Sexual OrientationAwareness of romantic attraction may begin 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 seen more frequently among females . A 2011 study of the nationally representative 2002 National Survey of Family Growth (NSFG) found that 11% of adolescent women and 4% of adolescent men (age 15-21) reported same-sex sexual activity. However, only 6% of adolescent women and 3% of adolescent men identified themselves as gay or bisexual .
Most lesbian, gay, bisexual, and/or transgender students experience harassment at school. In 2011, 82% of LGBTQ middle and high school students reported verbal harassment, 38% physical harassment, and 18% physical assault. Over 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, 4].
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 ExperienceHalf of all teens have dated, and close to one third have been in a relationship they describe as serious . 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 . Most teens age 15-19 have first heterosexual sex with a partner with whom they are "going steady," but the numbers are quite different for girls (70%) and boys (52%) . Sexual activity that goes beyond kissing and other "light" behaviors is 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 .
An analysis of the 2006-2010 National Survey of Family Growth (NSFG) found that among youth age 15-19, 43% of females and 42% of males had had heterosexual vaginal intercourse . In 2013, just under half (47%) of high school students reported having had sexual intercourse at some point in their lives (38% in New York State), and 34% were currently sexually active (had sexual intercourse at least once in the three months before taking the survey) . In New York State, fewer than one-third of high school students (28%) were currently sexually active . On average, youth in the U.S. first have sexual intercourse at age 17 . Over 80% of adolescent women age 15-21 who report lesbian/bisexual identities or same-sex attractions report having had sex with men .
Since 1988, there has been a steady decline in the number of teens (age 15-19) who have engaged in penile-vaginal intercourse ; however, this does not necessarily indicate that other forms of sexual activity are decreasing. Oral sex  and heterosexual anal intercourse , for example, may be increasing. One survey of 9th grade students found that 20% of respondents had had oral sex . A Guttmacher Institute study of the 2002 NSFG indicates that of all adolescents age 15-19, 54% of females and 55% of males have had heterosexual oral sex and 11% have had heterosexual anal sex. Youth who are white or have a higher socio-economic status are more likely to engage in heterosexual oral or anal sex than are youth of other groups .
Condoms and ContraceptivesAmong sexually active students, condom use at most recent sexual intercourse increased from 46% in 1991  to 60% in 2013 (63% in New York State ). Most teens use a condom or other form of contraception the first time they have sexual intercourse (78% of sexually experienced females, 85% of males) . Among sexually active students nationally, in 2013, black males reported the highest levels of condom use (73%) . In that same group, 9% of females and 7% of males reported using condoms together with another form of birth control .
According to the 2006-2010 NSFG, the most popular form of birth control among teen women age 15-19 is the condom (used at least once by 96% of sexually experienced females), followed by withdrawal (57%) and the pill (56%). Young women also indicated having at some point used the following contraceptive drugs or devices: injectables such as Depo-Provera (used by 20% of sexually experienced women age 15-19), periodic abstinence/rhythm method (15%), emergency contraception (14%), the contraceptive patch (10%), and the contraceptive ring (5%) .
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 .
Risky BehaviorsMale 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: 8% males and 3% females in 2013), and having four or more sexual partners in their lifetime (17% male high school students; 13% female high school students) .
Adolescent Pregnancy, Abortion, and Birth RatesAdolescent pregnancies are largely, but not entirely, unplanned: 82% 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 2010, the pregnancy rate among women age 15-19 declined 43% to a rate of 126.6 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 58 per 1,000 in 2010 . About 6% 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 (2010 data) . The teen abortion rate (15 abortions per 1,000 women age 15-19 in 2010) declined by 66% between 1988 and 2010 . In New York State, where over half of teen pregnancies end in abortion, the abortion rate has also declined . 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 2013, birth rates declined 57% among teens age 15-19 (to 27 births per 1,000), with a 10% drop between 2012-2013 alone .
In New York State in 2012, there were 12,592 births to women age 15-19. Most births in this group were to Latinas (4,940), followed by non-Hispanic white teens (4,003). New York's teen birth rate is 20 births per 1,000 teen women .
Sexually Transmitted Diseases (STDs) and HIVAmong 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.
Over one million people in the U.S. are living with HIV, and 7% of these are youth age 13-24 . In 2011, while only 15% of youth age 13-19 were black, black youth accounted for approximately 67% of HIV diagnoses in their age group . The same was true among young adults (age 20-24): while 14% of youth age 20-24 were black, black youth carried 58% of the burden of HIV diagnoses.
Gay, bisexual, and other men who have sex with men are at high risk, and the risk is increasing among young men. In 2011, among males age 13-19, male-to-male sexual contact accounted for nearly 93% of diagnoses. Among females in the same age group, heterosexual contact accounts for nearly 93% of diagnoses .
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