New Study on Differences in Health by Sexual Orientation

May 25, 2022

Questions for Kevin Heslin, Health Statistician and Lead Author of “Sexual Orientation Differences in Access to Care and Health Status, Behaviors, and Beliefs: Findings from the National Health and Nutrition Examination Survey, National Survey of Family Growth, and National Health Interview Survey.”

Q: Why did you decide to do this report?

KH: Lesbian, gay, and bisexual (LGB) people have historically been underrepresented in national health surveillance systems, which has limited efforts to identify disparities in population health status and access to care by sexual orientation. However, the National Center for Health Statistics (NCHS) has included measures of sexual orientation in three nationally representative data systems for a number of years: National Health and Nutrition Examination Survey (NHANES), the National Survey of Family Growth (NSFG), and the National Health and Interview Survey (NHIS). These three surveys have complementary strengths that, when brought together in a single analysis, can provide a more KHThis is the first report to bring together national health statistics from three NCHS data systems for the purpose of analyzing these data by sexual identity. We wanted to show the breadth of topics that can be studied by researchers using NCHS data about the health of lesbian, gay, and bisexual (LGB) people.

Q: What did you find in your analysis?

KH: To a few, the analyses found that the association with sexual identity differed between men and women for several measures of health and access to care.

  • Mean body weight was lower in gay men than heterosexual men, but higher in lesbian and bisexual women than heterosexual women.
    • Gay men were more likely than heterosexual men to have received treatment for an STD in the previous 12 months, while lesbian women were less likely than heterosexual women to have received STD treatment in the last year.
    • Gay men reported having a usual place of medical care more often than heterosexual men. In contrast, both lesbian and bisexual women reported having this type of health care access less often than heterosexual women.
  • Other health measures showed similar associations according to LGB sexual orientation.
    • NHIS data showed that lesbian, gay, and bisexual adults all reported that they couldn’t afford common health services more often than heterosexual adults.
    • Bisexual men and women, gay men, and lesbian women all reported smoking and heavy drinking (NHIS) and using marijuana and illicit stimulants (NSFG) more often than heterosexual people.
  • There was some consistency in related health measures across the different data systems.
    • NHIS data showed that lesbian and bisexual women had higher lifetime prevalence of three conditions associated with overweight or obesity—diabetes, heart disease, and hypertension. These NHIS findings are consistent with findings from the NHANES physical examinations showing higher average body weight, waist circumference, and BMI in lesbian and bisexual women than heterosexual women.

Q: Is it fair to say that LGB people have more health problems and access to care problems than heterosexual people?

KH: There were some health measures that showed similar associations according to LGB sexual orientation. For instance, NHIS data showed that lesbian, gay, and bisexual adults all reported that they couldn’t afford common health services more often than heterosexual adults.

One of the strengths of this report was the stratification by sex. These findings suggest that the association of sexual identity with some indicators of health and access to care is different for men and women, which may have implications for the development of health programs and policies to reduce sexual orientation disparities and promote health equity. The results of this report also underscore how important it is to keep the bisexual and gay or lesbian categories separate in these kinds of analyses – in contrast to creating an overarching “sexual minority and heterosexual” categorization. Bisexual people were different from their gay or lesbian and heterosexual counterparts on several health indicators.

Additionally, there are other health problems and access to care problems that were beyond the scope of this report.

Q: What is the take-home message from this report?

KH: NHANES, NHIS, and NSFG enable research on topics relevant to the health of LGB people, which may inform efforts to advance health equity by focusing on disparities by sexual orientation.

Q: Are there plans for any follow-up research that looks into these issues further?

KH: NCHS data can support further health research relevant to LGB people. We analyzed a wide range of health-related topics in this report, but there’s more data and topics within all of these surveys to further advance health research.  These resources can help to monitor progress toward the goal of improving the health, safety, and well-being of LGB people.   

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QuickStats: Percentage of Women Who Have Ever Used Emergency Contraception† Among Women Aged 22–49 Years Who Have Ever Had Sexual Intercourse, by Education

January 29, 2021

Among women aged 22–49 years who have ever had sexual intercourse, 24.3% have ever used emergency contraception.

The percentage of women who have ever used emergency contraception increased with education level, from 12.6% among women without a high school diploma or GED to 27.9% among women with a bachelor’s degree or higher.

Source: National Survey of Family Growth, 2017–2019. https://www.cdc.gov/nchs/nsfg/index.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7004a7.htm

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Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019

October 20, 2020

Questions for Kim Daniels, Health Statistician and Lead Author of “Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019.”

Q: Why does the CDC collect information on contraceptive use? 

KD: Collecting information on contraceptive use from women and men of reproductive age helps inform our understanding of variation in use across groups such as by age and education.  Information on contraceptive use offers potential insight into larger fertility patterns, including birth rates and incidence of unintended pregnancies. The chance that a woman not seeking a pregnancy will have an unintended pregnancy varies by whether any method of contraception is used and which method or methods she and her partner use.

Q: Was there a specific finding in the data that surprised you from this report?

KD: This report provides a snapshot of current contraceptive status among women ages 15-49 based on data from the 2017-2019 National Survey of Family Growth (NSFG).  It describes contraceptive use and non-use during the month of interview and includes further detail on specific methods being used and reasons for non-use of contraception.  Differences in the most common methods currently used (female sterilization, oral contraceptive pill, long-acting reversible contraceptives (LARCs), and the male condom) are shown by age, Hispanic origin and race, and education.

It may not count as surprising, but some of the overall percentages for specific types of methods being used are interesting.  If you look at contraceptive status among all women (shown in Figure 2), 18.1% of all women aged 15-49 are relying on female sterilization, 14.0% on the oral contraceptive pill, 10.4% on LARCs, and 8.4% on male condoms.  Taken together that accounts for about half of women in this age range (about 37 million of the 72.7 million women aged 15-49).

Some of the differences in current contraceptive use, by age, Hispanic origin and race, and education may be surprising.  For example, there are differences by education in the use of female sterilization, the oral contraceptive pill, and LARCs, but there are no statistically significant differences seen by education in the use of male condoms, as reported by women.

Q: How did you obtain this data for this report?

KD: This report is based on data from the 6,141 women in the female respondent file of the 2017-2019 National Survey of Family Growth (NSFG).  The NSFG is a nationally representative sample of women and men ages 15-49 conducted using in-person interviews.  The 2017-2019 NSFG public-use data files are being released on the same day as this report.  Information about the survey, including how data were collected, as well as the downloadable data files and documentation, are available on the NSFG website here:  https://www.cdc.gov/nchs/nsfg/index.htm

Q: Is there any trend data for this report?

KD: This report does not include any information about trends in contraceptive use.  However, since it is an update of a report published in 2018 using NSFG data from 2015-2017, comparisons can be made between the estimates in this report and those from the 2018 report.  The 2018 report using 2015-2017 NSFG data is available on the NCHS webpage here:  https://www.cdc.gov/nchs/data/databriefs/db327-h.pdf

Q: Where can I find more NSFG data?

KD: All NSFG data files, including the 2017-2019 public-use files, released on the same day as this report’s publication, are available to download from the NSFG website here:

https://www.cdc.gov/nchs/nsfg/index.htm

The NSFG website also includes information about the survey, including how data were collected, as well as documentation about the survey methodology and how to analyze the data. Also on our website are reports published from data files released prior to this, which show statistics for contraceptive use and many other topics included in the NSFG.

Those previously published NSFG reports are available on this page:

https://www.cdc.gov/nchs/nsfg/nsfg_products.htm

This report is the first to be released with this data from 2017-2019.

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Sexual Activity and Contraceptive Use Among Teenagers Aged 15-19 in the United States, 2015-2017

May 6, 2020

Questions for Gladys Martinez, Health Statistician and Lead Author of “Sexual Activity and Contraceptive Use Among Teenagers Aged 15-19 in the United States, 2015-2017.”

Q: Why does NCHS conduct studies on sexual activity and contraception?

GM: We conduct studies on sexual activity and contraceptive use to better understand the risk for sexually transmitted diseases, birth and pregnancy rates, and differences between groups in the U.S. reproductive age population.

For this report they are crucial for understanding differences in the risk of teen pregnancy and to put into context recent declines in the U.S. teen birth rate.

Q: Can you summarize how the data varied by sex and age groups?

GM: There has been a decline in the percentage of male and female teens who ever had sex from 1988 to 2017.  But the percentage of male teens who ever had sex continues to decline in most recent time period 2011-2015 to 2015-2017, but has remained the same for female teens.

Male and female had similar:

  • cumulative probabilities of having had sex at each age in their teen years
  • relationship between age at first sex and contraceptive use: teens with younger ages at first sexual intercourse were less likely to use a method of contraception

Q: Was there a specific finding in the data that surprised you from this report?

GM: For the first time since we have been collecting these data, the cumulative probabilities of having had sex by each age in the teen years were similar for young males and females.

Ever use of implant is 15% which is an increase from 2011-2015 when it was only 3%.

Q: How did you obtain this data for this report?

GM: Data for this report are from the 2015-2017 National Survey of Family Growth, a nationally representative in-person survey of men and women aged 15-49 in the United States.

Q: Do you have older data that is comparable beyond 2002?

GM: Yes, we have been tracking these data since the 1970s and the earliest published NSFG report shows data from 1988.

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Trends and Characteristics of Sexually Transmitted Infections During Pregnancy: United States, 2016-2018

March 26, 2020

Questions for Elizabeth Gregory, Health Statistician and Lead Author of “Trends and Characteristics of Sexually Transmitted Infections During Pregnancy: United States, 2016-2018.”

Q: Why did you decide to a study on sexually transmitted infections (STI) during pregnancy?

EG: Maternal STIs during pregnancy are infrequently reported but important health issues given the potential for negative health outcomes for both women and infants. However, there have been limited studies on the prevalence and characteristics of women with STIs during pregnancy.  Data on chlamydia, gonorrhea, and syphilis were new to the 2003 revision of the birth certificate, and with all jurisdictions using the 2003 birth certificate revision starting in 2016, we decided to look at trends and rates of these STIs by selected characteristics.

Q: How did you obtain this data for this report?

EG: Birth certificate data for 2016–2018 were analyzed for trends, while a more detailed analysis was conducted using 2018 data.

Q: Can you summarize how the data varied by rates by selected characteristics?

EG: The rates for the three maternal STIs studied increased 2% (chlamydia), 16% (gonorrhea), and 34% (syphilis), from 2016 through 2018.  In 2018, rates of chlamydia and gonorrhea decreased with advancing maternal age whereas those for syphilis by maternal age decreased with age through 30-34 years and then increased for women aged 35 and older.  In 2018, rates of all three STIs were highest for non-Hispanic black women, women who smoked during pregnancy, women who received late or no prenatal care, and women for whom Medicaid was the principal source of payment for the delivery.  Among women aged 25 and over, rates of each of the STIs decreased with increasing maternal education.

Q: Do you have data that goes back further than 2016?

EG: Due to the staggered implementation of the 2003 revision of the birth certificate by the states, 2016 is the first data year for which we have national data on these items.  We do have data for earlier years, but they are subnational.

Q: What is the take home message for this report?

EG: The rates for chlamydia, gonorrhea, and syphilis increased from 2016 through 2018.  Rates for these STIs varied by selected characteristics, but were generally highest among younger women, non-Hispanic black women, women who smoked during pregnancy, women who received late or no prenatal care, and women for whom Medicaid was the principal source of payment for the delivery.

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Receipt of a Sexual Risk Assessment From a Doctor or Medical Care Provider in the Past Year Among Women and Men Aged 15–44 With Recent Sexual Activity

March 29, 2018

Questions for Casey Copen, Ph.D., M.P.H., Statistician and Author of “Receipt of a Sexual Risk Assessment From a Doctor or Medical Care Provider in the Past Year Among Women and Men Aged 15–44 With Recent Sexual Activity.”

Q: Why did you decide to examine the percentage of women and men aged 15-44 in the U.S. who received a sexual risk assessment?

CC: Sexually transmitted infections (STIs) including chlamydia and gonorrhea are among the most common reportable infections nationwide. If left untreated, STIs can result in serious health consequences, including infertility.   The first step in the prevention of HIV and other STIs is to identify the people who may be at risk.  Health care providers who talk to their patients about aspects of their sexual experience may make them aware of behaviors that may increase their risk, such as not using condoms and having multiple sexual partners.  In 2011 (for men) and 2013 (for women), four questions were added to the audio computer-assisted self-interview portion of the National Survey of Family Growth (NSFG) that asked whether a doctor or other medical care provider had questioned them in the past year about 1) their sexual orientation or the sex of their sexual partners; 2) their number of sexual partners; 3) their use of condoms; 4) the types of sex they have, whether vaginal, oral or anal.  Taken together, these questions comprise what is referred to in this report as a sexual risk assessment.  I conducted these analyses because it is important to have a general sense for whether doctors or other medical care providers ask their patients these types of questions.

Q: What are we seeing with the overall percentage of U.S. adults with recent sexual activity who received a sexual risk assessment?

CC: Overall, 47% of women and 23% of men aged 15-44 with recent sexual activity (i.e., sex with an opposite-sex or same-sex partner in the past year) received a sexual risk assessment from a doctor or other medical care provider in the past year.

Q: What differences did you see in the receipt of a sexual risk assessment by selected social, demographic and behavioral characteristics in this analysis?

CC: Receipt of a sexual risk assessment was higher among women and men aged 15-24, those who were Hispanic and Non-Hispanic black, those who had income below 300% of the poverty level, or who had public health insurance.  Additionally, receipt of a sexual risk assessment was higher among men who identified as gay or bisexual, lived in urban areas , or who had a usual place to go for medical care. Higher receipt of a sexual risk assessment was also seen for women and men who had two or more opposite-sex partners in the past compared with those who had only 1 opposite-sex sexual partner and for men who had a same-sex sexual partner in the past year or who had any HIV-related sexual risk behaviors in the past year.

Q:  Were there any findings that surprised you?

CC: It is not surprising that studies on the prevalence of sexual risk assessment are generally concerned with clinic populations (i.e., those who may be most at risk for HIV/STI infection).  However, I do find it interesting that, to my knowledge, this is the first time a nationally representative household survey has provided estimates of sexual risk assessment receipt in the general reproductive-aged population.

Q: What overall message do you hope to leave with the general public when it comes to sexual risk assessment?

CC: A sexual risk assessment is a primary prevention tool that can help identify persons at risk of HIV/STIs.  While about half of women aged 15-44 received a sexual risk assessment in the past year, for men, receipt was more focused among those who engaged in HIV risk-related behaviors in the past year.  In addition, both women and men who received a sexual risk assessment were more likely to have been tested for HIV/STI in the past year.  This positive relationship suggests that where clinical conversations about sexual behavior occur, HIV/STI testing may follow.

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Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015–2016

February 7, 2018

Geraldine McQuillan, Ph.D., Infectious Disease Epidemiologist

Questions for Geraldine McQuillan, Ph.D., Infectious Disease Epidemiologist and Lead Author of “Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14-49: United States, 2015–2016”

Q: In the first bullet in the key findings section of your new report, 47.8% is listed for 2015-2016 herpes simplex type 1 prevalence and 11.9% is listed for type 2. Yet in the last bullet there, it reads that prevalence is 48.1% and 12.1%. Why are these estimates different?

GM: This report offers two statistical estimates – a crude rate, or “real” prevalence estimate, and an age-adjusted one. If you look at the data table for Figure 1, you can see that the unadjusted prevalence — or the true prevalence for herpes simplex virus type 1 (HSV-1) — is 47.8% in the U.S population. In order to compare across subgroups that have differing age distributions, we need to age-adjust the data to allow for a more accurate comparison among groups. The age-adjusted prevalence for the total population is 48.1%. Crude rates are influenced by the underlying age distribution of a population, and age-adjusting the rates assures that differences are not due to the age distribution of the populations being compared.

Q:  What made you decide to focus on the prevalence of the herpes simplex virus for the subject of your new report?

GQ: Our main motivation for conducting this study is to offer a current assessment of herpes prevalence in the United States. Though we have included HSV-1 and -2 testing in the National Health and Nutrition Examination Survey (NHANES) since 1999, we have not looked at the data since 2010 (Bradley et al. Seroprevalence of herpes simplex virus type 1 and 2 – United States, 1999-2010. JID 2014:209; 325-333). With the addition of six more years of data and a sufficient amount of years to look at trends over time, we decided it was time to re-look at the prevalence of these common viruses in the United States.

Q:  Was there a result in your study that you had not expected and that really surprised you?

GQ: The decline in herpes simplex virus type 2 (HSV-2) across all race and ethnic groups was quite striking. The linear decline in prevalence was seen in the previous study for HSV-1 that used data from 1999-2010. There was no decline with the prevalence of HSV-2 at that time. With the addition of six more years of data, we now also see a linear downward trend for HSV-2 and again for HSV-1. We did not expect to see the decline of HSV-2 in all race and ethnic subgroups.

Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

GQ: The difference by race and ethnic subgroups in herpes simplex virus prevalence did not differ from previous reports even with the declines in prevalence in both viruses. Mexican-Americans still have the highest prevalence of HSV-1, and non-Hispanic whites have the lowest. The prevalence of HSV-2 is highest in the non-Hispanic black population and lowest in the non-Hispanic Asian population. Non-Hispanic whites and Mexican- Americans have a similar prevalence. All these race/ethnic differences have been seen in many of our infectious diseases especially those that are transmitted sexually.

Q: What is the take-home message of this report?

GQ: This is a good news data report. I think its take-home message is that two of our most prevalent viruses, HSV-1 and HSV-2, are steadily declining in the U.S population. Though NHANES provides prevalence estimates (new and old infections), once a person is infected with a herpes virus they are infected for life. The only way we see a decline is if there is a drop in new infections or a decrease in the incidence of both HSV-1 and HSV-2. While this report is a presentation of data findings, and did not go into an analysis of risk factors to determine why we are seeing this decline, other industrialized countries have observed declines in HSV-1 during the past two decades. Improvements in living conditions, better hygiene and less crowding likely explain these declines. Other countries who also have seen a decline in HSV-2 in their populations, suggest that the increase in safe-sex practices in the post-AIDS pandemic may contribute to the decline.

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Condom Use During Sexual Intercourse Among Women and Men Aged 15-44 in the United States: 2011-2015 National Survey of Family Growth

August 10, 2017

Questions for Casey Copen, Ph.D., M.P.H., Statistician and Author of “Condom use during sexual intercourse among women and men aged 15-44 in the United States: 2011-2015 National Survey of Family Growth”

Q: Why did you decide to examine condom use in this report?

CC: There are about 20 million new sexually transmitted infections (STI) in the United States each year. These infections can lead to long-term health consequences, such as infertility. Condoms can provide protection against most STIs but are often used incorrectly and inconsistently. Similarly, condoms can reduce the risk of pregnancy but have one of the highest rates of contraceptive failure of any contraceptive method.

The purpose of this report was to examine recent trends in condom use during vaginal (sexual) intercourse and measure the prevalence of condom use, alone or in combination with another contraceptive method. This information can be used to plan health services and educational programs in the U.S.

Q: Has the data in this report been previously published?

CC: Data on condom use has been collected for women since 1973 and for men, since 2002. Starting in 2013, questions on problems with condom use were asked of women aged 15-44 who used a condom during intercourse in the past 4 weeks. Periodically, the National Survey of Family Growth (NSFG) publishes reports on current contraceptive use, which includes condoms, to measure how contraceptive use among women has changed over time.

Last month, NSFG released a report on contraceptive use among female and male teens aged 15-19 that included information on condom use at first and most recent intercourse (https://www.cdc.gov/nchs/data/nhsr/nhsr104.pdf). However, the data on condom use problems have not been previously published.

Q: What do you think were the main findings of your report?

CC: In 2011-2015, 23.8% of women and 33.7% of men aged 15–44 used a condom at last sexual intercourse in the past 12 months. Among condom users aged 15-44, the majority of women and men used only a condom and no other method during last intercourse in the past 12 months (59.9% of women and 56.4% of men); another 25.0% of women and 33.2% of men used condoms plus hormonal methods; and 15.1% of women and 10.5% of men used condoms plus non-hormonal methods. Almost 7% of women aged 15–44 who used a condom in the past four weeks said the condom broke or completely fell off during intercourse or withdrawal and 25.8% said the condom was used for only part of the time during intercourse.

Q: How has the percentage of condom use in the U.S. during sexual intercourse changed since 2002?

CC: The percentages of women aged 15-44 who used condoms at last sexual intercourse in the past 12 months were similar from 2002 to 2011-2015, but for men aged 15–44, the percentages increased from 29.5% in 2002 to 33.7% in 2011–2015. Percentages of female and male condom users aged 15–44 who used condoms only at last intercourse in the past 12 months decreased from 67.9% of women and 63.0% of men in 2002 to 59.9% and 56.4% in 2011-2015. Alongside this decline, percentages of female condom users aged 15–44 who used condoms plus non-hormonal methods at last intercourse increased from 11.9% in 2006–2010 to 15.1% in 2011–2015.

Q: What is the take-home message of your report?

CC: This report showed that the majority of women and men aged 15-44 in each NSFG survey period did not use a condom at all during last sexual intercourse. It is important to note that there are many factors associated with condom nonuse, such as being in a monogamous relationship, using hormonal or other methods to prevent pregnancy or trying to get pregnant. Although this report could not address each of these factors directly, these findings indicate there are differences in condom use by age, education, Hispanic origin and race, relationship at last sexual intercourse and number of sexual partners in the past 12 months. About one-quarter of women aged 15-44 who used a condom during intercourse in the past 4 weeks reported that the condom was used for only part of the time during intercourse (25.8%), suggesting that condoms are often used inconsistently.

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Sexual Activity and Contraceptive Use Among Teenagers in the United States: 2011-2015

June 22, 2017

Questions for Joyce Abma, Ph.D., Social Scientist and Lead Author on “Sexual Activity and Contraceptive Use Among Teenagers in the United States: 2011-2015”

Q: Is the bottom line here in this study that teens are less sexually active than in the past?

JA: Yes. Although this has changed very gradually, fewer teens have ever had sex than was the case three decades ago. In the late 1980s, just over half of female teens and 61% of male teens had had sex, and the most recent data through 2015 show this percent is well under half: 42% for females and 44% for males.- So males have had a particularly large decrease in the percent who have ever had sex during the teen years.

Over the past 3 decades, since 1988, the percent of teens who had ever had sex has been declining gradually. (decreasing from over half – 51% for females and 60% for males, to under half – 42% for females and 44% for males in 2011-15). Since 2002, however, the decline slowed and there has been no significant change for female or male teens. And this plateau continued through the most recent time period, 2011-2015.

Q: Are the teens of today also more likely to use contraception than past generations?

JA: Yes. Although even about 3 decades ago, in the late 1980s, contraceptive use was common among teens – for example 84% of males used a method at last sex in 1988 – they have become increasingly more likely since then. In the most recent data, 2011-2015, 95% of males used a contraceptive method at last sex. Related to this increase among females is another big change across the time period: the development and availability of a wider variety of contraceptives for females. These include Depo-Provera injectable, implants, emergency contraception, the patch, and more recently, the IUD has been re-designed and recommended for teens. These newer hormonal methods are starting to be used more commonly, but use of the pill remains common as well among female teens.

Q: With such a sensitive topic, do you meet with a lot of resistance in trying to collect this data?

JA:  Actually, the response rate for the survey is 70%, meaning of the people eligible for the survey, 70% agree to participate and complete it. Generally, people recognize the importance, validity and value of the survey. Those who participate tend to find it an interesting and positive experience. And many topics are covered, including some questions about education, health services, attitudes and opinions, questions about children, and relationships.

Q: Do these findings include teens with same-sex partners?

JA: No, this report covers only sexual intercourse with opposite-sex partners. The purpose of the report is primarily to understand risk behaviors for pregnancy among teens, thus the focus is only on opposite sex sexual activity.

Q: Any other important points of note?

JA: There are several interesting findings in this report, both in terms of sexual activity as well as contraceptive use among teens. For example, teens who had not yet had sex – which is over half of all teens — were asked to identify the main reason they hadn’t yet had sex, from 5 possible reasons. Female and male teens were very similar in the reasons they chose. Female and male teens both chose “against religion or morals”, followed by “don’t want to get (a female) pregnant”, and “haven’t found the right person yet” as the most common reasons. So female and male teens seem to be thinking along the same lines when considering the issue of not being sexually active.

As for contraceptive use, recently the IUD and contraceptive implants have been re-designed and are recommended by reproductive health professionals for teens to reduce the chances of pregnancy. These methods, referred to as “LARC” – for “long-acting reversible contraception”– are important because they offer protection for multiple years, they don’t require regular action on the part of the teen, and their failure rates are extremely low. These methods are still relatively rarely used among teens but are being used more often: 6% of teens had ever used either of these two methods as of the 2011-15 data.

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Posted by Kim Rodriguez

Prevalence of HPV in Adults Aged 18–69: United States, 2011–2014

April 6, 2017

Questions for Geraldine McQuillan, Ph.D., Statistician, and Lead Author of “Prevalence of HPV in Adults Aged 18–69: United States, 2011–2014”

Q:  Are these the first HPV estimates you’ve released?  If not, how has this problem changed over time?

GQ:  In this report we do not examine changes over time. But based on a report authored by one of our Co-authors, Dr. Markowitz, analyzing previously released NHANES data, since the highly efficaciously vaccine against HPV 6,11 and 18 was introduced in 2006, the prevalence of high risk HPV in female adolescents has decreased by 64% and among females age 20-24 years by 34%.

Q:  What do you think is the most striking finding in your report?

GQ:  That over 20% of the adult population of the US have high risk HPV detected with significant race/ethnic differences.

Q:  What are we to make of the relatively low HPV prevalence numbers among Asians?  Are they less promiscuous/sexually active?

GQ:  This is a brief report that provides estimates on HPV prevalence overall and by race/ethnic differences.  We did not further examine the characteristics of these individuals and cannot speculate on why the prevalence may be lower among Asian adults.

Q: Your report talks about people with “high risk” HPV being at a higher risk for cancer – but what is the difference between low risk HPV and high risk HPV?  How is that determined medically?

GQ:  It is not determined medically but by a laboratory test looking at subtypes that are associated with cancer. High risk subtypes have been associated with oral, genital and anal cancers, while low risk types have been associated with warts.

Q: Are people with genital HPV at a higher risk to contract other STIs, including HIV?

GQ:  We again did not examine this in the current report, but based on prior research, we know that men who have HIV and men who have sex with men are at particular risk for anal, penile and throat cancers due to persistent HPV infection.

Q: What are the current recommendations for HPV vaccine?

GQ:  According to Dr. Lauri Markowitz with the CDC’s National Center for Immunization and Respiratory Diseases, CDC recommends two doses of HPV vaccine for 11 and 12 year olds to prevent HPV cancers. Younger adolescents need fewer doses to complete the HPV vaccination series compared to older adolescents. The first dose is recommended at 11-12 years old. Vaccination can be started at age 9. The second dose of the vaccine should be administered 6 to 12 months after the first dose. Teens and young adults who start the series at ages 15 through 26 years need three doses of HPV vaccine to protect against cancer-causing HPV infections. Adolescents aged 9 through 14 years who have already received two doses of HPV vaccine less than 5 months apart, will require a third dose. Three doses are recommended for people with weakened immune systems aged 9-26 years. Here’s a link to the press release that describes the changes: https://www.cdc.gov/media/releases/2016/p1020-hpv-shots.html

Q: What other findings in your report did you find striking?

GQ:  That among all race/ethnic groups males were significantly more likely to be infected with oral HPV except for high risk HPV among Asian adults.

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