Madina Agénor1, Ashley E Pérez2, Sarah M Peitzmeier3, Jennifer Potter4,5, Sonya Borrero6,7. 1. 1 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts. 2. 2 Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing , San Francisco, California. 3. 3 Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing , Ann Arbor, Michigan. 4. 4 Department of Medicine, Harvard Medical School , Boston, Massachusetts. 5. 5 Division of General Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts. 6. 6 Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania. 7. 7 Center for Health Equity Research and Promotion , VA Pittsburgh Health care System, Pittsburgh, Pennsylvania.
Abstract
INTRODUCTION: Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11-26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an intersectional approach to ascertain HPV vaccine uptake among sexual orientation identity and racial/ethnic subgroups of U.S. women and girls. METHODS: Using 2011-2015 National Survey of Family Growth data, we used multivariable logistic regression to estimate differences in the odds of HPV vaccination initiation (i.e., ≥ one dose) across sexual orientation identity and racial/ethnic subgroups of black and white U.S. women aged 15-24 years (N = 2,413), adjusting for demographic factors. We also assessed whether socioeconomic and health care factors helped explain observed disparities. RESULTS: The overall prevalence of HPV vaccination initiation was 47.7%. Compared to white heterosexual women, black lesbians (odds ratio [OR] = 0.16; 95% confidence interval [95% CI]: 0.06-0.46) had the lowest adjusted odds of HPV vaccination initiation, followed by white lesbians (OR = 0.33; 95% CI: 0.13-0.82) and black heterosexual women (OR = 0.63; 0.47-0.85). Including socioeconomic factors in the model only slightly attenuated the HPV vaccination initiation odds ratios for black lesbians (OR = 0.19; 95% CI: 0.06-0.56), white lesbians (OR = 0.37; 95% CI: 0.15-0.90), and black heterosexual women (OR = 0.70; 95% CI: 0.52-0.93) compared to white heterosexual women. Adding health care factors only slightly additionally attenuated the odds ratio comparing black lesbians and white heterosexual women (OR = 0.21; 95% CI: 0.07-0.67). CONCLUSIONS: Our findings identified black lesbians as a particularly underserved subgroup and suggest that sexual orientation identity and race/ethnicity may have a compounding effect on HPV vaccination initiation among black and white U.S. women and girls. Evidence-based interventions that are adapted to the specific needs and experiences of black lesbians and other multiply marginalized groups are needed to promote equity in HPV-related outcomes.
INTRODUCTION:Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11-26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an intersectional approach to ascertain HPV vaccine uptake among sexual orientation identity and racial/ethnic subgroups of U.S. women and girls. METHODS: Using 2011-2015 National Survey of Family Growth data, we used multivariable logistic regression to estimate differences in the odds of HPV vaccination initiation (i.e., ≥ one dose) across sexual orientation identity and racial/ethnic subgroups of black and white U.S. women aged 15-24 years (N = 2,413), adjusting for demographic factors. We also assessed whether socioeconomic and health care factors helped explain observed disparities. RESULTS: The overall prevalence of HPV vaccination initiation was 47.7%. Compared to white heterosexual women, black lesbians (odds ratio [OR] = 0.16; 95% confidence interval [95% CI]: 0.06-0.46) had the lowest adjusted odds of HPV vaccination initiation, followed by white lesbians (OR = 0.33; 95% CI: 0.13-0.82) and black heterosexual women (OR = 0.63; 0.47-0.85). Including socioeconomic factors in the model only slightly attenuated the HPV vaccination initiation odds ratios for black lesbians (OR = 0.19; 95% CI: 0.06-0.56), white lesbians (OR = 0.37; 95% CI: 0.15-0.90), and black heterosexual women (OR = 0.70; 95% CI: 0.52-0.93) compared to white heterosexual women. Adding health care factors only slightly additionally attenuated the odds ratio comparing black lesbians and white heterosexual women (OR = 0.21; 95% CI: 0.07-0.67). CONCLUSIONS: Our findings identified black lesbians as a particularly underserved subgroup and suggest that sexual orientation identity and race/ethnicity may have a compounding effect on HPV vaccination initiation among black and white U.S. women and girls. Evidence-based interventions that are adapted to the specific needs and experiences of black lesbians and other multiply marginalized groups are needed to promote equity in HPV-related outcomes.
Entities:
Keywords:
health disparities; human papillomavirus vaccination; intersectionality; race/ethnicity; sexual orientation; women
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