Intersectional nativity and racial/ethnic disparities in human papillomavirus vaccination initiation among U.S. women: a national population-based study
Overall, foreign-born women are less likely than U.S.-born women to have initiated human papillomavirus (HPV) vaccination. However, foreign-born women are a racially/ethnically diverse population, and race/ethnicity is an independent predictor of HPV vaccination.
Using 2011–2015 National Health Interview Survey data, we used multivariable logistic regression to estimate odds ratios for foreign-born black, Latina, and Asian women compared to foreign-born white women and U.S.-born white women, adjusting for sociodemographic factors. We added socioeconomic factors followed by health care access indicators, which we conceptualized as potential mediators, to each model to assess whether they helped explain observed disparities.
Foreign-born Asian ([odds ratio=] 0.43; [95% confidence interval:] 0.29–0.65) and Latina (0.46; 0.32–0.68) women had significantly lower adjusted odds of initiating HPV vaccination compared to foreign-born white women. Foreign-born white (0.64; 0.45–0.90), black (0.44; 0.29, 0.67), Latina (0.29; 0.24–0.35), and Asian (0.28; 0.21–0.38) women had significantly lower adjusted odds of HPV vaccination initiation compared to U.S.-born white women. Socioeconomic factors only explained HPV vaccination initiation disparities between foreign-born Latina women and foreign-born and U.S.-born white women. Health care access indicators modestly explained disparities between foreign-born white, black, and Latina women and U.S.-born white women only.
We observed pronounced HPV vaccination initiation disparities among foreign-born women in relation to race/ethnicity and between foreign-born women from minoritized racial/ethnic backgrounds and U.S.-born white women. Research on nativity disparities in HPV vaccination should take into account race/ethnicity, and vice versa. Interventions that seek to facilitate HPV vaccination among foreign-born women are needed and should address the unique needs of those from minoritized racial/ethnic backgrounds to promote cancer equity.
KeywordsHuman papillomavirus vaccination Nativity status Race/ethnicity Health disparities Women
We thank the National Center for Health Statistics and 2011–2015 National Health Interview Survey participants for the data used in this study. Madina Agénor and Sarah Abboud are supported by R25MH087217 awarded by the National Institute of Mental Health at the National Institutes of Health. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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