National Survey Of Family Growth Research Articles

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.

QuickStats: Percentage* of Women Aged 25-44 Years Who Had Ever Used Infertility Services,† by Type of Service - National Survey of Family Growth, United States, 2006-2010 and 2015-2019.

QuickStats: Percentage* of Women Aged 25-44 Years Who Had Ever Used Infertility Services,† by Type of Service - National Survey of Family Growth, United States, 2006-2010 and 2015-2019.

Nonvoluntary or Forced Sex Among Women, by Sexual Identity, Attraction, and Behavior — National Survey of Family Growth, United States, 2011–2017

Nonheterosexual (sexual minority) women report experiencing more sexual violence than heterosexual (sexual majority) women (1,2). Sexual minority women are often categorized as a collective whole, which fails to capture the nuances in sexual violence among subgroups of sexual minority women, such as bisexual and lesbian women (3). To estimate the prevalence of lifetime forced vaginal intercourse (forced sex) and of nonvoluntary first vaginal intercourse among women aged 18-44 years in the United States, CDC analyzed data from female respondents who were interviewed during 2011-2017 for the National Survey of Family Growth (NSFG); respondents were stratified by self-reported sexual identity, attraction, and behavior. Log-binomial regressions and analyses of variance (ANOVAs) were performed to compare experiences across each dimension of sexual orientation, controlling for demographic characteristics. Compared with sexual majority women,* prevalence of any male-perpetrated nonvoluntary first vaginal intercourse or forced sex (nonvoluntary or forced sex) was higher among women who identified as bisexual (36.1% versus 17.5%), reported attraction to the opposite and same sex (30.3% versus 15.8%), and reported sexual behavior with the opposite and same sex (35.7% versus 15.9%). These sexual minority women reported that their earliest experience of nonvoluntary or forced sex occurred at younger ages than did that of sexual majority women. Among women who were unsure of their sexual attraction, the prevalence of nonvoluntary first vaginal intercourse was also higher than among sexual majority women. These findings underscore the need for comprehensive prevention approaches tailored for sexual minority women and prevention of child sexual abuse, given the average ages at earliest nonvoluntary or forced sex experience among sexual minority women (range = 12.5-16.3 years). Additional research is needed into the circumstances of and norms or attitudes that influence perpetration of nonvoluntary or forced sex and broader sexual violence against sexual minority women. Prevention of nonvoluntary or forced sex victimization among sexual minority women will require comprehensive approaches to prevent sexual violence and child sexual abuse. Engaging sexual minority women in the development of sexual violence prevention efforts and research would help ensure that the experiences of sexual minority women across the spectrum are represented.

A social history of racial disparities in breastfeeding in the United States

Over the past five decades in the United States, White women have breastfed at higher rates than Black women. While a small but growing body of social historical research has examined racial disparities in breastfeeding over time, empirical research, particularly quantitative research, has focused on single historical snapshots, unintentionally treating the persistent racial disparities in breastfeeding as a static phenomenon, rather than one with distinct social mechanisms at different points in time. Further, few studies on racial disparities in health deconstruct difference both within and across racial groups. But what if we thought about persistent racial disparities instead as discrete trends with distinct social mechanisms at different points in time? In a binary logistic regression of breastfeeding initiation rates from 1973 to 2015 using the National Survey of Family Growth (NSFG), I found that the persistent racial disparities were actually comprised of three distinct types of changing racial disparities: (1) increases in racial disparities that derive from improvements for Whites not captured by Blacks (1973–1982); (2) decreases in racial disparities that stem from improvements for Whites captured even more strongly by Blacks (1995–2006); and, (3) leveling off of racial disparities (2006–2015). Placing results of this quantitative analysis within the context of public policy and social movement history, I identify three distinct mechanisms that drive the different trends in racial disparities in breastfeeding. This paper contributes to the literature on motherhood, race, and health a more nuanced understanding of the social historical mechanisms that pattern breastfeeding, and more broadly, racial disparities in health.

Rising nonmarital first childbearing among college-educated women: Evidence from three national studies

Levels of nonmarital first childbearing are assessed using recent administrations of the National Longitudinal Survey of Youth, 1997 Cohort; the National Longitudinal Study of Adolescent to Adult Health; and the National Survey of Family Growth. Results confirm that the higher a woman's educational attainment, the less likely she is to be unmarried at the time of her first birth. A comparison over time shows increases in nonmarital first childbearing at every educational level, with the largest percentage increase occurring among women with college degrees at the BA or BS level or higher. This article projects that 18 to 27% of college-educated women now in their thirties who have a first birth will be unmarried at the time. In addition, among all women who are unmarried at first birth, women with college degrees are more likely to be married at the time of their second birth, and, in a majority of cases, the other parent of the two children was the same person. A growing proportion of well-educated women, and their partners, may therefore be pursuing a family formation strategy that proceeds directly to a first birth, and then proceeds, at a later point, to marriage, followed by a second birth. Possible reasons for the increase in nonmarital first births among the college-educated include the stagnation of the college wage premium; the rise in student debt; decreasing selectivity; and the growing acceptability of childbearing within cohabiting unions, which have become a common setting for nonmarital childbearing, and among single parents.

Health associations for male survivors of unwanted and non-consensual sex.

Literature has established that men with non-consensual sexual experiences exhibit a higher likelihood of engaging in high-risk sexual behaviors; however, previous research does not explore men with unwanted sexual experiences, nor their sexual and general health outcomes. Weighted data from the 2011-2017 National Survey of Family Growth included men aged 18-49 years who ever experienced oral, vaginal, or anal sex by partners of any gender (N = 10,763). The Pearson χ2 test compared the sociodemographic of men with or without a history of unwanted or non-consensual sex. Logistic regressions were used to examine the association of this history to sexual health and general health outcomes, while controlling for age, race/ethnicity, and education level. Approximately 1 in 10 (10.3%) American men reported experiencing unwanted or non-consensual sex in their lifetime. Men with these experiences were more likely to rate their health as fair or poor (aOR = 1.5, 95% CI = [1.1, 2.0]) and have difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition (aOR = 2.1, 95% CI = [1.7, 2.7]). Men with forced sex experiences reported higher odds of gonorrhea (aOR = 5.4; 95% CI = [3.0, 10.0]) or chlamydia diagnoses (aOR = 2.5; 95% CI = [1.5, 4.4]) in the past year, and a diagnosis of genital herpes (aOR = 2.7; 95% CI = [1.6, 4.6]), genital warts (aOR = 1.7; 95% CI = [1.0, 5.6]), and syphilis (aOR = 2.4; 95% CI = [1.0, 5.6]) in their lifetime than men who did not report these experiences. The association of sexually transmitted infections and general health outcomes to unwanted and non-consensual sex validates the demand for clinicians to integrate trauma-informed care into their practice with male patients.

Vasectomy utilization in men aged 18-45 declined between 2002 and 2017: Results from the United States National Survey for Family Growth data.

Vasectomy remains a safe, simple, and effective contraceptive option. Conflicting data on the trend of vasectomy use among men have been described previously at various snapshots in time over the last two decades. This paper seeks to describe the trend of vasectomy utilization in the last 15 years using a nationally representative US survey. We analyzed data from male respondents aged 18 to 45 years of the Cycle 6 (2002), 2006-2010, 2011-2013, 2013-2015, and 2015-2017 National Survey of Family Growth (NSFG) surveys. Population estimates are calculated based on the official NSFG instructions, accounting for the complex survey design. Multivariate logistic regression models are used to study demographic and socioeconomic factors associated with vasectomy use in men. Baseline characteristics for men undergoing vasectomy do not differ significantly across survey years. Increased age, White race, marital status, higher education level, birthplace within the United States, higher household income, non-Catholic affiliation, and higher number of biological kids have significant positive associations with vasectomy use. After accounting for factors associated with vasectomy utilization, there was a significant temporal decline in vasectomy utilization rates in all age groups across survey years which remained in subgroup analyses of all men greater than 25, 30, and 35 years of age. This is the first population-based analysis of US data to observe a decline in vasectomy utilization over the past two decades. The decline was statistically significant after accounting for all demographic and socioeconomic factors. There is a steady decline in the prevalence of vasectomy use in men from 2002 to 2017. Given the limited contraceptive options for men and the importance of contraception and family planning in the United States, further research is needed to understand the temporal decline.

Women's Divergent Union Transitions After Marital Dissolution in the United States.

In the United States, high marital instability calls for more research on union transitions after marital dissolution. Previous studies focus on remarriage and pay little attention to rising post-dissolution cohabitation. In this study, I apply marital search theory to examine the level, pace, and differentials of repartnering (remarriage or cohabitation vs. staying single) and the exit from cohabitation (remarriage or dissolution vs. staying cohabiting). Adopting union history data from the pooled National Survey of Family Growth (2011-2017), I track union transitions among a sample of N = 2129 women. Analyses based on life tables and discrete-time event history analyses reveal important findings. First, most women repartner after marital dissolution. Compared to remarriage, cohabitation occurs more frequently and shows a quicker pace. Second, post-dissolution cohabitation is short-lived, and its transition to remarriage is more common than to dissolution. Third, these union transitions differ by demographic and socioeconomic predictors, including age, race and ethnicity, and education. Overall, I reveal that post-dissolution union transition is a divergent and unequal process, and I further discuss the implications on theory and family inequality.

Contraceptive use and preferences among females with sickle cell disease

ObjectivesFemales with sickle cell disease now have a life expectancy that extends well into and beyond their reproductive years. Pregnancy and childbirth are accompanied by high morbidity and mortality in this population, rendering contraception a critical part of their health care. Study DesignWe approached adult female patients of the Hospital of the University of Pennsylvania hematology clinic who were of reproductive age (ages 18–45) and carried a diagnosis of sickle cell disease. We evaluated contraceptive method uptake and method characteristic preferences, as well as other reproductive history, and compared contraceptive uptake rates to that from female respondent data from the National Survey of Family Growth (2017–2019). ResultsOf 95 eligible patients, we completed surveys with 48 participants (response rate of 51%). Over half (n = 27, 56%) of participants were not currently using any form of contraception—double the rate of the general United States population (25%). The most common contraceptives currently used were the depot medroxyprogesterone (DMPA) injection (n = 6, 13%) and the progestin intrauterine device (IUD) (n = 6, 13%). DMPA uptake was significantly higher, and permanent contraceptive and oral contraceptive pill uptake significantly lower, among these participants with sickle cell disease compared to the general United States population. Participants’ preferred contraceptive characteristics included effectiveness (n = 39, 81%), control over when to use the contraceptive (n = 39, 81%), and lack of side effects (n = 38, 79%). ConclusionsContraceptive uptake was significantly lower and method mix different among females with sickle cell disease compared to the general United States population. Further research is needed on contraceptive safety, non-contraceptive benefits, and contraceptive decision-making for females with sickle cell disease. ImplicationsThis study sheds light on the contraceptive choices and preferences of females with sickle cell disease, who are at disproportionate risk for pregnancy complications. In order to maximize the reproductive health of females with sickle cell disease, we must consider how their disease interacts with contraception and better understand how they approach contraceptive decision-making.

The Burden of and Trends in Pelvic Inflammatory Disease in the United States, 2006-2016.

Pelvic inflammatory disease (PID) is an infection of the upper genital tract that has important reproductive consequences to women. We describe the burden of and trends in PID among reproductive-aged women in the United States during 2006-2016. We used data from 2 nationally representative probability surveys collecting self-reported PID history (National Health and Nutrition Examination Survey, National Survey of Family Growth); 5 datasets containing International Classification of Diseases, Ninth/Tenth Revision codes indicating diagnosed PID (Healthcare Utilization Project; National Hospital Ambulatory Medical Care Survey, emergency department component; National Ambulatory Medical Care Survey; National Disease Therapeutic Index; MarketScan); and data from a network of sexually transmitted infection (STI) clinics (Sexually Transmitted Disease Surveillance Network). Trends during 2006-2016 were estimated overall, by age group and, if available, race/ethnicity, region, and prior STIs. An estimated 2 million reproductive-aged women self-reported a history of PID. Three of 4 nationally representative data sources showed overall declines in a self-reported PID history, and PID emergency department and physician office visits, with small increases observed in nearly all data sources starting around 2015. The burden of PID in the United States is high. Despite declines in burden over time, there is evidence of an increase in recent years.

Condom Use at Coitarche Among Men in Non-Steady Relationships in the United States, 2006–2013

PurposeUsing U.S. National Survey of Family Growth (NSFG) data from 2006 to 2013, we characterized men aged 15–44 years who reported not using a condom at their first vaginal intercourse (coitarche), while in a non-steady relationship with a female partner. MethodsMen who reported ever having intercourse were asked about male and female contraceptives used at coitarche. Analysis was restricted to respondents whose first sexual relationship was reported as non-steady, thereby comprising a population for whom condoms are recommended for preventing both pregnancy and sexually transmitted infections. Demographic and behavioral factors were examined against condom use, with significant associations included in multivariable logistic regression. We additionally describe young men’s receipt of various components of sex education prior to coitarche. ResultsNearly half (43%) of men aged 15–44 in the U.S. reported not using a condom at coitarche during a non-steady relationship. Among these men, coitarche was reported on average at 16 years old; more than one third (37%) endorsed mixed feelings or not wanting to have sex at the time. Older men (adjusted odds ratio [adjOR] 1.07, 95% confidence interval [CI] 1.06–1.08), as with men from earlier National Survey of Family Growth cycles, were increasingly likely to have reported unprotected coitarche. Similarly, men reporting coitarche before the age of 15 (adjOR 2.39, 95% CI 1.99–2.87) or having a younger sex partner at coitarche (adjOR 1.73, 95% CI 1.11–2.69) were more likely to have not used condoms. About three quarters of men received at least some form of sex education prior to coitarche. ConclusionsCondomless coitarche is commonly reported among men in non-steady adolescent relationships and with mixed feelings about having sex. Condomless coitarche among these men is independently associated with initiating sex before the age of 15 and having sex with a younger female partner. These findings may guide how to structure young men’s sexual education programing.

Comparability of estimates and trends in adolescent sexual and contraceptive behaviors from two national surveys: National Survey of Family Growth and the Youth Risk Behavior Survey.

ObjectiveTo compare adolescents’ reports of sexual and contraceptive behaviors between the National Survey of Family Growth (NSFG) and the Youth Risk Behavior Survey (YRBS).MethodsFor each survey, we estimated the year- and sex-specific prevalence of sexual and contraceptive behaviors among a comparably defined sample of US respondents ages 15–19 currently attending high school. We used logistic regression to test for changes in prevalence from 2007–2019 and conducted sensitivity analyses to investigate between-survey differences.ResultsWe found differences in both prevalence and trends between the YRBS and NSFG when limited to a comparably defined sample. Compared to the NSFG, adolescents in the YRBS were more likely to report being sexually experienced, less likely to report use of prescription methods for both sexes, and less likely to report condoms among males. Only the YRBS estimated significant declines in sexual experience for both sexes, and significant increases in prescription methods and declines in condom use among males. Differences between surveys in the prevalence of specific contraceptive methods reflected greater combined use of methods in the NSFG. We identified differences in question-wording and other aspects that may influence these differential patterns.ConclusionsThe NSFG and YRBS produced inconsistent prevalence estimates and trends for sexual and contraceptive behaviors among in-school adolescents. Further efforts to improve these national surveillance systems are critical to inform policy and research efforts that support adolescent sexual and reproductive health and wellbeing.

Trends in binge drinking, marijuana use, illicit drug use, and polysubstance use by sexual identity in the United States (2006–2017)

Background: National studies often examine associations between sexual identity and substance use at a single point in time and neglect to examine whether these associations change over time. The present study examines U.S. trends in the past-year prevalence of binge drinking, marijuana use, illicit drug use, and polysubstance use across sexual identity subgroups (gay, lesbian, bisexual and heterosexual). Methods: The data come from four independent, cross-sectional samples measured by the National Survey of Family Growth (2006–2010, 2011–2013, 2013–2015, and 2015–2017). Based on the consistency in the sampling procedures used over time, merging the four data sets was possible. The target population is men and women 15–44 years of age. Results: Lesbian women had the sharpest decline in past-year binge drinking over time, followed by heterosexual women. The prevalence of binge drinking for bisexual women did not change significantly over time and was higher in 2015–2017 than for any sexual identity subgroup. In contrast, there were no significant differences in the prevalence of binge drinking among men by sexual identity subgroup. Past-year abstinence from substance use was consistently lower among lesbian women, gay men, and bisexual women relative to other sexual identity subgroups. Polysubstance use was consistently more prevalent among bisexual women (e.g., 32.3% in 2015–2017) as compared to other sexual identity subgroups. Conclusion: This is the first study to examine U.S. national trends in alcohol, marijuana, illicit drug, and polysubstance use across sexual identity subgroups, and demonstrates that sexual identity subgroup differences were robust with relatively few changes in trends over time. The consistently high rates of binge drinking and polysubstance use among bisexual women deserve much closer attention based on the related health consequences.