New research emerges on teen sexuality issues
By Melanie Gold, DO
Clinical Associate Professor of Pediatrics
University of Pittsburgh School of Medicine
University of Pittsburgh Student Health Service
and Kaiyti Duffy, MPH
Assistant Director of Medical Education
Physicians for Reproductive Choice
New York City
Need to catch up on your reading when it comes to teen sexuality issues? Stay current on adolescent health topics with the following reviews of six recently published papers:
• LGB adolescents.
Sexual minority youth face disproportionate risk of negative health outcomes. Though it has been widely believed that this is due to external and internal homophobia, there has been little empiric evidence to support this hypothesis until now. New research establishes a clear linkage between families rejecting lesbian, gay, and bisexual (LGB) adolescents and negative health outcomes in early adulthood.1 Published in the January 2009 issue of Pediatrics, this study demonstrates that parents' rejecting behaviors toward their LGB children dramatically compromises their children's health. This new study has important implications for the provision of services to LGB youth. Based on the article's findings, providers are encouraged to:
— ask all LGB adolescents about their families' reactions to their sexuality and gender expression, and refer them for counseling as needed;
— identify community LGB support programs and online resources for parents and teens;
— counsel parents that negative reactions to their children's LGB identities may negatively affect their children's' health;
— advise parents and caregivers to modify highly rejecting behaviors that have the greatest influence of health risks.
Though it is known that LGB youth are vulnerable, there is little data available about the prevalence of those youth in the United States. A new prospective study of 13,450 adolescents found that, overall, 8.5% of males and 16.1% of females reported a minority sexual orientation.2
• Virginity pledges.
A new study published in the January 2009 issue of Pediatrics describes the effect of taking a virginity pledge on the sexual behaviors of youth. In this study, pledgers were matched with nonpledgers in their religiosity and attitudes toward sex and birth control. Results indicated that five years after taking the pledge, 82% of pledgers denied having ever pledged. Pledgers and matched nonpledgers did not differ in their rates of sexually transmitted diseases, or their reports of anal and oral sex. Though pledgers had 0.1 fewer past-year partners, they did not differ in the number of lifetime sexual partners or their age at first intercourse. Importantly, fewer pledgers than matched nonpledgers used birth control and condoms in the past year, and fewer used birth control at last intercourse. Researchers concluded that clinicians should provide birth control information to all adolescents, especially those who take virginity pledges.3
• Contraception and BMD.
Researchers continue to examine the effect of hormonal contraception on bone mineral density (BMD) in young women. In a December 2008 study, 423 females using injectable depot medroxy- progesterone acetate (DMPA) or combination oral contraceptive pills (COCs) containing 20 mcg ethinyl estradiol and 100 mcg levonorgestrel were followed for 24 months.4 BMD measurements were obtained by using dual X-ray absorptiometry (DEXA). Though the mean percentage change in spine BMD decreased by 1.4% in the first 12 months in the DMPA group, this decrease slowed to a 0.1% decrease over the second 12 months. Echoing earlier findings, adolescent girls receiving DMPA in this study had significant loss in BMD compared with BMD gain in the COC and untreated groups. However, no BMD loss reached the level of osteopenia.
• HPV vaccine in males.
The first study evaluating the immunogenicity and safety of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (Cervarix) in males was published in the January 2009 issue of the Journal of Adolescent Health.5 Healthy males, ages 10-18, were randomized to receive HPV-16/18 AS04-adjuvanted vaccine or hepatitis B virus (HBV) control vaccine at zero, one, and six months. Participants were followed for seven months. Results indicated that all initially seronegative participants in the HPV-16/18 group seroconverted for HPV-16 and -18 at the second month. At the seventh month, all participants were seropositive, and the HPV-16 and -18 antibody levels were, respectively, four- and twofold higher than at the second month. The reactogenicity profiles of the HPV-16/18 AS04 and HBV vaccines were similar, except that pain and swelling at the injection site were more common in the HPV-16/18 group. Vaccine-related symptoms did not affect compliance with the three-dose course, which was equally high (97%) in both groups.
The authors concluded that the HPV-16/18 AS04-adjuvanted vaccine is immunogenic and well tolerated in boys ages 10-18. However, further data on the potential public health benefits of vaccination of boys are required before any recommendations can be made.
• Access to EC.
A new study was published in the January 2009 issue of Obstetrics and Gynecology exploring the effects of providing unrestricted access to emergency contraception (EC) in advance of need on various psychosocial outcomes and pregnancy.6
A total of 1,490 sexually active women ages 14-24 were randomly assigned to increased access to EC (two free packs at enrollment with unlimited free resupply) or standard access. On average, women in the increased access group had significantly stronger perceptions of both the "relative benefit" and "accessibility" of EC. Women in the increased access group were significantly more likely to report that they had ever used EC because they did not want to use condoms or another contraceptive method. Interestingly, advanced access to EC had a protective effect on those with the least aversion toward pregnancy. Among those with the most aversion toward pregnancy, increased access had a deleterious effect.6
- Ryan C, Huebner D, Diaz R, et al. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 2009; 123:346-352.
- Corliss H, Rosario M, Wypij D, et al. Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: Findings from the Growing Up Today Study. Arch Pediatr Adolesc Med 2008; 162:1,071-1,078.
- Rosenbaum J. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers. Pediatrics 2009; 123(1):e110-e120.
- Cromer BA, Bonny AE, Stager M, et al. Bone mineral density in adolescent females using injectable or oral contraceptives: A 24-month prospective study. Fertil Steril 2008; 90:2,060-2,067.
- Petäjä T, Keränen H, Karppa T, et al. Immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04- adjuvanted vaccine in healthy boys aged 10-18 years. J Adolesc Health 2009; 44:33-40.
- Weaver MA, Raymond EG, Baecher L. Attitude and behavior effects in a randomized trial of increased access to emergency contraception. Obstet Gynecol 2009; 113:107-116.