Lesbian, gay, and bisexual (LGB) youths continue to experience more violence victimization and suicide risk than heterosexual youths; however, few studies have examined whether the proportion of LGB youths affected by these outcomes has varied over time, and no studies have assessed such trends in a nationally representative sample. This report analyzes national trends in violence victimization and suicide risk among high school students by self-reported sexual identity (LGB or heterosexual) and evaluates differences in these trends among LGB students by sex (male or female) and race/ethnicity (non-Hispanic black, non-Hispanic white, or Hispanic). Data for this analysis were derived from the 2015, 2017, and 2019 cycles of CDC's Youth Risk Behavior Survey (YRBS), a cross-sectional, school-based survey conducted biennially since 1991. Logistic regression models assessed linear trends in prevalence of violence victimization and indicators of suicide risk among LGB and heterosexual students during 2015-2019; in subsequent models, sex-stratified (controlling for race/ethnicity and grade) and race/ethnicity-stratified (controlling for sex and grade) linear trends were examined for students self-identifying as LGB during 2015-2019. Results demonstrated that LGB students experienced more violence victimization and reported more suicide risk behaviors than heterosexual youths. Among LGB youths, differences in the proportion reporting violence victimization and suicide risk by sex and race/ethnicity were found. Across analyses, very few linear trends in these outcomes were observed among LGB students. Results highlight the continued need for comprehensive intervention strategies within schools and communities with the express goal of reducing violence victimization and preventing suicide risk behaviors among LGB students.

BACKGROUND: With the onset of the COVID-19 pandemic, reported rates of chlamydia and gonorrhea dropped and remained low for several months of 2020 as compared to 2019. Additional data are needed to reveal causes of reported rate changes. Here, we analyze STI-related conversations from the online-discussion platform Reddit to gain insight into the role of the pandemic on public experience of STIs in 2020. METHOD: We collected data from Pushshift's and Reddit's application programming interfaces via programs coded in Python. We focused data collection on the 'r/STD' subreddit. Collected submissions contained the term(s) "covid" and/or "coronavirus" and were submitted between 01/01/2020 and 12/31/2020. We collected the title and text of each submission. We used a Latent Dirichlet Allocation (LDA) algorithm to create a topic model of post content and complemented this approach with key term analysis and qualitative hand-coding. RESULTS: Of the 288 posts collected, 148 were complete and included in analyses. LDA revealed four main topics in the collected posts: narration of sexual experiences, STI testing, crowdsourcing of visual STI diagnoses, and descriptions of STI-related pains and treatments. Hand-coding of COVID-19 mentions revealed pandemic-related anxieties about STI care seeking and experienced delays in and changes to quality of STI care received. CONCLUSIONS: References to COVID-19 and associated mitigation efforts were woven into Reddit posts pertaining to several domains of STI care. These data support the notion that Reddit discussions may represent a valuable source of STI information, standing to corroborate and further contextualize STI survey and surveillance work.

Objective: To estimate the potential contributions of reported changes in frequency of penile-vaginal sex (PVS), condom use and STI screening to changes in gonorrhea and chlamydial diagnoses from 2012 to 2019. Methods: An agent-based model of the heterosexual population in the U.S. simulated the STI epidemics. Baseline was calibrated to 2012 diagnosis rates, testing, condom use, and frequency of PVS. Counterfactuals used behaviors from the 2017-2019 NSFG, and we evaluated changes in diagnosis and incidence rates in 2019. Results: Higher testing rates increased gonorrhea and chlamydia diagnosis by 14% and 13%, respectively, but did not reduce incidence. Declining frequency of PVS reduced the diagnosis rate for gonorrhea and chlamydia 6% and 3% respectively while reducing incidence by 10% and 9% respectively. Declining condom use had negligible impact on diagnosis and incidence. Conclusion: Understanding how changing behavior drives STI incidence is essential to addressing the growing epidemics. Changes in testing and frequency of PVS likely contributed to some, but not all, of the changes in diagnoses. More research is needed to understand the context within which changing sexual behavior and testing are occurring. © 2023 The Authors

BACKGROUND: Oral and anal sex with opposite-sex partners are common and associated with STI transmission. Trends in these behaviors over the last decade, during which bacterial STI diagnoses have reached historic highs while HIV diagnoses have decreased, are not well understood. We examined recent trends in oral and anal sex and associated condom use with opposite-sex partners among females and males. METHODS: We analyzed data from 16,926 female and 13,533 male respondents ages 15-44 who reported sex with an opposite-sex partner in the past 12 months from the National Survey of Family Growth, 2011-2019. We used survey-weighted linear or logistic regression to evaluate linear temporal trends in oral and anal sex behaviors. RESULTS: From 2011-13 to 2017-19, reports of oral sex and number of oral sex partners in the past 12 months increased among females (85.4% in 2011-13 to 89.4% in 2017-19, OR = 1.05, 95%CI = 1.02-1.09; and β = 0.014, 95%CI = 0.005-0.023; respectively) but not males (ranges = 87.9-89.1%; 1.27-1.31). Condom use at last oral sex decreased among both females and males (6.3% to 4.3%, OR = 0.93, 95%CI = 0.88-0.99; 5.9% to 4.4%, OR = 0.95, 95%CI = 0.91-1.00). Anal sex (female range = 21.0-23.3%, male = 23.3-24.6%), number of anal sex partners (females = 0.22-0.25; males = 0.26-0.30), and condom use at last anal sex (females = 15.3-18.2%; males = 27.0-28.7%) remained stable. CONCLUSIONS: The frequency of oral and anal sex with opposite-sex partners among U.S. 15-44-year-olds, paired with limited and - for oral sex - decreasing condom use, demonstrates the need to understand the role of these behaviors in increasing STI diagnosis rates and the potential role of extragenital screening and condoms in reducing STI transmission.

BACKGROUND: Telehealth offers one approach to improving access to Sexually Transmitted Infection (STI) prevention and care services. Therefore, we described recent telehealth use among those providing STI related care and identified opportunities for improving STI service delivery. MATERIALS AND METHODS: Using the DocStyles web-based, panel survey conducted by Porter Novelli from September 14 to November 10, 2021, 1,500 healthcare providers were asked about their current telehealth usage, demographics, and practice characteristics, and compared STI providers (>10% of time spent on STI care and prevention) to non-STI providers. RESULTS: Among those whose practice consisted of at least 10% STI visits (n = 597), 81.7% used telehealth compared to 75.7% for those whose practice consisted of less than 10% STI visits (n = 903). Among the providers with at least 10% STI visits in their practice, telehealth use was highest among obstetrics and gynecology specialists (OB/GYNs), those practicing in suburban areas, and those practicing in the South. Among providers whose practice consisted of at least 10% STI visits and who used telehealth (n = 488), the majority were female and OB/GYNs practicing in suburban areas of the South. After controlling for age, gender, provider specialty, and geographic location of their practice, providers whose practice consisted of at least 10% STI visits had increased odds (OR:1.51, 95% CI:1.16-1.97) of using telehealth compared to providers whose visits consisted of less than 10% STI visits. CONCLUSIONS: Given the widespread use of telehealth, efforts to optimize delivery of STI care and prevention via telehealth are important to improve access to services and address STIs in the United States.

Rates of reported gonorrhea and chlamydial infections have increased substantially over the past decade in the USA and disparities persist across age and race/ethnicity. We aimed to understand potential changes in sexual behaviors, sexual network attributes, and sexually transmitted infection (STI) screening that may be contributing to these trends. We analyzed data from 29,423 female and 24,605 male respondents ages 15-44 years from the National Survey of Family Growth, 2008-2019. We used survey-weighted linear or logistic regression to evaluate linear temporal trends in sexual behaviors with opposite-sex partners, network attributes, and STI testing, treatment, and diagnosis. Significant declines were observed in condom use at last vaginal sex, mean number of vaginal sex acts, proportion of condom-protected sex acts in the past 4weeks, and racial/ethnic homophily with current partners among males and females from 2008-2010 through 2017-2019. Among males, mean number of female partners in the past 12months and concurrency also declined, while the percent reporting ever having sex with another male increased. Past-year testing for chlamydia and any STI increased among females. Research is needed to understand how these changes interact and potentially contribute to increasing reported gonorrhea and chlamydia diagnoses and identify avenues for future intervention.

We examined mean chlamydia and gonorrhea case rates from 2014-2018 by categorizing U.S counties by social vulnerability. Overall, these rates were approximately 1.0 to 2.4 times higher in high vulnerability counties than low vulnerability counties. Percentage change in case rates from low to high social vulnerability counties varied by sex, geographic region, and urbanicity.

BACKGROUND: Recent increases in high-risk substance use (HRSU) (i.e., injection drug use, heroin, methamphetamine, crack/cocaine) have coincided with rising primary and secondary (P&S) syphilis rates. To further understand these trends, we examined sexual risk behaviors among women, men who have sex with women only (MSW) and men who have sex with men (MSM) who were diagnosed with P&S syphilis in 2018 and reported HRSU. METHODS: Data on HRSU and sexual risk behaviors among persons with P&S syphilis were drawn from syphilis case reports in 2018 from the National Notifiable Diseases Surveillance System. Persons with P&S syphilis were asked about sexual risk behaviors in the past 12 months including exchange sex for drugs/money; sex while intoxicated and/or high on drugs; sex with a person who injects drugs (PWID); sex with an anonymous partner; and number of sex partners. We describe percentages and adjusted prevalence ratios for women, MSW and MSM reporting these behaviors by age, race/Hispanic ethnicity, type of drug used, and incarceration history (both in past 12 months). RESULTS: Among 19,634 persons diagnosed with P&S syphilis in 2018 with information on HRSU, 29.3% of women, 22.7% of MSW and 12.4% of MSM reported HRSU. Among those reporting HRSU, percentages reporting exchange sex ranged from 17%-35% (highest for women), while reports of anonymous sex ranged from 44%-71% (highest for MSM). In this population, sexual risk behaviors were more commonly reported among those with recent incarceration history than those without such history. Among those reporting injection drug use or heroin use, percentages reporting sex with a PWID ranged from 51%-77%. In adjusted models, HRSU was significantly associated with one or more sexual risk behaviors for women (aPR, 2.63 (95% CI, 2.39-2.90); MSW aPR, 1.38 (95% CI, 1.31-1.46); and MSM aPR, 1.30 (95% CI, 1.26-1.34). CONCLUSIONS: Collaborative partnerships across the US public health system could help address barriers to timely clinical care among persons diagnosed with P&S syphilis who report HRSU.

Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.

BACKGROUND: Pelvic inflammatory disease (PID) is an infection of the upper genital tract that has important reproductive consequences to women. We describe the burden of and trends in PID among reproductive-aged women in the United States during 2006-2016. METHODS: We used data from 2 nationally representative probability surveys collecting self-reported PID history (National Health and Nutrition Examination Survey, National Survey of Family Growth); 5 datasets containing International Classification of Diseases, Ninth/Tenth Revision codes indicating diagnosed PID (Healthcare Utilization Project; National Hospital Ambulatory Medical Care Survey, emergency department component; National Ambulatory Medical Care Survey; National Disease Therapeutic Index; MarketScan); and data from a network of sexually transmitted infection (STI) clinics (Sexually Transmitted Disease Surveillance Network). Trends during 2006-2016 were estimated overall, by age group and, if available, race/ethnicity, region, and prior STIs. RESULTS: An estimated 2 million reproductive-aged women self-reported a history of PID. Three of 4 nationally representative data sources showed overall declines in a self-reported PID history, and PID emergency department and physician office visits, with small increases observed in nearly all data sources starting around 2015. CONCLUSIONS: The burden of PID in the United States is high. Despite declines in burden over time, there is evidence of an increase in recent years.

From 2014–2019, reported cases of three nationally notifiable sexually transmitted infections (STI) − chlamydia, gonorrhea, and primary and secondary (P&S) syphilis − have been rising in the United States (US).(https://www.cdc.gov/std/statistics/2019/default.htmhttps://www.cdc.gov/std/statistics/2019/default.htm) During this time, health inequities persisted by age with a higher burden among adolescents and young adults, and by race-ethnicity with a higher burden among subgroups other than non-Hispanic whites and non-Hispanic Asians. Racial-ethnic inequities in STI are also prevalent among adolescents aged 15–19 years. Factors commonly associated with STI that may have contributed to the recent STI increases include sexual behavior and networks, STI testing, and contextual factors (e.g., social determinants).

The sexually transmitted disease (STD) Prevention Conference occurs every 2 years, bringing together experts from government, academia, medicine, industry, and beyond. This conference is a place where advancements in STD diagnostics, treatments, and program science are unveiled alongside earnest conversations about the prevention and control challenges facing the field of STDs in the 21st century. Planning for the 2020 Conference began in late 2018—organized around the theme “2020 Vision: Disrupting Epidemics and Dismantling Disparities.” The theme spoke both to an interest in reducing the overall STD burden and to an interest in reducing that burden in such a way that centers health equity—ambitious but reasonable goals for a new decade.

Though pre-exposure prophylaxis (PrEP) can prevent HIV acquisition, it provides no protection against bacterial sexually transmitted infections (STIs). PrEP use may increase STI acquisition due to sexual risk compensation, but that could be counterbalanced by increased STI screening at regular PrEP visits. We conducted a literature search of studies with quantitative data published prior to March 2020, assessing sexual risk compensation or STI screening among men who have sex with men (MSM) before and after PrEP initiation. We identified 16 relevant publications. Changes in condom use were inconsistent across studies. Partner acquisition following PrEP initiation decreased in most studies, likely due to behavioral counseling. In publications comparing a PrEP arm to a non-PrEP arm, serodiscordance increased in the PrEP arm and decreased in the non-PrEP arm. STI screening among MSM was low within a month of PrEP initiation. Monitoring trends in sexual risk compensation and STI screening will be critical to understand PrEP's effects on STI burden.

Objective: To determine whether sexual-risk and STI-testing behaviors differ by college student status.Participants: Sexually experienced 17- to 25-year-olds from a 2013 nationally representative panel survey that evaluated the "Get Yourself Tested" campaign. Non-students (n = 628), 2-yr (n = 319), and 4-yr college students (n = 587) were surveyed.Methods: Bivariate analyses and multiple logistic regression were used.Results: Students were less likely than non-students to have had an early sexual debut and to have not used condoms in their most recent relationship. 4-yr students were less likely than non-students to have had multiple sexual partners. 2-yr students were less likely than non-students to have not used contraception in their most recent relationship.Conclusions: 2-yr and 4-yr college students were less likely than non-students to engage in sexual-risk behaviors. Given potentially greater risk for STI acquisition among non-students, identification and implementation of strategies to increase sexual health education and services among this population is needed.

OBJECTIVES: Food insecurity is linked to poor sexual health outcomes, especially among persons engaged in sexual behaviors that are associated with the risk of acquiring sexually transmitted infections (STIs). We examined this link using nationally representative data. METHODS: We used data on adolescents and adults aged 15-44 who reported sexual activity in the past year from 6 years (September 2011-September 2017) of cross-sectional, weighted public-use data from the National Survey of Family Growth. We compared data on persons who did and did not report food insecurity, accounting for demographic characteristics, markers of poverty, and past-year STI risk indicators (ie, engaged in 1 of 4 high-risk activities or diagnosed with chlamydia or gonorrhea). RESULTS: Respondents who reported at least 1 past-year STI risk indicator were significantly more likely to report food insecurity (females: adjusted risk ratio [ARR] = 1.63; 95% confidence interval [CI], 1.35-1.97; P < .001; males: ARR = 1.46; 95% CI, 1.16-1.85) than respondents who did not report food insecurity. This finding was independent of the association between food insecurity and markers of poverty (</=100% federal poverty level [females: ARR = 1.46; 95% CI, 1.23-1.72; P < .001; males: ARR = 1.81; 95% CI, 1.49-2.20; P < .001]; if the respondent or someone in the household had received Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program benefits in the past year [females: ARR = 3.37; 95% CI, 2.81-4.02; P < .001; males: ARR = 3.27; 95% CI, 2.76-3.87; P < .001]). Sex with opposite- and same-sex partners in the past year was significantly associated with food insecurity (females: ARR = 1.44; 95% CI, 1.11-1.85; P = .01; males: ARR = 1.99; 95% CI, 1.15-3.42; P = .02). CONCLUSIONS: Food insecurity should be considered a social determinant of health independent of poverty, and its effect on persons at highest risk for STIs, including HIV, should be considered when planning interventions designed to decrease engagement in higher-risk sexual behaviors.

Introduction:Sexually transmissible infections (STIs) are increasing in the US. Pregnant women and infants are susceptible to serious STI-related sequelae; however, some STIs can be cured during pregnancy with appropriate, timely screening. Methods: We used data from the 2011-15 National Survey of Family Growth to examine STI testing (in the past 12 months) among women who were pregnant in the past 12 months (n = 1155). In bivariate and multivariable analyses, we examined associations between demographics, health care access and two outcome variables, namely receipt of a chlamydia test and receipt of other STI tests. Results: Among women who were pregnant in the past 12 months, 48% reported receiving a chlamydia test and 54% reported that they received an STI test other than chlamydia in the past 12 months. In adjusted analyses, non-Hispanic Black women were more likely to receive a chlamydia test (adjusted odds ratio (aOR) 2.82; 95% confidence interval (CI) 1.86-4.26) and other STI tests (aOR 2.43; 95% CI 1.58-3.74) than non-Hispanic White women. Women living in a metropolitan statistical area but not the principal city were less likely to report chlamydia (aOR 0.62; 95% CI 0.44-0.86) and other STI (aOR 0.57; 95% CI 0.40-0.81) testing than women living in a principal city. Women born outside the US were significantly less likely to have received a chlamydia test (aOR 0.35; 95% CI 0.19-0.64) or other STI test (aOR 0.34; 95% CI 0.20-0.58), whereas those who had received prenatal care were more likely to receive a chlamydia test (aOR 2.10; 95% CI 1.35-3.28) or another STI test (aOR 2.32; 95% CI 1.54-3.49). Conclusions: The findings suggest that interventions are needed to increase adherence to recommended STI screenings during pregnancy.

From a nationally representative survey, 2011-17, we found that 80.7% of sexually active men who have sex with men were insured and 82.0% had a usual place for care but only 39.8% received sexual risk assessment and 45.8% received STD screening, of whom 58.0% received extragenital STD screening.

Opioid use and the rising case reports of STDs represent co-occurring epidemics; research indicates that persons who inject drugs (PWID) may be at increased risk for acquiring STDs. We use the National Survey of Family Growth (NSFG, 2011-2015) to examine the prevalence of risky sexual behaviors and STD diagnoses among PWID. We describe demographic characteristics, sexual behaviors, and self-reported STD diagnoses of sexually active women and men, separately, by whether they had ever engaged in injection-related behaviors (age 15-44; N=9006 women, N=7210 men). Results indicate that in 2011-15, 1.4% of women and 2.6% of men reported ever engaging in injection-related behaviors. Examining the full logistic regression models indicate that for women, sex with a PWID in the past 12months (AOR=5.8, 95% CI: 2.9, 11.7), exchanging money/drugs for sex in the past 12months (AOR=3.6, 95% CI: 1.2, 10.9), chlamydia and/or gonorrhea diagnosis in the past 12months (AOR=2.6, 95% CI: 1.2, 5.3), ever having a syphilis diagnosis (AOR=8.5, 95% CI: 3.1, 23.4), and ever having a herpes diagnosis (AOR=3.3, 95% CI: 1.0, 10.3) were associated with increased odds of engaging in injection-related behaviors. For men, sex with a PWID in the past 12months (AOR=10.9, 95% CI: 4.3, 27.7), ever being diagnosed with syphilis (AOR=5.8, 95% CI: 1.8, 18.0), and ever being diagnosed with herpes (AOR=2.7, 95% CI: 1.0, 7.1) were significantly associated with increased odds of engaging in injection-related behaviors. Future research may examine critical intervention points, including co-occurring factors in both STD acquisition and injection drug use.

BACKGROUND: Human papillomavirus (HPV) infections cause approximately 30,700 cancers annually among US men and women, cervical cancer being the most common. Human papillomavirus vaccination is recommended routinely for US girls and boys at age 11 to 12 years, and for those not previously vaccinated, through age 26 and 21 years for women and men, respectively. Our objective was to assess current cervical cancer screening and HPV vaccination practices among sexually transmitted disease (STD) clinics in the United States. METHODS: We surveyed a geographically diverse convenience sample of US STD clinics identified by members of the National Coalition of STD Directors within 65 state, territorial, and local jurisdictions. An online multiple-choice survey about clinical services was administered to clinic directors or designees during October 2014 to February 2015. RESULTS: Survey respondents included 78 clinics from 46 states and territories. Of these clinics, 31 (39.7%) offered both cervical cancer screening and HPV vaccination, 6 (7.7%) offered cervical cancer screening only, 21 (26.9%) offered HPV vaccination only, and 20 (25.6%) offered neither cervical cancer prevention service. Among those not offering the service, the most commonly reported barrier to cervical cancer screening was time constraints (25/41, 61.0%); for HPV vaccination it was reimbursement (11/26, 42.3%). CONCLUSIONS: By early 2015, in a geographically diverse group of 78 STD clinics, 39.7% provided nationally recommended HPV vaccination and cervical cancer screening, whereas 25.6% provided neither. Further research could identify strategies for STD clinics to reduce HPV-associated cancers by increasing provision of HPV vaccination and cervical cancer screening services, particularly among medically underserved populations.

The Patient Protection and Affordable Care Act is expected to reduce the number of uninsured people in the United States during the next eight years, but more than 10% are expected to remain uninsured. Uninsured people are one of the main populations using publicly funded safety net sexually transmitted disease (STD) prevention services. Estimating the proportion of the uninsured population expected to need STD services could help identify the potential demand for safety net STD services and improve program planning. In 2013, an estimated 8.27 million people met the criteria for being in need of STD services. In 2023, 4.70 million uninsured people are expected to meet the criteria for being in need of STD services. As an example, the cost in 2014 U.S. dollars of providing chlamydia screening to these people was an estimated $271.1 million in 2013 and is estimated to be $153.8 million in 2023. A substantial need will continue to exist for safety net STD prevention services in coming years.

OBJECTIVES: We examined Hispanic men's recent risky and protective sexual behaviors with female partners by acculturation. METHODS: Using the 2006-2010 National Survey of Family Growth, we performed bivariate analyses to compare acculturation groups (Hispanic Spanish-speaking immigrants, Hispanic English-speaking immigrants, Hispanic US natives, and non-Hispanic White men) by demographics and recent sexual behaviors with women. Multivariable logistic regression models for sexual behaviors by acculturation group were adjusted for demographics. RESULTS: Compared with Hispanic Spanish-speaking immigrants, non-Hispanic White men were less likely to report exchange of money or drugs for sex (adjusted odds ratio [AOR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9), but were also less likely to report condom use at last vaginal (AOR = 0.6; 95% CI = 0.4, 0.8) and anal sex (AOR = 0.4; 95% CI = 0.3, 0.7). Hispanic US natives were less likely to report condom use at last vaginal sex than were Spanish-speaking immigrants (AOR = 0.6; 95% CI = 0.4, 0.8). English- and Spanish-speaking immigrants did not differ in risky or protective sexual behaviors. CONCLUSIONS: Our findings suggest that targeted interventions focusing on unique sexual risks and sociodemographic differences by acculturation level, particularly nativity, may be helpful for preventing sexually transmitted infections.

PURPOSE: To examine national estimates of sexual behaviors and health care access by acculturation among adolescents. METHODS: Using the 2006-2010 National Survey of Family Growth, four acculturation groups of Hispanic and non-Hispanic whites aged 15-24 years were analyzed by sexual behaviors and health care access. RESULTS: In analyses adjusted for demographics, English-speaking immigrants, Hispanic natives, and non-Hispanic white youth were less likely to have a partner age difference of ≥6 years (adjusted odds ratio [AOR], .28; 95% confidence interval [CI], .13-.60; AOR, .13; 95% CI, .07-.26; AOR, .16; 95% CI, .08-.32, respectively) and more likely to use a condom at the first vaginal sex (AOR, 1.99; 95% CI, 1.10-3.61; AOR, 2.10; 95% CI, 1.33-3.31; AOR, 2.39; 95% CI, 1.53-3.74, respectively) than Spanish-speaking immigrants. Non-Hispanic white youth and Hispanic natives were more likely to have a regular place for medical care (AOR, 2.07; 95% CI, 1.36-3.16; AOR, 3.66; 95% CI, 2.36-5.68, respectively) and a chlamydia test in the past 12 months (AOR, 3.62; 95% CI, 1.52-8.60; AOR, 2.94; 95% CI, 1.32-6.54) than Spanish-speaking immigrants. CONCLUSIONS: Interventions to reduce risk and increase health care access are needed for immigrant Hispanic youth, particularly Spanish-speaking immigrants.

Using data from the 2006-2010 National Survey of Family Growth, we found that lifetime number of vaginal sex partners is positively associated with the number of sex partners in the past 12 months and negatively associated with age at first vaginal intercourse among 15- to 44-year-old male and female respondents.

BACKGROUND: To describe recent trends in the receipt of sexually transmitted disease (STD) services among women (age, 15-44 years) from 2002 to 2006-2010 using the National Survey of Family Growth. METHODS: We analyzed trends in demographics, health insurance, and visit-related variables of women reporting receipt of STD services (counseling, testing, or treatment) in the past 12 months. We also analyzed trends in the source of STD services and the payment method used. RESULTS: Receipt of STD services reported by women in the past 12 months increased from 2002 (12.6%) to 2006-2010 (16.0%; P < 0.001). Receipt of services did not increase among adolescents (P = 0.592). Among women receiving STD services from a private doctor/HMO, the percentage with private insurance decreased over time (74.6%-66.8%), whereas the percentage with Medicaid increased (12.8%-19.7%; P = 0.020). For women receiving STD services at a public clinic or nonprimary care facility, there were no statistically significant differences by demographics, except that fewer adolescents but more young adults reported using a public clinic over time (P = 0.038). Among women who reported using Medicaid as payment, receipt of STD services at a public clinic significantly decreased (36.8%-25.4%; P = 0.019). For women who paid for STD services with private insurance, the only significant difference was an increase in having a copay over time (61.3%-70.1%; P = 0.012). CONCLUSIONS: Despite a significant increase in receipt of STD services over time, many women at risk for STDs did not receive services including adolescents. In addition, we identified important shifts in payment methods during this time frame.

Little is known about national trends in sexual behavior among MSM in the U.S. Data from the 2002 and 2006-10 National Survey of Family Growth were used to compare sexual behaviors of sexually active MSM. Mean number of recent male partners significantly decreased from 2.9 in 2002 to 2.1 in 2006-10 (p=.027), particularly among young MSM. Other sexual risk behaviors did not change or decreased over time. Our findings that sexual risk decreased as HIV and syphilis increased among MSM suggest that factors in addition to individual-level sexual risk should also be examined in relation to recent disease increases.