P4A226: Does Prospective Report of Changes in Sexual Orientation Identity and Attractions Match Retrospective Report Among Adolescents and Young Adults? Findings from the Longitudinal Sexual Orientation Fluidity in Youth (SO*FLY) Study

Background: Changes in sexual orientation identity (SOI) or attractions are common among adolescents and young adults (AYA) as they explore their sexuality. Yet limited information is available regarding how best to measure SOI and attraction change both in clinical and research settings. The aim of this study was to understand whether retrospective recall of SOI or attraction change matches prospective reporting of change among AYA.

Methods: AYA (N=1,230) from across the US, ages 14-25 years, participated in the Sexual Orientation Fluidity in Youth (SO*FLY) study, a longitudinal online cohort. Over half (64.5%) identified as cisgender girl/woman, 28.1% cisgender boy/man, and roughly 7% of the sample identified as non-binary or transgender. Just under 17% (16.9%) identified as Latina/o/x/e or Hispanic, and 16.3% identified as Black/African American. Retrospective recall of change in SOI and attractions were determined via 2 separate questions at 4-month follow-up (e.g., Have you experienced a change in your attractions in the past 4 months: yes, no). Prospective SOI change was determined by comparing self-reported SOI at baseline and 4-month follow-up (single select of SOI: straight/heterosexual, bisexual, gay or lesbian, pansexual/omnisexual, queer, asexual spectrum, not sure, another/other identities). Similarly, prospective attraction change was determined by comparing current attractions at baseline and 4-month follow-up (multiple select: girls/women, boys/men, nonbinary people, and/or another gender identity). The sensitivity and specificity of recall of SOI change and attraction change were compared with changes detected prospectively.

Results: At baseline, AYA reported a wide variety of SOIs with straight/heterosexual (66%) and bisexual (16.5%) being most common. For attractions, the largest proportion of participants reported attraction to boys/men only (46.5%) and girls/women only (25.8%), with a quarter (24.9%) reporting attraction to multiple gender identities. Prospectively, 13.1% changed their reported SOI between the baseline and follow-up survey. Retrospectively, only 5.0% reported change for the same period. Sensitivity for recall of SOI change was low; only 18.2% (28/154) of those who experienced prospective change also reported change via the retrospective question. Positive predictive value was 47.5% (28/59). Prospectively, 22.3% changed their reported attractions between the baseline and follow-up survey. Retrospectively, only 12.5% reported change for the same period. Sensitivity for recall of attraction change was low; only 28.3% (77/272) of people who experienced change prospectively also reported change via the retrospective recall question. Positive predictive value was 50.7% (77/152).

Conclusion: A substantial proportion of AYA report changes in their SOI and attractions over a four-month period. As prospective report exhibited more change in this sample, it is likely a better way to capture minute changes in SOI and attractions across a short time period. When possible AYA should be asked about their SOI and attractions prospectively.