Abstract
Understanding the frequency and patterns of experiencing changes in sexual orientation identity (SOI) is critical to the health of adolescents and young adults (AYA). Failure to measure and acknowledge change experiences may miss opportunities to tailor care, such as sexual and reproductive health care, accordingly. Much of the prior research among AYA assesses change either retrospectively, or prospectively over relatively long time intervals. The study objective was to prospectively examine the prevalence and sociodemographic patterns of sexual orientation identity change over a short interval among adolescents and young adults (AYA). AYA ages 14-25 years in the United States who participated in two consecutive waves of a longitudinal, online cohort survey in 2021 (N=1,628) were included in the analyses. Self-reported SOI at baseline and follow-up (2 months later) were compared. Overall, 11.4% of AYA reported a different SOI at follow-up. SOI change was more common among transgender boys/men (30.4%) and nonbinary people (25.7%) compared to cisgender girls/women (11.9%) and cisgender boys/men (7.4%; p<0.01). Participants selecting "not sure" or who preferred to self-identify/write-in their SOI were most likely to report SOI change (55.8% and 81.8%, respectively) compared to those identifying as heterosexual (4.3%), queer (13.6%), and bisexual (18.9%) AYA (p<0.01). Participants reporting sexual minority identities at baseline who experienced a change in SOI (n=110) often reported another sexual minority identity at follow-up (54.5%). Surveys with a single time measure of SOI likely underestimate the extent of SOI change among AYA and may introduce bias in addressing needs of AYA experiencing SOI change.