Reproductive health screening disparities and sexual orientation in a cohort study of U.S. adolescent and young adult females

J Adolesc Health. 2011 Nov;49(5):505-10. doi: 10.1016/j.jadohealth.2011.03.013. Epub 2011 Jun 8.


Purpose: To examine sexual orientation group disparities in the Papanicolaou (Pap) and sexually transmitted infection (STI)/human papillomavirus (HPV) tests among adolescents and young adult females.

Methods: Survey data from 4,224 adolescents and young adults aged 17-25 years who responded to the 2005 wave questionnaire of the Growing Up Today Study were cross-sectionally examined with multivariate generalized estimating equations regression. We examined associations between sexual orientation and reproductive healthcare utilization as well as abnormal results with completely heterosexual 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 with the completely heterosexual group. Additionally, lesbians had very low odds of having a Pap test in their lifetime (odds ratio = .13, p ≤ .0001) and having a Pap test within the last year (odds ratio = .25, p = .0002), as compared with 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 because this may suggest opportunities to improve reproductive health screenings as well as broader healthcare access issues.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Health Status Disparities
  • Healthcare Disparities / statistics & numerical data*
  • Heterosexuality / statistics & numerical data*
  • Homosexuality, Female / statistics & numerical data*
  • Homosexuality, Male / statistics & numerical data*
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Reproductive Medicine / organization & administration
  • Sex Factors
  • Sexually Transmitted Diseases / diagnosis
  • Sexually Transmitted Diseases / epidemiology
  • United States / epidemiology
  • Young Adult