title: 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.
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.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, USA. Electronic address: magenor@mail.harvard.edu.
authors.forename: Madina
authors.initials: M
authors.lastname: Agénor
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Krieger
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, USA; Department of Pediatrics, Harvard Medical School, USA.
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, USA.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, USA; Harvard Medical School, USA; Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, USA.
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D055088:Early Detection of Cancer; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D019529:Sexuality / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D044465:White People / Q000706:statistics & numerical data
keywords: Cervical cancer screening; Ecosocial theory; Intersectionality; Race/ethnicity; Sexual orientation