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At the intersection of sexual orientation, race/ethnicity, and cervical cancer screening: Assessing Pap test use disparities by sex of sexual partners among black, Latina, and white U.S. women

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  • Agénor, Madina
  • Krieger, Nancy
  • Austin, S. Bryn
  • Haneuse, Sebastien
  • Gottlieb, Barbara R.

Abstract

Understanding how various dimensions of social inequality shape the health of individuals and populations poses a key challenge for public health. Guided by ecosocial theory and intersectionality, we used data from the 2006–2010 National Survey of Family Growth, a national probability sample, to investigate how one dimension of sexual orientation, sex of sexual partners, and race/ethnicity jointly influence Pap test use among black, Latina and white U.S. women aged 21–44 years (N = 8840). We tested for an interaction between sex of sexual partners and race/ethnicity (p = 0.015) and estimated multivariable logistic regression models for each racial/ethnic group, adjusting for socio-demographic factors. The adjusted odds of Pap test use for women with only female sexual partners in the past year were significantly lower than for women with only male sexual partners in the past year among white women (odds ratio [OR] = 0.25, 95% confidence interval [CI]: 0.12,0.52) and may be lower among black women (OR = 0.32, 95% CI: 0.07,1.52); no difference was apparent among Latina women (OR = 1.54, 95% CI: 0.31,7.73). Further, the adjusted odds of Pap test use for women with no sexual partners in the past year were significantly lower than for women with only male sexual partners in the past year among white (OR = 0.30, 95% CI: 0.22,0.41) and black (OR = 0.23, 95% CI: 0.15,0.37) women and marginally lower among Latina women (OR = 0.63, 95% CI: 0.38,1.03). Adding health care indicators to the models completely explained Pap test use disparities for women with only female vs. only male sexual partners among white women and for women with no vs. only male sexual partners among Latina women. Ecosocial theory and intersectionality can be used in tandem to conceptually and operationally elucidate previously unanalyzed health disparities by multiple dimensions of social inequality.

Suggested Citation

  • Agénor, Madina & Krieger, Nancy & Austin, S. Bryn & Haneuse, Sebastien & Gottlieb, Barbara R., 2014. "At the intersection of sexual orientation, race/ethnicity, and cervical cancer screening: Assessing Pap test use disparities by sex of sexual partners among black, Latina, and white U.S. women," Social Science & Medicine, Elsevier, vol. 116(C), pages 110-118.
    • Handle: RePEc:eee:socmed:v:116:y:2014:i:c:p:110-118
    DOI: 10.1016/j.socscimed.2014.06.039
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    References listed on IDEAS

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    4. Ssirai Kim & Sun-Young Lee & Smi Choi-Kwon, 2020. "Cervical Cancer Screening and Human Papillomavirus Vaccination among Korean Sexual Minority Women by Sex of Their Sexual Partners," IJERPH, MDPI, vol. 17(23), pages 1-11, November.
    5. Gkiouleka, Anna & Huijts, Tim, 2020. "Intersectional migration-related health inequalities in Europe: Exploring the role of migrant generation, occupational status & gender," Social Science & Medicine, Elsevier, vol. 267(C).
    6. Bauer, Greta R. & Scheim, Ayden I., 2019. "Methods for analytic intercategorical intersectionality in quantitative research: Discrimination as a mediator of health inequalities," Social Science & Medicine, Elsevier, vol. 226(C), pages 236-245.
    7. Sundstrom, Beth & Smith, Ellie & Delay, Cara & Luque, John S. & Davila, Caroline & Feder, Bailey & Paddock, Vincenza & Poudrier, Jessie & Pierce, Jennifer Young & Brandt, Heather M., 2019. "A reproductive justice approach to understanding women's experiences with HPV and cervical cancer prevention," Social Science & Medicine, Elsevier, vol. 232(C), pages 289-297.
    8. Gkiouleka, Anna & Huijts, Tim & Beckfield, Jason & Bambra, Clare, 2018. "Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions - A research agenda," Social Science & Medicine, Elsevier, vol. 200(C), pages 92-98.

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