identity Differences in the Receipt of a Sexual History Assessment from a Health Care Provider among Women in the United States.

Differential sexual history assessment, whereby certain groups are more or less likely to be asked questions about their sexual behavior by a health care provider, may lead to differential sexual health care and counseling. Using nationally representative data from the 2013 through 2019 waves of the National Survey of Family Growth, we examined racial/ethnic and sexual orientation identity differences in receiving a sexual history assessment from a health care provider in the last 12months among U.S. women aged 15-44years (N=14,019). Adjusting for survey wave, Black and Latina heterosexual women; White, Black, and Latina bisexual women; and Black or Latina lesbian women had higher odds (odds ratio range, 1.47 [Latina heterosexual] to 2.71 [Black bisexual]) of having received a sexual history assessment in the last 12months compared with White heterosexual women. All differences except for those among Black or Latina lesbian women persisted after controlling for demographic, socioeconomic, and health care factors (odds ratio range, 1.43 [Latina heterosexual] to 2.14 [Black bisexual]). Of note, Black bisexual women, about whom providers may hold biased assumptions of promiscuity rooted in both racism and biphobia, had the highest predicted probability of being asked about their sexual behavior by a provider. Person-centered, structurally competent, and anti-oppressive practices and programs aimed at combating bias, stigma, and discrimination in the health care system and facilitating an inclusive clinic environment for all patients are needed to address differences in the provision of sexual health services and promote sexual health equity.

Sexual Violence Against Women With Disabilities: Experiences With Force and Lifetime Risk

Emerging research suggests that people with disabilities experience an increased risk of sexual violence. However, few studies have examined the relationship between disability types and various forms of sexual violence, involving either physical or nonphysical force. This cross-sectional study used nationally representative data from years 2011-2017 of the National Survey of Family Growth among women aged 18-44 years. Analyses were conducted in March 2020-June 2021. Using binary and multinomial logistic regression models, lifetime risk of sexual violence and experience of physical or nonphysical force at first intercourse were modeled as a function of disability type (sensory, physical, cognitive, or ≥2 disabilities). Models also controlled for relevant demographic confounders. Women with any type of disability reported experiencing sexual violence in their lifetime approximately double the proportion of that experienced by nondisabled women (∼30% vs 16.9%), with women with multiple disabilities experiencing the greatest prevalence (42.1%) and risk (AOR=2.94, p<0.001) than nondisabled women. Women with cognitive disabilities or multiple disabilities were significantly more likely to experience either physical (cognitive: AOR=1.55, p<0.001; multiple: AOR=1.50, p<0.05) or nonphysical force (cognitive: AOR=2.28, p<0.01; multiple: AOR=2.74, p<0.001) during their first intercourse than nondisabled women. Results of this study suggest that future research should focus on the association between various types of disability and sexual violence. The development of inclusive evidence-based violence intervention and prevention programs for girls and women with disabilities is recommended.

Associations Between Social Determinants of Health and Adolescent Contraceptive Use: An Analysis From the National Survey of Family Growth.

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy.

Discrepant abortion reporting by interview methodology among men from the United States National Survey of Family Growth (2015-2017)

Objective: To examine discrepancies in men's abortion reporting when queried via face-to-face interview versus audio computer-assisted self-interviewing (ACASI) in the National Survey of Family Growth (NSFG). Study Design: The NSFG collects nationally representative data on family life, sexual behavior, and reproductive health in the United States. The questionnaire is administered to participants via face-to-face interview (FTF), with selected items also asked of the same participant via ACASI for direct comparison. As the 2015-2017 NSFG queried individuals’ abortion history via both methods, we examined discrepant reporting among respondents. We additionally explored sociodemographic and reproductive characteristics associated with discrepant abortion reporting in a multivariable logistic regression model. Results: Of 4540 male respondents ages 15-49, 45.3% reported a pregnancy. Via FTF, 12.3% reported an abortion, compared to 19.9% via ACASI (p < 0.01). With respect to discrepancies in the number of reported abortions, 8.5% of respondents reported more abortions via ACASI versus FTF. Multivariable logistic regression modeling noted independently greater odds of abortion reporting in ACASI among non-Hispanic Black men (aOR 2.31, 95% CI 1.19-4.45), men living below the Federal Poverty Level (less than 100% FPL: aOR 3.65, 95% CI 1.93-6.89; 100-400% FPL: aOR 2.04, 95% CI 1.20-3.45), and those desiring more children in the future (aOR 1.91, 95% CI 1.20-3.04). Conclusion: Men were more likely to disclose their abortions in ACASI compared to FTF interview. Disproportionate, discrepant abortion reporting among low-income, minority men who report desiring more children in the future warrants further research. Implications: Surveys utilizing ACASI as an adjunct to FTF interviews may more accurately capture men's abortion experience.

Risk of Sterilization Regret and Age: An Analysis of the National Survey of Family Growth, 2015-2019.

To estimate the risk of sterilization regret based on age at the time of sterilization in a contemporary group of women. We conducted a retrospective analysis of cross-sectional data from the 2015-2017 and 2017-2019 National Survey of Family Growth, Female Respondent Files, to estimate the proportion of women who experience sterilization regret. Descriptive statistics were used to describe the population and the proportion with regret. Sterilization regret was defined as someone who either underwent sterilization reversal or who definitely wanted sterilization reversal. Multivariable logistic regression models were used to assess associations with sterilization regret. A total of 1,549 women who underwent sterilization were included in the analysis; 8% were aged 21-30 years, and 92% were aged older than 30 years. Of the participants, 16.9% identified as Black, 22.0% as Hispanic, and 57.2% as White. Most (58.4%) underwent a tubal sterilization procedure between age 21 and 30 years. The cumulative proportion of regret was 10.2% (12.6% for women who underwent sterilization at age 21-30 years and 6.7% for those who underwent sterilization at older than age 30 years). After controlling for covariates including age, race, parity, educational attainment, and medical reason for sterilization, the only variable that had a statistically significant association with regret was age at the time of the interview (P<.001). As women got older, they were less likely to report sterilization regret. Younger women experience more sterilization regret. As women get older, sterilization regret decreases. Counseling about sterilization should reveal the unpredictability of future desire, but age alone must not be a barrier to performing sterilization.

An intersectional analysis of contraceptive types chosen among sexual minority women: A nationally representative study

ObjectiveThe purpose of this study is to use an intersectional approach in which race, insurance, care setting, and disclosure of sexual orientation to a provider are used to assess patterns of contraceptive use in sexual minority women. Study designThis study analyzes cross-sectional data from the 2011–2019 National Survey of Family Growth (NSFG). Sexual orientation of 21,075 respondents’ data was used to investigate contraceptive use in sexual minority women, specifically lesbian and bisexual women, as compared to heterosexual women, controlling for variables such as race, age, and socioeconomic factors. ResultsBlack and Hispanic lesbian women (adjusted odds ratio [aOR] = 0.39 confidence interval [CI] 0.20–0.76 and aOR = 0.44 CI 0.23–0.82, respectively) and Hispanic and Other Race bisexual women use hormonal contraceptive methods less than their White lesbian and bisexual peers (aOR = 0.45 CI 0.29–0.69 and aOR = 0.43 CI 0.20–0.94). Care setting was not correlated with long-acting reversible contraceptive methods (LARC; such as intra-uterine device, hormonal implants) or prescription-based hormonal methods (such as oral contraceptive pills, injectables, vaginal rings, and patches) in lesbian women (aOR = 2.92 CI 0.60–14.2 and aOR = 1.43 CI 0.47–4.38, respectively) or bisexual women (aOR = 0.90 CI 0.48–1.58 and aOR = 0.83 CI 0.37–1.86), but it was for straight women (aOR = 1.28 CI 1.03–1.59 and aOR = 0.68 CI 0.53–0.86). Similarly, insurance status did not correlate with contraceptive patterns in sexual minority women. Importantly, adjusting for nationally representative data did not impact the results; in other words, the odds ratios after adjusting yielded the same results as before adjustment. ConclusionsInsurance and care setting are important determinants of straight women's contraceptive use patterns with fewer effects seen among sexual minority women. These findings support previous work and indicate that known advantages of insurance coverage or use of public clinics may not positively impact sexual minority women as much as they do straight women. Provider awareness of sexual identity and sexual orientation is important for adequate contraceptive care. ImplicationsWhile prior research has presented findings on sexual minority women contraceptive use, to our knowledge there are limited studies that address the social and demographic implications for contraceptive use in this population.

Reasons for Intent to Discontinue and Remove Long-Acting Reversible Contraceptives: National Survey of Family Growth 2017-2019.

Background: Long-acting reversible contraceptives (LARCs) are highly effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARC effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among U.S. women 15-49 years of age from 2017 to 2019. Methods: The National Survey of Family Growth 2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results: Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10 years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include side effects (29.6%), LARC expiration (26.8%), LARC complications (19.3%), and decided to get pregnant (15.9%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), other reasons (13.4%), discouragement by provider (5.8%), and provider's inability to remove (4.9%). Conclusions: Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered is needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. To respect the reproductive autonomy of LARC users' method for pregnancy prevention, these barriers must be overcome.

A Web-Based Event History Calendar Approach for Measuring Contraceptive Use Behavior.

Event history calendars (EHCs) are frequently used in social measurement to capture important information about the time ordering of events in people's lives, and enable inference about the relationships of the events with other outcomes of interest. To date, EHCs have primarily been designed for face-to-face or telephone survey interviewing, and few calendar tools have been developed for more private, self-administered modes of data collection. Web surveys offer benefits in terms of both self-administration, which can reduce social desirability bias, and timeliness. We developed and tested a web application enabling the calendar-based measurement of contraceptive method use histories. These measures provide valuable information for researchers studying family planning and fertility behaviors. This study describes the development of the web application, and presents a comparison of data collected from online panels using the application with data from a benchmark face-to-face survey collecting similar measures (the National Survey of Family Growth).

Women's experiences with person-centered family planning care: Differences by sociodemographic characteristics

ObjectivePerson-centered contraceptive care is associated with positive reproductive health outcomes. Our objective was to analyze patients’ ratings on the newly developed Person-Centered Contraceptive Counseling scale (PCCC) to provide distributions for a nationally representative population and to assess differences by sociodemographic characteristics. Study designUsing data from 2017 to 2019 National Survey of Family Growth (NSFG), we analyzed ratings across the four PCCC items among 2242 women who received contraceptive counseling in the past year. Items measured patients’ reports of how providers respected them, let them describe their contraceptive preferences, took their preferences seriously, and adequately informed them about their options. We studied each PCCC item individually as well as the combined scale, distinguishing between ratings of “excellent” versus lower ratings. Bivariate and multivariate logistic regression models assessed how patients’ characteristics (age, race/ethnicity and English proficiency, sexual orientation, income, and parity) and provider type were associated with the likelihood of experiencing person-centered care. ResultsThe majority of women (59%–69%) reported that their family planning provider was “excellent” across the four PCCC items and just over half (51%) reported “excellent” on all items. In multivariate analyses, having a lower income, Black race, non-heterosexual identity, and Hispanic ethnicity combined with low English proficiency were associated with lower PCCC ratings. ConclusionsIn a nationally representative sample, the PCCC captured variation in women's experiences with person-centered family planning care by sociodemographic characteristics. Findings highlight the need for contraceptive counseling that centers on clients’ preferences and experiences, particularly for patients who belong to groups experiencing health inequities. ImplicationsPerson-centered care is a key component of high-quality family planning services. This analysis highlights sociodemographic disparities in person-centered care by analyzing PCCC ratings. Findings show the value of this new health care performance measure and affirm the need for family planning care that centers individuals' preferences and lived experiences.

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

ObjectiveTo identify prevalence of unfulfilled contraceptive preferences due to cost among low-income United States female contraceptive method users and nonusers, and associations between access to, and experience with, contraceptive care and this outcome. MethodsWe drew on data from the 2015–2019 National Surveys of Family Growth to conduct simple and multivariable logistic regression analyses on unfulfilled contraceptive preferences due to cost among nationally representative samples of low-income women ages 15 to 49 who were current contraceptive users (N = 3178) and nonusers (N = 1073). ResultsOverall, 23% of female contraceptive users reported they would use a different method, and 39% of nonusers reported they would start using a method, if cost were not an issue. Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0–2.5), while having private (aOR = 0.6, CI 0.4–0.9) or public (aOR = 0.7, CI 0.5–1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0–5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4–1.0). ConclusionsCost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences. ImplicationsFactors related to contraceptive access at the systems level—specifically the subsidization and experience of contraceptive care—impact whether cost serves as a barrier to individuals’ contraceptive preferences. Delivery of patient-centered care and shoring up health insurance coverage for all can help to mitigate cost barriers and enable individuals to realize their contraceptive preferences.

Employment Status in the United States and Use of Moderately Effective or Long-Acting Reversible Contraception Before and after the Affordable Care Act: National Survey of Family Growth 2006-2010 and 2015-2017

Employment Status in the United States and Use of Moderately Effective or Long-Acting Reversible Contraception Before and after the Affordable Care Act: National Survey of Family Growth 2006-2010 and 2015-2017

Parental Cohabitation and Breastfeeding Outcomes Among United States Adolescent Mothers.

AbstractBackground: Adolescent mothers in the United States experience disproportionately lower rates of breastfeeding compared to older mothers. Evidence suggests that paternal support helps improve breastfeeding outcomes; however, support is difficult to quantify. Parental cohabitation is easy to identify and could be used to quantify paternal support. Research Aim: Our study is to investigate the association between parental cohabitation and breastfeeding initiation and duration among US adolescent mothers. Materials and Methods: Data from the 2011-2017 National Survey of Family Growth were used. Our study sample included primipara, adolescent mothers (aged 15-19 years) who gave birth to a singleton (n = 1,867). Multivariate logistic regression and Cox Proportional Hazards models were used to analyze the relationship between cohabitation and breastfeeding initiation and duration, respectively. All models were subsequently stratified by race/ethnicity due to evidence of effect modification. Results: After adjusting for all a priori confounders, cohabiting with the infant's father at birth was associated with increased odds of breastfeeding initiation compared to noncohabiting adolescent mothers (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.08-2.16). After stratifying by race/ethnicity, both Hispanic and non-Hispanic white adolescent mothers were more likely to initiate breastfeeding if cohabiting with the infant's father (ORHispanic: 1.9, 95% CI: 1.10-3.35; ORNon-Hispanic white: 1.7, 95% CI: 1.05-2.87). We found no evidence of an association between parental cohabitation and breastfeeding duration. Conclusions: Our study found evidence that cohabitation status at birth increases the odds of breastfeeding initiation in adolescent mothers. Practitioners should consider cohabitation status when working with adolescent mothers.

Factors Associated with Long-Acting Reversible Contraceptives Usage: Results from National Survey of Family Growth

Factors Associated with Long-Acting Reversible Contraceptives Usage: Results from National Survey of Family Growth

Associations Between Sex Education Types and Sexual Behaviors Among Female Adolescents: a Secondary Data Analysis of the National Survey of Family Growth 2011–2019

Associations Between Sex Education Types and Sexual Behaviors Among Female Adolescents: a Secondary Data Analysis of the National Survey of Family Growth 2011–2019

Adolescents' Receipt of Sex Education in a Nationally Representative Sample, 2011–2019

PurposeUpdated estimates of adolescents' receipt of sex education are needed to monitor trends and potential inequities. MethodsUsing nationally representative data from the 2011–2015 and 2015–2019 National Survey of Family Growth, we use logistic regression to examine changes in the receipt of formal sex education by gender. For 2015–2019, we estimate patterns by gender and race/ethnicity for content, timing, and location of instruction. ResultsBetween 2011–2015 and 2015–2019, there were few significant changes in adolescents' receipt of formal sex education. Between these periods, instruction on waiting until marriage to have sex declined (73%–67% female [F.], p = .005; 70%–58% males [M.], p < .001). In both the periods, about half of the adolescents received sex education that meets the minimum standard articulated in national goals. In 2015–2019, there were significant gender differences in the instruction about waiting until marriage to have sex (67% F., 58% M., p < 001) and condom skills (55% F., 60% M., p = .003). Non-Hispanic Black and Hispanic males were less likely than non-Hispanic White males to receive formal instruction before the first sex on sexually transmitted infection/HIV, birth control, or where to get birth control. Many adolescents reported religious settings as the sources of instruction about waiting until marriage to have sex (56% F. and 49% M.), but almost none received instruction about birth control from those settings. ConclusionsDifferences in the receipt of sex education, by gender, race/ethnicity, and the location of instruction, leave many adolescents without critical information. Gaps in meeting national objectives indicate the need to expand the provision of sex education.

Obesity in Infertile Women, a Cross-Sectional Study of the United States Using NSFG 2011-2019.

Reproductive health can be affected by obesity through various mechanisms. Obesity-associated inflammatory markers and altered hormones can have direct and indirect impacts on female reproductive health. However, little is known about obesity prevalence and trend among infertile women and obesity association with infertility in reproductive-age women of the U.S. In a cross-sectional study, we sought to conduct a secondary analysis of National Survey of Family Growth (NSFG) data from 2011 to 2019. A total of 6,035 infertile and non-pregnant fecund women aged 20-44years were included in a nationally representative sample of the U.S. The weighted prevalence of obesity (BMI ≥ 30) among infertile women was 41.63% for the period 2011-2019. Obese women had 62% higher odds of infertility (95% CI 1.24, 2.17) compared to non-obese women of reproductive age (20-44years). However, there was no specific trend of obesity among infertile and non-pregnant fecund women aged 20-44years in the U.S. from 2011 to 2019. Given the negative impact of obesity on female reproductive health and in light of our results, it is important to counsel obese infertile reproductive-age women of the U.S. about behavioral changes that include weight management. Future longitudinal studies are needed to evaluate the risk of infertility among obese women.

Is There Really a Sex Recession? Period and Cohort Effects on Sexual Inactivity Among American Men, 2006-2019.

There has been a growing concern among researchers and media commentators that men in the United States may be increasingly less sexually active, creating a form of a “sex recession.” Using 14 years of survey data from men in the National Survey of Family Growth (2006–2019), this study assesses whether such concerns are warranted. Cross-classified mixed-effects models are estimated to ascertain whether there is evidence of a population-wide sex recession among men due to secular conditions specific to different time periods, or if birth cohorts that comprise the male population at any given point in time are exhibiting distinct patterns of sexual behavior. The analysis finds no evidence of a population-wide sex recession among men. Rates of sexual inactivity among men have been constant across the time series, but those born between 2000 and 2004 had significantly higher rates of sexual inactivity than previous birth cohorts did at the same age. Additionally, men who are unemployed and/or living at home with their parents are more likely to refrain from sexual intercourse than their peers who are employed and/or living independently of their parents.

An Experimental Evaluation of Alternative Methods for Case Prioritization in Responsive Survey Design

Abstract Growing reluctance of households to participate in surveys has led to a variety of methodological efforts to combat this phenomenon. Several organizations employ case prioritization in a responsive survey design framework, dedicating increased effort to specific subgroups of sampled cases during certain data collection phases. For example, some surveys may prioritize subgroups defined by age and/or race/ethnicity if balanced response rates across these subgroups are important for minimizing nonresponse bias. Unfortunately, no methodological studies to date have identified optimal approaches for applying this increased effort to prioritized cases. This study experimentally examined three alternative methods for case prioritization in the National Survey of Family Growth: simply flagging the cases to receive increased effort in the sample management system (a “standard” method), developing tailored approaches to working the prioritized cases, and no prioritization (a “control” method). In the “tailored” method, which was designed to provide the interviewers with more guidance than simple “flagging,” interviewers worked with their supervisors to develop tailored strategies for how to best work each case within the prioritized subgroup. We find that both prioritization methods improved response rates and led to significant reductions in calling effort per completed case, with the “flagging” approach working particularly well. Given the additional costs associated with the “tailored” method, the results of our experiment provide support for a “hybrid” case prioritization approach that combines optimal features of these two methods.

Timing of First Sexual Experience with a Same-Sex Partner: A Life Course Approach.

Theories of sexual identity development recognize the initiation of sexual experience with same-sex partners (SESSP) to be a significant event in the coming-out process, yet the research literature lacks a population-based description of its timing and variation across population subgroups. Using data from the 2011-2017 National Survey of Family Growth and guided by the life course paradigm, we explored the timing and correlates of first SESSP among individuals (1425 women; 545 men) who identified as lesbian (n = 307), gay (n = 285), or bisexual (n = 1378) (LGB). Descriptive findings revealed that the median age at first SESSP was about 19years for lesbian women and gay men and one to two years later for bisexual women and men. Notably, initiation of SESSP occurred over a wide age range, particularly among bisexual men. Multivariable results indicated that the probability of first SESSP did not vary by demographic characteristics or family background among men. Among women, nativity status, family stability, and independent living were associated with probability of first SESSP. Coital experience predicted timing among both women and men. Tests for statistical interactions suggested that age at first SESSP was contingent on mother's education (women), sexual identity (men), family stability (men), and birth cohort (women and men). Our findings highlight the complicated nature of LGB sexual experiences, and we end with a call for greater effort to ensure that LGB individuals are represented in national surveys designed to provide data on sexual and reproductive health.