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Human papillomavirus vaccination disparities among U.S. college students: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

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  • Zubizarreta, Dougie
  • Beccia, Ariel L.
  • Trinh, Mai-Han
  • Reynolds, Colleen A.
  • Reisner, Sari L.
  • Charlton, Brittany M.

Abstract

We investigated how gender identity, sexual orientation, and race/ethnicity intersect to shape the social epidemiology of HPV vaccination initiation among U.S. college students. Cross-sectional survey data were from the National College Health Assessment (Fall, 2019-Spring, 2020; N = 65,047). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 36 social strata defined using gender identity, sexual orientation, and race/ethnicity. Bayesian multilevel logistic regression models with random intercepts for social strata were fit for HPV vaccination initiation. Intersectional models adjusted for the additive main effects to isolate intersectional interactions, controlling for age and geographic region. Social strata that included cisgender men, transgender women, and non-binary assigned-male-at-birth individuals and strata that included racial/ethnic minorities had a significantly lower likelihood of HPV vaccination initiation relative to strata including cisgender women and non-Hispanic White individuals, respectively, while strata including lesbian/gay and bisexual/pansexual/queer individuals had a significantly higher likelihood of HPV vaccination initiation relative to strata including heterosexual individuals. We also observed substantial between-stratum inequities in the predicted prevalence of HPV vaccination initiation, with estimates ranging from 59.2% for heterosexual, racial/ethnic minority, cisgender men to 87.1% for bisexual/pansexual/queer, racial/ethnic minority, non-binary assigned-female-at-birth individuals. That being said, the majority of the observed between-stratum variance was driven by additive rather than intersectional interaction effects and the discriminatory accuracy of intersectional stratification with respect to predicting HPV vaccination initiation was low. Collectively, our findings point to a need for more universal guidelines and clinician recommendations that promote HPV vaccine uptake for all adolescents, regardless of race/ethnicity, gender identity, sex-assigned-at-birth, or sexual orientation; however, utilizing an intersectional lens will ensure that resulting public health interventions address inequities and center the needs and experiences of multiply marginalized adolescents.

Suggested Citation

  • Zubizarreta, Dougie & Beccia, Ariel L. & Trinh, Mai-Han & Reynolds, Colleen A. & Reisner, Sari L. & Charlton, Brittany M., 2022. "Human papillomavirus vaccination disparities among U.S. college students: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," Social Science & Medicine, Elsevier, vol. 301(C).
    • Handle: RePEc:eee:socmed:v:301:y:2022:i:c:s0277953622001770
    DOI: 10.1016/j.socscimed.2022.114871
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    References listed on IDEAS

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    7. Truong-Vu, Kim-Phuong, 2021. "On-time, late, or never: Incorporating intersectionality to predict age-specific probabilities of initiating the HPV vaccine series," Social Science & Medicine, Elsevier, vol. 287(C).
    8. Evans, Clare R., 2019. "Adding interactions to models of intersectional health inequalities: Comparing multilevel and conventional methods," Social Science & Medicine, Elsevier, vol. 221(C), pages 95-105.
    9. Beccia, Ariel L. & Baek, Jonggyu & Austin, S. Bryn & Jesdale, William M. & Lapane, Kate L., 2021. "Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminat," Social Science & Medicine, Elsevier, vol. 281(C).
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    1. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo-Alessón & Beatriz González López-Valcárcel & Juan Merlo, 2023. "Impact of the Economic Crisis on Body Mass Index in Spain: An Intersectional Multilevel Analysis Using a Socioeconomic and Regional Perspective," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-31, August.
    2. Bell, Andrew & Evans, Clare & Holman, Daniel & Leckie, George, 2023. "Extending intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) for longitudinal data, with application to mental health trajectories in the UK," SocArXiv jq57s, Center for Open Science.
    3. Wilkes, Rima & Karimi, Aryan, 2024. "What does the MAIHDA method explain?," Social Science & Medicine, Elsevier, vol. 345(C).
    4. Gustafsson, Per E. & Fonseca-Rodríguez, Osvaldo & Castel Feced, Sara & San Sebastián, Miguel & Bastos, João Luiz & Mosquera, Paola A., 2024. "A novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish populatio," Social Science & Medicine, Elsevier, vol. 343(C).
    5. Bell, Andrew & Evans, Clare & Holman, Dan & Leckie, George, 2024. "Extending intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to study individual longitudinal trajectories, with application to mental health in the UK," Social Science & Medicine, Elsevier, vol. 351(C).

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