Sexual OrientationAwareness of romantic attraction typically begins prior to puberty . Sexual attraction, behavior, and identity are not always aligned: a person primarily attracted to women may also have sexual contact with men and may or may not identify as gay, bisexual, or straight. This fluidity may be true of both adolescents and adults, and is reported more frequently by females [2, 3].
Among youth age 15-19, according to data from the 2006-2008 National Survey of Family Growth (NSFG) :
- 11% of girls have had a same-sex partner in their lifetime, and 10% report having had a same-sex partner within the last year.
- 5% of boys have had a same-sex partner in their lifetime, and 4% report having had a same-sex partner within the last year.
- 82% of women described themselves as attracted only to the opposite sex, 9% mostly to the opposite sex, 5% equally to both, 1% mostly to the same sex, and 1% only to the same sex, with 1% unsure.
- 90% of women identified with the term "heterosexual or straight"; 2% "homosexual, gay, or lesbian"; and 6% "bisexual."
- 92% of men described themselves as attracted only to the opposite sex, 6% mostly to the opposite sex, 1% mostly to the same sex, and 1% only to the same sex, with less than 1% unsure.
- 97% of men identified with the term "heterosexual or straight"; nearly 2% "homosexual or gay"; and 1% "bisexual."
- 89% of students identified with the term "heterosexual (straight)."
- 2% identified as "gay" or "lesbian."
- 6% identified as "bisexual."
- 3% indicated they were not sure of their sexual identity.
Most lesbian, gay, bisexual, and/or transgender students experience harassment at school. In 2013, 85% of LGBTQ middle and high school students reported verbal harassment, 39% physical harassment, and 19% physical assault. About half had heard homophobic remarks from teachers or other school staff . Boys who are perceived to be gay or feminine are especially likely to face intense stigma . The presence of Gay-Straight Alliance clubs within a school setting has been demonstrated to foster a safer environment [2, 6].
Most lesbian, gay, and bisexual youth achieve health and well-being at levels similar to those achieved by heterosexual youth, though many face higher risks for violence and rejection .
Romantic Relationships and Sexual ExperienceAbout one in three 13-year-olds has had a romantic relationship (not necessarily sexual), and the number naturally increases with age: By age 17, 70% report having had a special romantic relationship within the last 18 months . Despite relatively high levels of conflict in adolescent romantic relationships, most youth report a sense of equal power, decision making, and emotional support within their relationships .
Interest in romantic and sexual contact typically begins around age 11-14 . Adolescent sexual behaviors most often occur within romantic relationships , or with friends or ex-partners . Sexual activity that goes beyond kissing and other "light" behaviors may be associated with depression and other problems in early adolescence when these behaviors are uncommon. However, these problems are not associated with sexual activity in late adolescence within the context of a romantic relationship .
In one nationally representative study, "having sex" was defined as including vaginal, anal, or oral sex. With that inclusive definition, the researchers found the median age of sexual initiation to be 16 years for both males and females. By age 19, 75% of youth have had vaginal, anal, and/or oral sex .
An analysis of the 2011-2013 NSFG found that among youth age 15-19, 44% of females and 47% of males have had heterosexual vaginal intercourse . In 2015, 41% of high school students reported having had sexual intercourse at some point in their lives (30% in New York State), and 30% were currently sexually active (had sexual intercourse at least once in the three months before taking the survey) . In New York State, about one-fourth of high school students (28%) were currently sexually active . On average, youth in the U.S. first have sexual intercourse at age 17 , and most people (68% females and 69% males) have had penile-vaginal intercourse by age 19 . Over 80% of adolescent women age 15-21 who report lesbian/bisexual identities or same-sex attractions report having had sex with men .
Heterosexual Oral Sex 
- Among young women age 15-19, 45% have had oral sex with a male.
- Among young men age 15-19, 48% have had oral sex with a female.
Heterosexual Anal Sex 
- Among young women age 15-19, 11% have had anal sex with a male.
- Among young men age 15-19, 10% have had anal sex with a female.
Same-Sex Oral or Anal Sex 
- Among young women age 15-19, 11% have had "oral sex or any sexual experience" with a female.
- Among young men age 15-19, 3% have had oral or anal sex with a male.
Condoms and ContraceptivesAmong sexually active students, condom use at most recent sexual intercourse increased from 46% in 1991 to 63% in 2003, falling to 57% by 2015 . Most teens use a condom or other form of contraception the first time they have sexual intercourse (79% of sexually experienced females, 84% of males) . Among sexually active students nationally, in 2015, black males reported the highest levels of condom use (74% at last sex) . In 2015, 9% of sexually active students reported using condoms together with another form of birth control .
According to the 2011-2013 NSFG, the most popular form of birth control among teen women age 15-19 is the condom (used at least once by 97% of sexually experienced females), followed by withdrawal (60%) and the pill (54%). Young women also indicated having at some point used the following contraceptive drugs or devices: injectables such as Depo-Provera (used by 15% of sexually experienced women age 15-19), periodic abstinence/rhythm method (15%), emergency contraception (22%), the contraceptive patch (2%), the contraceptive ring (5%), the IUD (3%), and implants (2%) .
Use of long-acting reversible contraceptives (LARCs) -- IUDs and implants -- has increased among teen women who use contraception, but remains low at 4% .
Access to Services
Among sexually experienced young women (age 15-24), use of family planning services increased between 1995 and 2002, then declined for several years. Rates were more stable in the period 2006-2010, but did not return to the utilization levels seen in 2002 . Only 37% of school-based health centers offer contraceptives to students .
Risky BehaviorsSexual exploration is a natural part of adolescent development. Certain behaviors, however, do increase risk of acquiring sexually transmitted diseases (STDs) and/or unwanted pregnancy. Multiple sex partners, early initiation of sexual intercourse, sex without a condom, and incorrect use of a condom increase the risk of poor outcomes.
Sexually experienced youth age 14-19 are quite likely to report having had at least three lifetime sexual partners (when sex is defined broadly as including oral, anal, and vaginal sex); just under half of females (45%) and just over half of males (55%) have had three or more partners .
Male adolescents are more likely than females to be exposed to or engage in certain risky sexual behaviors, including sexual intercourse before age 13 (as reported by high school students: 6% males and 2% females in 2015), and having four or more sexual partners in their lifetime (14% male high school students; 9% female high school students) . Among high school students, black males carry the highest burden of risk for intercourse before 13 (12%) and four or more partners (28%); however, as noted above, they are more likely to use condoms .
Adolescent Pregnancy, Abortion, and Birth RatesAdolescent pregnancies are largely, but not entirely, unplanned: 75% are unintended . The highest rates of unintended pregnancy are among young adult women in their early twenties . Women of color also experience disproportionately high rates of unintended pregnancy, but pregnancy rates among black and Hispanic teens are declining steeply .
Between 1990 and 2011, the pregnancy rate among women age 15-19 declined dramatically to a rate of 117.8 pregnancies per 1,000 sexually experienced teen women, the lowest rate in over 30 years . The rate more commonly cited includes all female teens, not just those who have had sex -- that rate fell to 52 per 1,000 in 2011 . About 5% of all females in this age group became pregnant . Among teens, 18-19 year old women have disproportionately high rates of pregnancy . Teens who identify as lesbian, gay, or bisexual have higher rates of pregnancy involvement than heterosexual teens .
Most pregnancies among teens end in birth (60%), while 26% end in abortion and 14% in miscarriage (2011 data) . The teen abortion rate (14 abortions per 1,000 women age 15-19 in 2011) declined by 66% between 1988 and 2011 . While most women (including teens) who have abortions do so in the first trimester of pregnancy, teens are overrepresented among women who have abortions at 13 weeks or later .
Birth rates among teens have fallen steeply since 1991, and are now at historic lows for all age and racial/ethnic groups . Between 1991 and 2015, birth rates declined 64% among teens age 15-19 (to 22 births per 1,000), with a 16% drop between 2014-2015 alone .
In New York State in 2014, there were 9,943 births to women age 15-19. Most births in this group were to Latinas (3,960), followed by non-Hispanic white teens (3,048) . Pregnancy rates for New York State teens are 17 per 1,000 females age 15-17 (25 in NYC) and 55 per 1,000 females age 18-19 (80 in NYC) .
Sexually Transmitted Diseases (STDs) and HIVOf the roughly 20 million new STD infections reported every year, half are found among young people (ages 15-24), although this age group makes up only 25% of people who are sexually experienced . The most common STD is human papillomavirus, which is contracted at some point by nearly every sexually active person. Teens age 15-19 accounted for 20% of gonorrhea and 26% of chlamydia cases reported in 2014 .
Over one million people in the U.S. are living with HIV, and 7% of these are youth age 13-24 . In 2014, while only 14% of youth age 13-19 were black, black youth accounted for approximately 63% of HIV diagnoses in their age group . The same was true among young adults (age 20-24): while 15% of youth age 20-24 were black, black youth carried 55% of the burden of HIV diagnoses.
Gay, bisexual, and other men who have sex with men are at high risk. In 2014, among males age 13-19, male-to-male sexual contact accounted for 92% of HIV diagnoses. Among females in the same age group, heterosexual contact accounted for 85% of diagnoses. Among teens with an HIV diagnosis, 81% are male and 19% are female .
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