Reproductive Health Screening Disparities and Sexual Orientation in a Cohort Study of U.S. Adolescent and Young Adult Females

Abstract

Purpose To examine sexual orientation group disparities in Pap and STI/HPV tests among adolescents and young adult females. Methods Survey data from 4,224 adolescents and young adults aged 17-25 who responded to the 2005 wave questionnaire of the Growing Up Today Study were examined cross-sectionally with multivariable generalized estimating equations regression. We examined associations between sexual orientation and reproductive health care utilization as well as abnormal results with completely heterosexuals as the referent group, controlling for age, race/ethnicity, geographic region, and sexual history. Results After accounting for sociodemographics and sexual history, mostly heterosexual/bisexual females had 30% lower odds of having a Pap test within the last year and almost 40% higher odds of being diagnosed with an STI, as compared to the completely heterosexual group. Additionally, lesbians had very low odds of having a Pap test in life (OR=.13, p-value=<.0001) and having a Pap test within the last year (OR=.25, p-value=.0002), compared to completely heterosexuals. Conclusions Our study demonstrates that sexual minority adolescent and young adult women underutilize routine reproductive health screenings including Pap smears and STI tests. Providers and health educators should be aware of these disparities so that they can provide appropriate care to young women and their families and ensure that all young women receive reproductive health screening. Further research is needed to explore reasons sexual minority females are not accessing care as recommended since this may suggest opportunities to improve reproductive health screenings as well as broader health care access issues.