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Purpose: The purpose of this study was to determine the extent to which sexual identity and/or sexual behaviors were associated with pregnancy risk factors (condom use, alcohol or other drug use before sex, and World Health Organization [WHO] Tier 1 [i.e., intrauterine device, implant] or Tier 2 [i.e., injectable, pill, patch, or ring] contraception use) and teen pregnancy among female high school students who reported having a sexual relationship with a male partner. Methods: Data were from the Youth Risk Behavior Survey (YRBS; 2005–2015) (n = 63,313). Logistic regression was used to analyze sexual identity and behavior disparities in pregnancy risk behaviors and teen pregnancy. Interactions between sexual identity and behavior were also tested. All models adjusted for the YRBS complex sampling frame. Results: Girls who reported being unsure of their sexual identity were less likely to use condoms or a WHO Tier 1 or Tier 2 contraceptive method at last sex, and more likely to report alcohol or other drug use at last sex than heterosexual girls. Girls who identified as lesbian were also less likely to use a condom at last sex, and girls who reported both male and female sexual partners were more likely to report alcohol or other drug use and less likely to use condoms at last sex. Girls who identified as bisexual were more likely to report pregnancy during teenage years than girls who identified as heterosexual. Conclusion: Our results support the need to assess both sexual identity and sexual behavior in research on teen pregnancy and pregnancy risk. Furthermore, the finding that girls who were unsure of their sexual identity showed heightened risk highlights the need for additional research that includes this group.

Purpose: We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Methods: Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Results: Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Conclusion: Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.