BackgroundA disproportionately high number of new HIV and sexually transmitted infection (STI) cases in the U.S. occur among teenagers. The highest risk sexual behavior for HIV transmission is anal intercourse. The risk of acquiring HIV per sexual act is estimated to be 18 times higher for receptive anal intercourse than receptive vaginal intercourse; heterosexual anal intercourse (HAI) is also associated with lower rates of condom use. This study examines the frequency of HAI and condom use, HAI motivations, and HIV knowledge among U.S. adolescents.MethodsThis study is a subgroup analysis of teenagers from a nationally representative sexual behavior survey of over five thousand women and men aged 15-50 years old, conducted in August 2015 with KnowledgePanel. We collected data from 251 teenagers aged 15-19 years old who had ever engaged in heterosexual intercourse. Data were analyzed using chi-square tests, t tests, and multivariable log-binomial regression. All estimates were based on sampling weights designed to produce nationally representative estimates. This study received IRB approval from the University of Washington.ResultsNineteen percent of teenagers reported ever having engaged in HAI. In the past three months, 15.0% have engaged in HAI, compared to 72.5% reporting vaginal intercourse. Of the 36 teenagers who reported HAI, 41% reported having ever used HAI as a method of contraception. The most common motivations for HAI were self and partner pleasure and curiosity. Male respondents were more likely to report personal pleasure as their primary motivation for HAI, while female respondents were more likely to cite their partner’s pleasure as their primary motivation (p = 0.03). Condom use rates were lower for anal versus vaginal intercourse (14.4% vs. 40.6%, p = 0.02). More than three-fourths of teenagers erroneously reported that HIV transmission risk is greater for vaginal versus anal intercourse.ConclusionsHAI is common among sexually active teenagers in the U.S. Both women and men report a wide range of motivations for both HAI and condom use with HAI. Significant knowledge gaps exist regarding HAI and HIV transmission. Health care providers should recognize that teenagers engage in anal intercourse and should inquire about types of sexual activities so they can tailor their education regarding HIV and STI risk reduction accordingly. BackgroundA disproportionately high number of new HIV and sexually transmitted infection (STI) cases in the U.S. occur among teenagers. The highest risk sexual behavior for HIV transmission is anal intercourse. The risk of acquiring HIV per sexual act is estimated to be 18 times higher for receptive anal intercourse than receptive vaginal intercourse; heterosexual anal intercourse (HAI) is also associated with lower rates of condom use. This study examines the frequency of HAI and condom use, HAI motivations, and HIV knowledge among U.S. adolescents. A disproportionately high number of new HIV and sexually transmitted infection (STI) cases in the U.S. occur among teenagers. The highest risk sexual behavior for HIV transmission is anal intercourse. The risk of acquiring HIV per sexual act is estimated to be 18 times higher for receptive anal intercourse than receptive vaginal intercourse; heterosexual anal intercourse (HAI) is also associated with lower rates of condom use. This study examines the frequency of HAI and condom use, HAI motivations, and HIV knowledge among U.S. adolescents. MethodsThis study is a subgroup analysis of teenagers from a nationally representative sexual behavior survey of over five thousand women and men aged 15-50 years old, conducted in August 2015 with KnowledgePanel. We collected data from 251 teenagers aged 15-19 years old who had ever engaged in heterosexual intercourse. Data were analyzed using chi-square tests, t tests, and multivariable log-binomial regression. All estimates were based on sampling weights designed to produce nationally representative estimates. This study received IRB approval from the University of Washington. This study is a subgroup analysis of teenagers from a nationally representative sexual behavior survey of over five thousand women and men aged 15-50 years old, conducted in August 2015 with KnowledgePanel. We collected data from 251 teenagers aged 15-19 years old who had ever engaged in heterosexual intercourse. Data were analyzed using chi-square tests, t tests, and multivariable log-binomial regression. All estimates were based on sampling weights designed to produce nationally representative estimates. This study received IRB approval from the University of Washington. ResultsNineteen percent of teenagers reported ever having engaged in HAI. In the past three months, 15.0% have engaged in HAI, compared to 72.5% reporting vaginal intercourse. Of the 36 teenagers who reported HAI, 41% reported having ever used HAI as a method of contraception. The most common motivations for HAI were self and partner pleasure and curiosity. Male respondents were more likely to report personal pleasure as their primary motivation for HAI, while female respondents were more likely to cite their partner’s pleasure as their primary motivation (p = 0.03). Condom use rates were lower for anal versus vaginal intercourse (14.4% vs. 40.6%, p = 0.02). More than three-fourths of teenagers erroneously reported that HIV transmission risk is greater for vaginal versus anal intercourse. Nineteen percent of teenagers reported ever having engaged in HAI. In the past three months, 15.0% have engaged in HAI, compared to 72.5% reporting vaginal intercourse. Of the 36 teenagers who reported HAI, 41% reported having ever used HAI as a method of contraception. The most common motivations for HAI were self and partner pleasure and curiosity. Male respondents were more likely to report personal pleasure as their primary motivation for HAI, while female respondents were more likely to cite their partner’s pleasure as their primary motivation (p = 0.03). Condom use rates were lower for anal versus vaginal intercourse (14.4% vs. 40.6%, p = 0.02). More than three-fourths of teenagers erroneously reported that HIV transmission risk is greater for vaginal versus anal intercourse. ConclusionsHAI is common among sexually active teenagers in the U.S. Both women and men report a wide range of motivations for both HAI and condom use with HAI. Significant knowledge gaps exist regarding HAI and HIV transmission. Health care providers should recognize that teenagers engage in anal intercourse and should inquire about types of sexual activities so they can tailor their education regarding HIV and STI risk reduction accordingly. HAI is common among sexually active teenagers in the U.S. Both women and men report a wide range of motivations for both HAI and condom use with HAI. Significant knowledge gaps exist regarding HAI and HIV transmission. Health care providers should recognize that teenagers engage in anal intercourse and should inquire about types of sexual activities so they can tailor their education regarding HIV and STI risk reduction accordingly.