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The National Longitudinal Study of Adolescent to Adult Health (Add Health) represents a data treasure for developmental psychologists working in both adolescent and life-span development. Add Health is a nationally representative sample of more than 20,000 adolescents in grades 7–12 in 1994–1995, who were followed for 25 years into early midlife over five interview waves. The innovative multilevel design collected direct measures of the social contexts of adolescent life and tracked developmental outcomes in health, health behaviors, cognition, achievement, and relationships over time. Biological data appropriate to the developmental stages of the cohort and relevant biosocial processes were integrated into the longitudinal waves of data collection. This review describes Add Health's design and data contents and highlights illustrative Add Health articles that examine developmental processes and outcomes in the areas of mental health, health behavior, cognition, and relationships. We conclude with new opportunities for developmental analyses and suggest future areas of research.

Over the last two decades, in-person interviewing costs continued to increase while the data quality advantages traditionally identified with this data collection mode have faded. Consequently, some longitudinal surveys have begun transitioning from in-person to web data collection despite risks to data quality and longitudinal comparability. This paper addresses the major issues involved in the transition process and proposes a multi-sample, multi-phase responsive design that attempts to minimize the data quality risks while preserving the considerable cost savings promised by the transition. The paper describes the design as it was applied to the National Longitudinal Study of Adolescent to Adult Health (Add Health)—a nationally representative panel survey of around 20,000 adolescents selected from grades 7 to 12 (typically 13 to 18 years of age) in the 1994–95 school year. Also described are key results from several experiments embedded within the design and the analysis of mode effects. Also presented are some lessons learned and recommendations for other in-person panel surveys that may be contemplating a similar transition to web or mixed-mode data collection.

PURPOSE: To examine the lifetime and pre-18 sexual partnering patterns of populations with physical disabilities from adolescence to early adulthood, and how these patterns further vary by biological sex, race/ethnicity, and sexual orientation. METHODS: Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Poisson regression models were used to assess differences in pre-18 and lifetime sexual partner counts among populations with physical disabilities compared to those without disabilities. Moderation analyses by biological sex, race/ethnicity, and sexual orientation were used to consider further differences among minority subgroups. RESULTS: Results indicated more similarities than differences in sexual partnering patterns across disability severity groups. Specifically, populations with disabilities had just as many pre-18 and lifetime sexual partners as peers without disabilities. There was variation by biological sex, race/ethnicity, and sexual orientation, though this was not tied to disability status. CONCLUSIONS: These results fill an important gap in the literature by considering the sexual partnering behaviors of populations with physical disabilities in the United States over the life course. Future research should continue to include populations with disabilities and other minority groups to ensure that their experiences are represented in sexual health policies and programs. IMPLICATIONS AND CONTRIBUTION: Findings show that the sexual partnering behaviors of populations with and without disabilities are more similar than they are different, providing valuable evidence for the provision of age- and developmentally-appropriate sex education to populations with physical disabilities.

BACKGROUND: Much remains unknown about the longitudinal health and well-being of individuals with intellectual disability (ID), thus new methods to identify those with ID within nationally representative population studies are critical for harnessing these data sets to generate new knowledge. OBJECTIVE: Our objective was to describe the development of a new method for identifying individuals with ID within large, population-level studies not targeted on ID. METHODS: We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet the criteria of ID. The three criteria of ID (intellectual functioning, adaptive functioning, and disability originating during the developmental period) were derived from the definitions of ID used by the American Psychiatric Association and the American Association on Intellectual and Developmental Disabilities. The ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations included in the Add Health database from Waves 1–3. RESULTS: This method identified 441 adolescents who met criteria of ID and had sampling weights. At Wave 1, the mean age of this subsample of adolescents with ID was 16.1 years (range: 12, 21). About half of the adolescents were male (53.1%) and from minority racial groups. Their parents were predominately female (97.6%), married (53.2%), had less than a high school education (47.4%), and their median age was 41.62 years. The adolescents’ mean maximum abridged Peabody Picture Vocabulary Test standardized score was 69.6 (range: 7, 89), and all demonstrated at least one adaptive functioning limitation. DISCUSSION: This study demonstrates the development of a data-driven method to identify individuals with ID using commonly available data elements in nationally representative population datasets. By utilizing this method, researchers can leverage existing rich data sets holding potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.

CONTEXT: Despite health risks associated with minority stress, few studies have examined intimate partner violence (IPV) among sexual minorities; those that do have significant limitations. This study addresses key limitations to generate victimization and perpetration estimates in a national sample of young adults (ages 24–32). METHODS: Data are from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (n=13,668). Sexual identity categories were: 100% heterosexual (94% of males, 80% of females), mostly heterosexual (4% males, 16% females), bisexual (1% males, 2% females), mostly homosexual, and 100% homosexual (2% males, 2% females – mostly and 100% combined). IPV outcomes included physical violence (slapping, hitting, or kicking); threatened or mild violence (threats, pushing or shoving); and forced sex. Multivariate logistic regression, stratified by biological sex, was used to estimate odds of IPV victimization and perpetration. RESULTS: Compared to same-sex heterosexual peers, adjusted odds of perpetrating (1.9) and experiencing (1.6) physical IPV were higher for mostly heterosexual females and mostly heterosexual males (3.1, 1.8 respectively). Mostly heterosexual females also had higher odds of experiencing threatened violence (1.6) and forced sex (1.6), and threatening violence (2.0). Mostly heterosexual males had higher odds of perpetrating forced sex (2.0) and threatening violence (1.8). Bisexual males had higher odds of forced sex victimization (4.9) and perpetration (5.0), and physical violence victimization (3.3). CONCLUSIONS. National prevalence estimates indicate heterogeneity in IPV perpetration and victimization by sexual identity and biological sex. Heterogeneity has important policy and prevention implications that require further study of stressor mechanisms.

While disparities in depressive symptoms by race/ethnicity and gender have been documented, left unclear is how such status characteristics intersect to influence mental well-being, particularly across early life and among a diverse set of population subgroups. This study investigates how intra- and inter-individual trends in depressive symptoms unfold across a 30-year span (ages 12-42) and are structured by the intersection of race/ethnicity and gender among White, Black, Hispanic, and Asian American young adults (N=18,566). Analyses use data from the National Longitudinal Study of Adolescent to Adult Health, a nationally-representative study of adolescents who have been followed through their fourth decade of life. We draw on Waves I-IV and a representative subsample of the brand-new Wave V data. Growth curve models indicate depressive symptoms decreased across adolescence and young adulthood before increasing in the late twenties/early thirties. Racial/ethnic minorities reported more depressive symptoms than Whites. Women reported more depressive symptoms than men and experienced especially steep increases in their late 30s. Racial/ethnic-gender disparities remained stable with age, except for Hispanic-White disparities among women and Asian-White disparities among men, which narrowed with age. Overall, findings demonstrate dynamic inequalities across a longer period of the life span than was previously known, as well as heterogeneity in trajectories of poor mental health within and between racial/ethnic-gender groups. Results also suggest that Black and Asian American women experience the highest mental health risks and that interventions for reducing disparities in depressive symptoms should focus on adults in their late 20s/early 30s, particularly women of color.

Currently, little is known about patterns of co-occurring risk and protective factors among young children. Understanding variations in co-occurring risk and protective factors among children in Alaska is important as experiences of collective trauma may contribute to differences in the intersection of risk and protective factors between Alaska Native/American Indian (AN/AI) and non-Native children. Using data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of the 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System survey and administrative data sources, and the 2012–2014 Childhood Understanding Behaviors Survey, we conducted latent class analysis to identify classes of AN/AI (N=593) and non-Native (N=1,018) children in terms of seven risk factors (poverty, maternal depression, maternal binge drinking, parental incarceration, intimate partner violence exposure, other violence exposure, child maltreatment) and four protective factors (father figure involvement, reading by adults, family meals, peer interactions) experienced prior to age three years. We identified two classes among AN/AI children: 1) high risk-moderate protection (29.1%) and 2) low socioeconomic status-high protection (70.9%). We identified two classes among non-Native children: 1) moderate risk-high protection (32.9%) and 2) low risk-high protection (67.1%). A test of invariance revealed that risk and protective factor probabilities differed significantly for corresponding classes of AN/AI and non-Native children. Overall, results demonstrate heterogeneity within and between AN/AI and non-Native children in early experiences of risk and protection and suggest that interventions will be more effective if tailored to the experiences and developmental needs of specific demographic groups of Alaska children.

Introduction Although previous research has suggested a positive association between child maltreatment and BMI over the life course, it is unclear when this develops. Methods The authors used time-varying effect models and data from a nationally representative, longitudinal, cohort study (Add Health), to test how childhood physical, sexual, and emotional abuse uniquely varied in associations with BMI from age 13 to 28 years, and whether different patterns existed for male and female participants. Add Health collected data from 1994 to 2008, and the present analyses took place in 2018. Results Age 18 years was the earliest that a relationship between maltreatment and BMI emerged for either sex. Child sexual abuse was negatively associated with BMI among male participants from 18.5 to 20 years, but positively associated with BMI among female participants from 19 to 24.5 years, and childhood emotional abuse was positively associated with BMI among female participants from 18 to 28 years. Conclusions The relationship between child maltreatment and BMI varies as a function of type of maltreatment, sex, and time. Notably, associations between maltreatment and BMI did not emerge until young adulthood. Future research should investigate mechanisms by which the association between maltreatment and BMI changes over time to identify trauma-informed intervention targets for improving weight outcomes.

Background: Sexual partners are the primary source of incident HIV infection among adolescent girls and young women (AGYW) in sub-Saharan Africa. Identifying partner types at greatest risk of HIV transmission could guide the design of tailored HIV prevention interventions. Methods: We conducted a secondary analysis of data from AGYW (aged 13-23 years) enrolled in a randomized controlled trial of cash transfers for HIV prevention in South Africa Annually, AGYW reported behavioral and demographic characteristics of their 3 most recent sexual partners, categorized each partner using prespecified labels, and received HIV testing. We used latent class analysis (LCA) to identify partner types from reported characteristics, and generalized estimating equations to estimate the relationship between both LCA-identified and prespecified partner types and incident HIV infection. Results: Across 2140 AGYW visits, 1034 AGYW made 2968 partner reports and 63 AGYW acquired HIV infection. We identified 5 LCA partner types, which we named monogamous HIV-negative peer partner; one-time protected in-school peer partner; out-ofschool older partner; anonymous out-of-school peer partner; and cohabiting with children in-school peer partner. Compared to AGYW with only monogamous HIV-negative peer partners, AGYW with out-of-school older partners had 2.56 times the annual risk of HIV infection (95% confidence interval: 1.23 to 5.33), whereas AGYW with anonymous out-of-school peer partners had 1.72 times the risk (95% confidence interval: 0.82 to 3.59). Prespecified partner types were not associated with incident HIV. Conclusion: By identifying meaningful combinations of partner characteristics and predicting the corresponding risk of HIV acquisition among AGYW, LCA-identified partner types may provide new insights for the design of tailored HIV prevention interventions.

An unhealthy body mass index (BMI) trajectory can exacerbate the burdens associated with child maltreatment. However, we have yet to explain why the relationship between maltreatment and BMI trajectories exists and what allows individuals to attain healthy BMI trajectories despite adversity. Guided by the Transactional Model of Stress and Coping, we evaluated (1) if peer friendship and adult mentors moderate, and (2) if impulsivity and depressive symptoms mediate, the relationship between maltreatment experiences and average excess BMI. We used data from four waves of the National Longitudinal Study of Adolescent to Adult Health (n = 17,696), following adolescents from ages 13-21 (Wave I) to 24-31 years (Wave IV). We did not find evidence of significant moderation or mediation of the maltreatment experience to average excess BMI relationship. However, models did demonstrate a relationship between peer friendship quality and average excess BMI, such that higher quality protected against higher average excess BMI (B = −0.073, s.e. = 0.02, p < 0.001). Age of maltreatment onset was also associated with average excess BMI, such that maltreatment onset in adolescence was associated with a higher average excess BMI (B = 0.275-0.284, s.e. = 0.11, p = 0.01). Although we found no evidence of moderation by social support or mediation by stress responses of the relationship between maltreatment experiences and average excess BMI, peer friendship appears to protect against higher average excess BMI from adolescence to young adulthood for all adolescents. Future public health interventions should consider how to leverage friendship in obesity prevention efforts.

Objectives. To test whether indicators of despair are rising among US adults as they age toward midlife and whether this rise is concentrated among low-educated Whites and in rural areas. Methods. We used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of US adolescents in 1994. Our sample was restricted to individuals who participated in 1 or more of 5 waves (1994–2017) and self-identified as non-Hispanic White, non-Hispanic Black, or Hispanic (n = 18 446). We examined change in indicators of despair from adolescence to adulthood using multilevel regression analysis, testing for differences by race/ethnicity, education, and rurality. Results. We found evidence of rising despair among this cohort over the past decade. This increase was not restricted to low-educated Whites or to rural areas. Conclusions. Results suggest that generally rising despair among the young adult cohort now reaching midlife that cuts across racial/ethnic, educational, and geographic groups may presage rising midlife mortality for these subgroups in the next decade.

Summary Modelling and computation for multivariate longitudinal surveys have proven challenging, particularly when data are not all continuous and Gaussian but contain discrete measurements. In many social science surveys, study participants are selected via complex survey designs such as stratified random sampling, leading to discrepancies between the sample and population, which are further compounded by missing data and loss to follow-up. Survey weights are typically constructed to address these issues, but it is not clear how to include them in models. Motivated by data on sexual development, we propose a novel non-parametric approach for mixed scale longitudinal data in surveys. In the approach proposed, the mixed scale multivariate response is expressed through an underlying continuous variable with dynamic latent factors inducing time varying associations. Bias from the survey design is adjusted for in posterior computation relying on a Markov chain Monte Carlo algorithm. The approach is assessed in simulation studies and applied to the National Longitudinal Study of Adolescent to Adult Health.

The goal of this article was to examine gender-typed behavior longitudinally and to consider its relationship with sexual orientation in adulthood. Data were from 10,624 respondents who completed Wave 1 (adolescence), Wave 3 (emerging adulthood), and Wave 4 (early adulthood) of the National Longitudinal Study of Adolescent to Adult Health. First, we described the distributions of gender-typed behavior by adult sexual orientation at each of the three developmental stages. Next, we performed multilevel mixed regression models to assess longitudinal variation in gender-typed behavior from adolescence to adulthood within sexual orientation groups. Results showed that gender-typed behavior varied both within and between sexual orientation groups, as well as over time. For males, the differences in gender-typed behavior among the sexual orientation groups were relatively consistent at each stage, whereas differences in gender-typed behavior among sexual orientation groups varied more at each stage among females. Longitudinal models exhibited curvilinear patterns, such that gender-typed behavior strengthened from adolescence to early adulthood but peaked in emerging adulthood. To our knowledge, this is the first study to use population representative data to study gender-typed behavior both prospectively and at multiple time points from adolescence to adulthood, and to consider how such behavior is related to adult sexual orientation. This research contributes to a growing body of prospective literature on the link between gendered behavior and sexual orientation and provides further justification for more age- and cohort-specific measures of gender-typed behavior in future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This work investigates the associations between experiences of domestic minor sex trafficking and adolescent interpersonal violence victimizations, including intimate partner violence (IPV) and community violence. Abuse and violence in childhood are commonly proposed as risk factors for domestic minor sex trafficking. However, less is known about how interpersonal violence victimizations in adolescence connect to domestic minor sex trafficking experiences. The poly-victimization framework provides a means to understand domestic minor sex trafficking as a type of violence amid a web of additional interconnected violence victimizations. Efforts to better understand the interpersonal violence experienced by survivors of domestic minor sex trafficking are valuable in contextualizing trafficking experiences for adolescents. Data from The National Longitudinal Study of Adolescent to Adult Health, a population-based sample of adolescents in the United States ( n = 12,605) were used to examine experiences of domestic minor sex trafficking for minor respondents, as measured through questions about exchanging sex for money or drugs. A multivariable logistic regression model was used to estimate the associations between domestic minor sex trafficking and IPV or community violence, while controlling for demographic variables and adolescent risk behaviors. Minors who experience community violence had significantly greater odds of having exchanged sex (aOR: 1.86; 95% CI: 1.32 -2.64). However, IPV was not significantly associated with minors’ experiences of sex exchange (aOR: 1.14; 95% CI: 0.85 -1.54). Alcohol or drug use (aOR: 1.87; 95% CI: 1.32 -2.65) and having run away (aOR: 2.04; 95% CI: 1.53 -2.72) were also significantly associated with minor sex exchange. As experiences of domestic minor sex trafficking were significantly associated with community violence victimizations, prevention and intervention efforts targeting youth at high risk for or survivors of domestic minor sex trafficking should consider how community violence victimizations impact these adolescent populations, and programming/messaging should be adjusted to account for these additional violence victimizations.

Funding reductions combined with increasing data-collection costs required that Wave V of the USA’s National Longitudinal Study of Adolescent to Adult Health (Add Health) abandon its traditional approach of in-person interviewing and adopt a more cost-effective method. This approach used the mail/web mode in Phase 1 of data collection and in-person interviewing for a random sample of nonrespondents in Phase 2. In addition, to facilitate the comparison of modes, a small random subsample served as the control and received the traditional in-person interview. We show that concerns about reduced data quality as a result of the redesign effort were unfounded based on findings from an analysis of the survey data. In several important respects, the new two-phase, mixed-mode design outperformed the traditional design with greater measurement accuracy, improved weighting adjustments for mitigating the risk of nonresponse bias, reduced residual (or post-adjustment) nonresponse bias, and substantially reduced total-mean-squared error of the estimates. This good news was largely unexpected based upon the preponderance of literature suggesting data quality could be adversely affected by the transition to a mixed mode. The bad news is that the transition comes with a high risk of mode effects for comparing Wave V and prior wave estimates. Analytical results suggest that significant differences can occur in longitudinal change estimates about 60 % of the time purely as an artifact of the redesign. This begs the question: how, then, should a data analyst interpret significant findings in a longitudinal analysis in the presence of mode effects? This chapter presents the analytical results and attempts to address this question.

To compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB). We used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospective cohort of women who had a live birth covered by Medicaid between September 2011 and 2012 (n = 58,201). To estimate the odds of receipt of contraception by PTB status (24–36 weeks compared to 37–42 weeks [referent]), we used logistic regression and tested for interaction by parity. To estimate the relationship between PTB and method effectiveness based on the Center for Disease Control and Prevention Levels of Effectiveness of Family Planning Methods (most, moderate and least effective [referent]), we used multinomial logistic regression. Less than half of all women with a live birth covered by Medicaid in North Carolina had a contraceptive claim within 90 days postpartum. Women with a recent PTB had a lower prevalence of contraceptive receipt compared to women with a term birth (45.7% vs. 49.6%). Women who experienced a PTB had a lower odds of receiving contraception. When we stratified by parity, women with a PTB had a lower odds of contraceptive receipt among women with more than two births (0.79, 95% CI 0.74–0.85), but not among women with two births or fewer. One-fourth of women received a most effective method. Women with a preterm birth had a lower odds of receiving a most effective method (0.83, 95% CI 0.77–0.88) compared to women with a term birth. Contraceptive receipt was low among women with a live birth covered by Medicaid in North Carolina. To optimize contraceptive use among women at risk for subsequent preterm birth, family planning strategies that are responsive to women’s priorities and context, including a history of preterm birth, are needed. Access to free or affordable highly effective contraception is associated with reductions in preterm birth. Self-report data indicate that women with a very preterm birth (PTB) are less likely to use highly or moderately effective contraception postpartum compared to women delivering at later gestational ages. Using Medicaid claims data, we found that less than half of all women with a Medicaid covered delivery in North Carolina in 2011–2012 had a contraceptive claim within 90 days postpartum, and one fourth received a most effective method. Women with a PTB and more than two children were least likely to receive any method. Family planning strategies that are responsive to women’s priorities and context, including a history of preterm birth, are needed so that women may access their contraceptive method of choice in the postpartum period.

This study used population-representative data to examine associations of risk and protective factor patterns among Alaska Native/American Indian (AN/AI; N = 592) and non-Native (N = 1,018) children with maternal and child outcomes at age 3 years. Among AN/AI children, a high risk/moderate protection class was associated with child developmental risk and mothers being less likely to feel comfortable asking for help or knowing where to go for parenting information compared to a low socioeconomic status/high protection class. Among non-Native children, a moderate risk/high protection class was associated with child developmental risk and mothers being less likely to feel comfortable asking for help compared to a low risk/high protection class. Results provide insight on the intersection of risk and protective factors among Alaska families.

This study examines the relationship between childhood maltreatment experiences and body mass index (BMI) over time. Using data from the National Longitudinal Study of Adolescent to Adult Health, we use latent profile analysis to create child maltreatment experience classes and latent growth modeling to understand how classes relate to BMI trajectories from adolescence to early adulthood. The best-fitting model suggests four child maltreatment experience classes: 1) poly-maltreatment (n=607); 2) physical abuse (n=1,578); 3) physical abuse and neglect (n=345); and 4) no childhood maltreatment (n=4,188). Class membership differentially predicts BMI trajectories, such that individuals in the no maltreatment, physical abuse, and physical abuse plus neglect classes exhibit the most stable BMI, and individuals in the poly-maltreatment class increase most rapidly (Χ(2)[9]=149.9, p < 0.001). Individuals in the poly-maltreatment class experience significantly higher BMI over time compared to the other three classes. In addition to overall growth differing between classes, there is substantial inter-individual variability in BMI trajectories within each class. Because BMI trajectories differ across different childhood maltreatment experiences—and substantial variability in BMI trajectories exists within these different experiences—future analyses should investigate mediators and moderators of this relationship to inform trauma-based therapies and interventions.

Background: A single measure that distills complex body mass index (BMI) trajectories into one value could facilitate otherwise complicated analyses. This study creates and assesses the validity of such a measure: average excess BMI. Methods: We use data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (n=17 669). We calculate average excess BMI by integrating to find the area above a healthy BMI trajectory and below each subject-specific trajectory and divide this value by total study time. To assess validity and utility, we (1) evaluate relationships between average excess BMI from adolescence to adulthood and adult chronic conditions, (2) compare associations and fit to models using subject-specific BMI trajectory parameter estimates as predictors, and (3) compare associations to models using BMI trajectory parameter estimates as outcomes. Results: Average excess BMI from adolescence to adulthood is associated with increased odds of hypertension (OR = 1.56; 95% CI: 1.47, 1.67), hyperlipidemia (OR = 1.36; 95% CI: 1.26, 1.47), and diabetes (OR = 1.57; 95% CI: 1.47, 1.67). The odds associated with average excess BMI are higher than the odds associated with the BMI intercept, linear, or quadratic slope. Correlations between observed and predicted health outcomes are slightly lower for some models using average excess BMI as the focal predictor compared to those using BMI intercept, linear, and quadratic slope. When using trajectory parameters as outcomes, some covariates associate with the intercept, linear, and quadratic slope in contradicting directions. Conclusions: This study supports the utility of average excess BMI as an outcome. The higher an individual’s average excess BMI from adolescence to adulthood, the greater their odds of chronic conditions. Future studies investigating longitudinal BMI as an outcome should consider using average excess BMI, whereas studies that conceptualize longitudinal BMI as the predictor should continue using traditional latent growth methods.

School attendance prevents HIV and herpes simplex virus-2 (HSV-2) in adolescent girls and young women, but the mechanisms to explain this relationship remain unclear. Our study assesses the extent to which characteristics of sex partners, partner age, and number mediate the relationship between attendance and risk of infection in adolescent girls and young women in South Africa.We use longitudinal data from the HIV Prevention Trials Network 068 randomized controlled trial in rural South Africa, where girls were enrolled in early adolescence and followed in the main trial for more than 3 years. We examined older partners and the number of partners as possible mediators.We used the parametric g-formula to estimate 4-year risk differences for the effect of school attendance on the cumulative incidence of HIV/HSV-2 overall and the controlled direct effect (CDE) for mediation. We examined mediation separately and jointly for the mediators of interest.We found that young women with high attendance in school had a lower cumulative incidence of HIV compared with those with low attendance (risk difference = -1.6%). Partner age difference (CDE = -1.2%) and the number of partners (CDE = -0.4%) mediated a large portion of this effect. In fact, when we accounted for the mediators jointly, the effect of schooling on HIV was almost removed, showing full mediation (CDE = -0.3%). The same patterns were observed for the relationship between school attendance and cumulative incidence of HSV-2 infection.Increasing school attendance reduces the risk of acquiring HIV and HSV-2. Our results indicate the importance of school attendance in reducing partner number and partner age difference in this relationship.

Background Longitudinal studies on resilience among children who have experienced maltreatment indicate that resilience is multi-dimensional. However, most research consolidates diverse developmental domains comprising resilience into a single score, which does not allow for detection of potentially heterogeneous associations between risk factors and outcomes of resilience processes. Objective This study seeks to improve our understanding of the association between early child maltreatment and development through middle childhood (6–12 years) using individual domains considered to be outcomes of resilience processes. Participants and setting Participants are 499 children from the Longitudinal Studies of Child Abuse and Neglect. Methods We used latent growth curve models to explore patterns of socialization and daily living skills, and internalizing and externalizing behaviors – outcomes of resilience processes – across three time points in middle childhood, and their association with early maltreatment, defined as referral to Child Protective Services (CPS) before age 6. Results In fully adjusted models, children experiencing early maltreatment had poorer baseline scores in activities of daily living (−4.22, 95% CI [−7.38, −1.46]) and externalizing behavior (2.95, 95% CI [1.05, 4.86]), but maltreatment was not associated with change over time in these domains. However, maltreatment was associated with increases in internalizing behavior over time (0.42, 95% CI [0.06, 0.77]). Conclusion Heterogeneity in patterns of association between maltreatment and outcomes of resilience processes support the utility of examining developmental domains individually, versus as a composite, to identify specific targets for intervention.

Male perpetration of intimate partner violence (IPV) against women in sub-Saharan Africa is widespread. Theory and empirical evidence suggest peer networks may play an important role in shaping IPV perpetration, though research on this topic in the region is limited. We assessed the degree to which peer network gender norms are associated with Tanzanian men's perpetration of IPV and examined whether the social cohesion of peer networks moderates this relationship. Using baseline data from sexually active men (n = 1103) nested within 59 peer networks enrolled in an on-going cluster-randomized HIV and IPV prevention trial, we fit multilevel logistic regression models to examine peer network-level factors associated with past-year physical IPV perpetration. Peer network gender norms were significantly associated with men's risk of perpetrating IPV, even after adjusting for their own attitudes toward gender roles (OR = 1.53 , p = . 04). Peer network social cohesion moderated this relationship (OR = 1.50 , p = . 04); the positive relationship between increasingly inequitable (i.e., traditional) peer network gender norms and men's risk of perpetrating IPV became stronger, as peer network social cohesion increased. Characteristics of the peer network context are associated with men's IPV perpetration and should be targeted in future interventions. While many IPV prevention interventions focus on changing individual attitudes, our findings support a unique approach, focused on transforming the peer context.

CONTEXT The typical understanding of sexual debut as first vaginal intercourse is often irrelevant to sexual minority youth. Better understanding of sexual initiation patterns among these youth is necessary to inform efforts to safeguard their sexual and reproductive health. METHODS Early sexual experiences were examined among 1,628 female and 526 male sexual minority participants in Waves 1 (1994–1995) and 4 (2008) of the National Longitudinal Study of Adolescent to Adult Health. Latent class analyses identified initiation patterns distinguished by the timing, sequence and spacing of first experiences of sexual behaviors. Multinomial logistic regression analyses assessed correlates of various patterns. RESULTS Initiation classes for females were categorized as typical debut (representing 41% of the sample, characterized by vaginal intercourse and short spacing between first two behaviors); dual behavior debut (35%, characterized by vaginal and oral sex in the same year); early sexual debut (17%, characterized by average debut at 13, vaginal intercourse, and anal sex before 18); and delayed debut with oral sex (6%). Male classes were single behavior (50%, characterized by oral sex and longer spacing); multiple behavior (32%, characterized by vaginal and oral sex); early anal sex (11%, characterized by anal intercourse before 18); and very early debut (6%, characterized by oral sex and average debut at 10). Class membership was associated with socioeconomic status for females; age and sexual victimization for males; and race, ethnicity and religiosity for both. CONCLUSIONS Initiation patterns of sexual minority youth differ between genders and involve noncoital behaviors and characteristics beyond timing.

Our objective was to identify preconception and prenatal predictors of early experiences of co-occurring risk and protective factors to help target prevention efforts to the highest-need families prior to the birth of the child. Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage project and the 2012–2014 Alaska Child Understanding Behaviors Survey. We used latent class analysis and Vermunt’s three-step approach to examine predictors of latent classes of risk and protective factors among Alaska children. Among children of Alaska Native/American Indian mothers, financial (OR 2.02, 95% CI 1.04, 3.90) and partner stress (OR 2.06, 95% CI 1.02, 4.10) prior to childbirth, maternal education

Surveys often require monitoring during data collection to ensure progress in meeting goals or to evaluate the interim results of an embedded experiment. Under complex designs, the amount of data available to monitor may be overwhelming and the production of reports and charts can be costly and time consuming. This is especially true in the case of longitudinal surveys, where data may originate from multiple waves. Other such complex scenarios include adaptive and responsive designs, which were developed to act on the results of such monitoring to implement prespecified options or alternatives in protocols. This paper discusses the development of an interactive web-based data visualization tool, the Adaptive Total Design (ATD) Dashboard, which we designed to provide a wide array of survey staff with the information needed to monitor data collection daily. The dashboard was built using the R programming language and Shiny framework and provides users with a wide range of functionality to quickly assess trends. We present the structure of the data used to populate the dashboard, its design, and the process for hosting it on the web. Furthermore, we provide guidance on graphic design, data taxonomy, and software decisions that can help guide others in the process of developing their own data collection monitoring systems. To illustrate the benefits of the dashboard, we present examples from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We also discuss features of the dashboard to be developed for future waves of Add Health.

OBJECTIVE: To provide national estimates of Donor Insemination (DI) use in the United States and a description of the population of users. DESIGN: Population estimates were generated from nationally-representative data through weighted proportions and count estimates. SETTING: Surveys were conducted on samples selected in 1995, 2002, and continuously in the years 2006–2010, 2011–2013, 2013–2015, and 2015–2017 in the United States. PATIENTS: Participants were U.S. women of childbearing age (15–44) sampled for interview in the National Survey of Family Growth. INTERVENTIONS: No interventions were conducted in this descriptive study. MAIN OUTCOME MEASURES: Respondents who reported having received artificial insemination were asked the origin of the sperm; responses could include husband/partner, donor only, or mixed donor and husband/partner. RESULTS: In 1995, an estimated 170,701 [95% CI: 106,577 – 234,825] women had undergone DI using donor or mixed sperm. In 2015–2017, 440,986 [95% CI: 108,458 – 773,513] were estimated to have used it. DI users were mostly White, urban, older, college-educated, and had high family incomes. CONCLUSIONS: DI use changed over time, from a drop between 1995 and 2013 to a precipitous growth in 2015–2017. In recent years, nearly half a million women may be dealing with personal, relationship, and familial issues born of DI use. The U.S. does not maintain records on the usage of donor sperm, but better tracking of the use and outcomes of treatment would provide better estimates of the size of the population affected.

Background Contact with child protective services (CPS) functions as an independent marker of child vulnerability. Alaska children are an important population for understanding patterns of CPS contact given high rates of contact overall and among specific demographic groups. Objective We aimed to identify longitudinal trajectory classes of CPS contact among Alaska Native/American Indian (AN/AI) and non-Native children and examine preconception and prenatal risk factors associated with identified classes. Participants and setting We used data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) births with administrative data including CPS records. Methods We conducted growth mixture modeling to identify trajectory classes of CPS contact from birth to age five years. We used Vermunt’s three-step approach to examine associations with preconception and prenatal risk factors. Results Among AN/AI children, we identified three classes: 1) no/low CPS contact (75.4%); 2) continuous CPS contact (19.6%), and 3) early, decreasing CPS contact (5.0%). Among non-Native children, we identified four classes: 1) no CPS contact (81.3%); 2) low, increasing CPS contact (9.5%); 3) early, rapid decline CPS contact (5.8%); and 4) high, decreasing CPS contact (3.3%). Maternal substance use had the largest impact on probabilities of class membership, increasing the probability of membership in classes characterized by CPS contact, among both AN/AI and non-Native children. Conclusions Results reveal heterogeneity in longitudinal patterns CPS contact across early childhood among Alaska children and identify maternal substance use as an important target for primary prevention.

The study tested if sexual orientation is associated with metabolic syndrome (MetS) in young adulthood (ages 24-32), and if economic strain impacts associations.Gender-stratified logistic regressions were fit among 11,575 young adults (1644 sexual minority [SM]) in Wave IV of The National Longitudinal Study of Adolescent to Adult Health.MetS was not associated with sexual orientation for either gender, yet economic strain was more prevalent among both SM males and females. Additional MetS risk factors (smoking, binge drinking, and lower education) emerged for SM females.Although MetS did not differ by sexual orientation, emergent sexual orientation disparities among females suggest increased future risk.

Self-rated health (SRH) is one of the most important social science measures of health. Yet its measurement properties remain poorly understood. Most studies ignore the measurement error in SRH despite the bias resulting from even random measurement error. Our goal is to estimate the measurement reliability of SRH in contemporaneous, retrospective, and proxy indicators. We use the National Longitudinal Study of Adolescent to Adult Health to estimate the reliability of SRH relative to proxy assessments and respondents’ recollections of past health. Even the best indicators – contemporaneous self-reports – have a modest reliability of ~0.6; retrospective and proxy assessments fare much worse, with reliability less than 0.2. Moreover, not correcting for measurement error in SRH leads to a ~20–40% reduction in its correlation with other measures of health. Researchers should be skeptical of analyses that treat these subjective reports as explanatory variables and fail to take account of their substantial measurement error.

Purpose Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship, and if so, in which direction it operates and how it may vary by sex. We examined the longitudinal associations between substance use frequency and depressive symptoms from adolescence into young adulthood and whether the associations were moderated by sex. Methods With data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 9,816), we used growth curve models to test if depressive symptoms predicted marijuana use or binge drinking frequency (Self-Medication Model) or if substance use frequency predicted depressive symptoms (Stress Model). Moderation by sex and age was tested for both potential pathways. Results Increases in adolescent depressive symptoms, compared to no symptoms, were associated with a steeper predicted increase in marijuana use frequency from adolescence to young adulthood. Increases in persistent binge drinking or marijuana use frequency had concurrent positive associations with depressive symptoms from adolescence to young adulthood, and these associations were significantly stronger for females compared to males. Conclusions The results not only support the Self-Medication Model for marijuana use but also provide modest support for the Stress Model, that substance use is associated with depressive symptoms, especially for females.

Past evidence has documented that attitudes toward marriage and cohabitation are related to sexual behavior in adolescence and young adulthood. This study extends prior research by longitudinally testing these associations across racial/ethnic groups and investigating whether culturally relevant variations within racial/ethnic minority groups, such as skin tone (i.e., lightness/darkness of skin color), are linked to attitudes toward marriage and cohabitation and sex. Drawing on family and public health literatures and theories, as well as burgeoning skin tone literature, it was hypothesized that more positive attitudes toward marriage and negative attitudes toward cohabitation would be associated with less risky sex, and that links differed for lighter and darker skin individuals. The sample included 6872 respondents (49.6 % female; 70.0 % White; 15.8 % African American; 3.3 % Asian; 10.9 % Hispanic) from the National Longitudinal Study of Adolescent to Adult Health. The results revealed that marital attitudes had a significantly stronger dampening effect on risky sexual behavior of lighter skin African Americans and Asians compared with their darker skin counterparts. Skin tone also directly predicted number of partners and concurrent partners among African American males and Asian females. We discuss theoretical and practical implications of these findings for adolescence and young adulthood.

Cash transfer programmes have recently emerged as promising interventions for HIV prevention among adolescents in Africa. However, the pathways through which risk reduction occurs are not well understood. We examine data on 1429 adolescents and youth from the Kenya Cash Transfer for Orphans and Vulnerable Children, which has been shown to result in delayed sexual debut among adolescents. We explored three potential mediating pathways: schooling, socio-economic status and psycho-social status. None of these hypothesised mediators greatly altered the main effect. However, school attendance had a larger protective effect on sexual debut among females but was only increased by the programme among males. This gendered pattern of effects may explain why we did not see a mediating effect of the cash transfer through schooling, despite schooling's protective effects against early sexual debut. Results also suggest that cash transfer programmes in Africa can contribute to the reduction of HIV related risk behaviours.

Time discounting is thought to influence decision-making in almost every sphere of life, including personal finances, diet, exercise and sexual behaviour. In this article, we provide evidence on whether a national poverty alleviation programme in Kenya can affect inter-temporal decisions. We administered a preferences module as part of a large-scale impact evaluation of the Kenyan Government's Cash Transfer for Orphans and Vulnerable Children. Four years into the programme, we find that individuals in the treatment group are only marginally more likely to wait for future money, due in part to the erosion of the value of the transfer by inflation. However, among the poorest households for whom the value of transfer is still relatively large we find significant programme effects on the propensity to wait. We also find strong programme effects among those who have access to credit markets though the programme itself does not improve access to credit.

Background Timing of first sex has important implications for later sexual health, but little research has considered this in populations with physical disabilities. Objective The purpose of this paper was to examine timing of sexual experiences among populations with physical disabilities in the United States from adolescence to early adulthood, and how timing varies by biological sex, race/ethnicity, and sexual orientation. We hypothesized that those with physical disabilities would exhibit earlier initiation of each type of sexual activity compared to those without disabilities, but the degree of differences would depend on disability severity. We further hypothesized that these associations would be moderated by biological sex, race/ethnicity, and sexual orientation. Methods Data were from 13,458 respondents to Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health. Cox proportional hazards models assessed differences in timing of vaginal, oral, anal, and first sex by disability severity. Results Populations with the most severe physical disabilities had a significantly slower progression to first vaginal sex, oral sex, and their first sexual experience compared to those without disabilities (aHR: 0.74–0.77). Timing also differed by biological sex, race/ethnicity, and sexual orientation, though the direction and degree of these differences varied by disability severity. Conclusions Results fill an important gap in the literature by considering variations in sexual timing among populations with physical disabilities using a longitudinal, nationally representative sample. Future research should continue to promote inclusion of populations with disabilities to inform future policies and programs for healthy sexual development.

The present study tests the assumption that peers wield sufficient influence to induce sexual homophily (i.e., similarities in sexual experiences). Because girls face greater stigma for their sexual experiences than do boys, sexual homophily may be greater in girls' friendship networks than in boys'. Stochastic actor-based models were used to analyze network data (n = 2,566; ages 14-18) from two high schools in the National Longitudinal Study of Adolescent to Adult Health. Sexual homophily was present in friendship networks. Girls and boys were equally susceptible to their friends' influence, but the former exhibited a stronger preference for befriending same sexual debut status peers than the latter. The findings suggest that adolescents-particularly girls-"curate" their networks to minimize peer ostracism. [ABSTRACT FROM AUTHOR]

Substance use is prevalent among adolescents in the U.S., especially males. Understanding the cross-sectional and longitudinal associations between gender norms and substance use is necessary to tailor substance use prevention messages and efforts appropriately. This study investigates the relationship between adherence to gender-typical behavior (AGB) and substance use from adolescence into young adulthood. Participants in the National Longitudinal Study of Adolescent to Adult Health completed self-report measures on the frequency of binge drinking, cigarette smoking and marijuana use as well as various behaviors and emotional states that captured the latent construct of AGB. Sex-stratified logistic regression models revealed cross-sectional and longitudinal relationships between AGB and high frequency substance use. For example, an adolescent male who is more gender-adherent, compared to less adherent males, has 75% higher odds of high frequency binge drinking in adolescence and 22% higher odds of high frequency binge drinking in young adulthood. Sex-stratified multinomial logistic regression models also revealed cross-sectional and longitudinal relationships between AGB and patterns of use. For example, a more gender-adherent adolescent male, compared to one who is less adherent, is 256% more likely to use all three substances in adolescence and 66% more likely to use all three in young adulthood. Cross-sectional and longitudinal results for females indicate greater gender-adherence is associated with lower odds of high frequency substance use. These findings indicate adherence to gender norms may influence substance use behaviors across the developmental trajectory, and inform strategies for prevention efforts.

OBJECTIVES: To refine by qualitatively comparing a patient-centered contraceptive effectiveness poster to a Centers for Disease Control and Prevention (CDC) poster based on comprehension, relevance, acceptability, design, and overall preference. STUDY DESIGN: We conducted cognitive interviews with 26 women aged 18–44 living in North Carolina who spoke and read English and had ever had sex. We interviewed women about both a CDC and a patient-centered poster in alternating order. Participants were contraceptive users and non-users that we selected purposively to have a range of characteristics that might influence their perspective: age, race/ethnicity, previous births and pregnancies, contraceptive method(s) used in the past three months, pregnancy intentions, and numeracy. The initial response rate for participants was 55%. We coded the interviews for comprehension, relevance, and acceptability as defined in cognitive theory, as well as design and overall preference. We structured the 26 interviews into four rounds and revised the patient-centered poster after each round to improve these measures. RESULTS: By the final round, 83% of women preferred the patient-centered poster overall, and it was preferred by the majority of women in terms of comprehension (86%), relevance (86%), and design (100%). Women raised few concerns about the acceptability of the final version of the patient-centered poster. Women identified many issues with both posters that the researchers did not anticipate, highlighting the value of patient-centered design approaches to educational materials. CONCLUSIONS: This study refined a patient-centered poster so that its language is clear and it addresses the informational needs of its target audience. IMPLICATIONS: The Centers for Disease Control and Prevention and the Office of Population Affairs recommend that clinicians educate women about contraception. This study developed a poster that could help clinicians follow this recommendation. Before widespread implementation, more research is needed to evaluate the poster’s impact on contraceptive knowledge and behaviors.

Objectives Herpes simplex virus type 2 (HSV-2) biomarkers are often used in adolescent sub-Saharan HIV prevention studies, but evaluations of test performance and disclosure outcomes are rare in the published literature. Therefore, we investigated the proportion of ELISA-positive and indeterminate samples confirmed by western blot (WB), the psychosocial response to disclosure and whether reports of sexual behaviour and HSV-2 symptoms are consistent with WB confirmatory results among adolescent orphans in Kenya. Methods In 2011, 837 Kenyan orphan youth in grades 7 and 8 enrolled in an HIV prevention clinical trial with HSV-2 biomarker outcomes. We used a modified algorithm for the Kalon HSV-2 ELISA to improve specificity; positive and indeterminate results were WB tested. We developed culturally sensitive protocols for disclosing positive results, and documented psychosocial responses, reports of sexual contact and HSV-2 symptoms. Results 28 adolescents (3.3%) were identified as HSV-2 seropositive, six as indeterminate. Of these, 22 positive and all indeterminates were WB tested; 20 and 5, respectively, were confirmed positive. Most youth reported moderate brief stress after disclosure; 22% reported longer and more severe distress. Boys were more likely to be in the latter category. Self-reported virginity was highly inconsistent with WB-confirmed positives. Conclusions The higher than manufacturer9s cut-off for Kalon ELISA modestly reduced the rate of false-positive test results, but also increased false negatives. Investigators should consider the risk:benefit ratio in deciding whether or not to disclose HSV-2 results to adolescent participants under specific field conditions. Trial registration number NCT01501864.

To determine which combination of risk factors from Community Care of North Carolina’s (CCNC) Pregnancy Medical Home (PMH) risk screening form was most predictive of preterm birth (PTB) by parity and race/ethnicity. This retrospective cohort included pregnant Medicaid patients screened by the PMH program before 24 weeks gestation who delivered a live birth in North Carolina between September 2011–September 2012 (N = 15,428). Data came from CCNC’s Case Management Information System, Medicaid claims, and birth certificates. Logistic regression with backward stepwise elimination was used to arrive at the final models. To internally validate the predictive model, we used bootstrapping techniques. The prevalence of PTB was 11 %. Multifetal gestation, a previous PTB, cervical insufficiency, diabetes, renal disease, and hypertension were the strongest risk factors with odds ratios ranging from 2.34 to 10.78. Non-Hispanic black race, underweight, smoking during pregnancy, asthma, other chronic conditions, nulliparity, and a history of a low birth weight infant or fetal death/second trimester loss were additional predictors in the final predictive model. About half of the risk factors prioritized by the PMH program remained in our final model (ROC = 0.66). The odds of PTB associated with food insecurity and obesity differed by parity. The influence of unsafe or unstable housing and short interpregnancy interval on PTB differed by race/ethnicity. Evaluation of the PMH risk screen provides insight to ensure women at highest risk are prioritized for care management. Using multiple data sources, salient risk factors for PTB were identified, allowing for better-targeted approaches for PTB prevention.

Background Emerging research suggests that young adult sexual minorities (identifying as lesbian, gay, or bisexual or engaging in same-sex attractions or behaviors) experience poorer health than their majority counterparts, but many measures of health inequity remain unexamined in population-based research. Purpose To describe a wide range of health status and healthcare access characteristics of sexual minorities in comparison with those of the majority population in a national sample of U.S. young adults. Methods Binary and multinomial logistic regression analyses of Wave IV data (2008) from the National Longitudinal Study of Adolescent Health (participants aged 24–32 years, n =13,088) were conducted. Health measures were self-rated health; diagnosis of any of several physical or mental illnesses or sexually transmitted infections; measured BMI; depression classified from self-reported symptoms; use of antidepressant and anxiolytic medication; uninsured; forgone care; and receipt of physical, dental, and psychological services. Analyses were conducted in 2012–2013. Results Sexual minority women had elevated odds of most adverse health conditions and lower odds of receiving a physical or dental examination. Sexual minority men had elevated odds of fewer adverse health conditions. Conclusions Young adult sexual minorities are at higher risk of poor physical and mental health. The results highlight the multidimensionality of sexual minority status and respond to calls for greater understanding of the health of this population.

Orphaned adolescents are a large and vulnerable population in sub-Saharan Africa, at higher risk for HIV than non-orphans. Yet prevention of new infection is critical for adolescents since they are less likely than adults to enter and remain in treatment and are the only age group with rising AIDS death rates. We report process evaluation for a randomized controlled trial (RCT) testing support to stay in school (tuition, uniform, nurse visits) as an HIV prevention strategy for orphaned Kenyan adolescents. The RCT found no intervention effect on HIV/HSV-2 biomarker outcomes. With process evaluation, we examined the extent to which intervention elements were implemented as intended among the intervention group (N = 412) over the 3-year study period (2012-2014), the implementation effects on school enrollment (0-9 terms), and whether more time in school impacted HIV/HSV-2. All analyses examined differences as a whole, and by gender. Findings indicate that school fees and uniforms were fully implemented in 94 and 96% of cases, respectively. On average, participants received 79% of the required nurse visits. Although better implementation of nurse visits predicted more terms in school, a number of terms did not predict the likelihood of HIV/HSV-2 infection. Attending boarding school also increased number of school terms, but reduced the odds of infection for boys only. Four previous RCTs have been conducted in sub-Saharan Africa, and only one found limited evidence of school impact on adolescent HIV/HSV-2 infection. Our findings add further indication that the association between school support and HIV/HSV-2 prevention appears to be weak or under-specified.

Purpose Few studies have sought to understand the typical sexual development of populations with physical disabilities in the United States, and those that do are often based on convenience samples or cross-sectional data. The purpose of this paper is to examine relationships between physical disability and experiences of vaginal, oral, and anal sex in a nationally representative sample of individuals in the United States who have been followed from adolescence through early adulthood. Methods We used data from 13,456 respondents who completed Waves I (1994–1995) and IV (2008–2009) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Physical disabilities were identified and grouped by severity using information regarding limb difficulties, blindness, and deafness during adolescence. Analyses included bivariate statistics and adjusted logistic regression models relating physical disability and experiences of each type of sex. Results Respondents with the most severe physical disabilities had significantly lower odds of experiencing vaginal sex, oral sex, and having any sexual experience compared with the odds of those without disabilities. After stratifying by biological sex, we found that males with the most severe physical disabilities had significantly lower odds of experiencing any type of sex compared with the odds of males without disabilities, whereas females with moderate and severe physical disabilities had significantly lower odds of experiencing vaginal sex compared with the odds of females without disabilities. Conclusions Our findings build on past research often conducted with convenience samples or cross-sectional data, indicating variation in sexual experiences among populations with disabilities.