Intersectional Immunity? Examining How Race/Ethnicity and Sexual Orientation Combine to Shape Influenza Vaccination Among US Adults

Abstract

Influenza vaccination is a critical preventive healthcare behavior designed to prevent spread of seasonal flu. This paper contributes to existing scholarship by applying an intersectional perspective to examine how influenza vaccination differs across specific intersections of racial/ethnic and sexual identity. Drawing on aggregated state-level data from Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2020, I examine how flu vaccination differs across 18 racial/ethnic-by-sexual orientation groups (N = 1,986,432). Findings from descriptive analyses and logistic regression modeling demonstrate three key findings. First, it corroborates previous studies of vaccination, finding lower rates of flu vaccination among black adults relative to whites; gays/lesbians vaccinate at higher rates than heterosexuals and bisexuals, with bisexuals reporting lower vaccination relative to both heterosexuals and gays/lesbians. Second, it demonstrates how sexual orientation complicates established patterns between race/ethnicity and vaccination (e.g., influenza vaccination is more racially stratified among heterosexuals, with patterns more variable among gays/lesbians) and how race/ethnicity complicates previous patterns of vaccination by sexual orientation (e.g., Asian bisexuals vaccinate more than both heterosexuals). Third, findings pinpoint identities (e.g., black heterosexuals relative to their white peers and white bisexuals relative to their gay/lesbian peers) most in need of influenza vaccination outreach efforts. Implications for findings suggest that heterosexuals, especially black, may be less likely to vaccinate against influenza thus may need more encouragement from clinicians to vaccinate. Additionally, influenza vaccination should be free for all persons to lessen the barrier of access for this preventative healthcare.

Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States

“…The BMHSU has been widely used to examine how a variety of sociodemographic/structural dimensions may influence individuals' utilization of health care resources (Babitsch et al 2012;Lederle et al 2021). However, most scholarship based on the BMHSU has not explicitly incorporated an intersectional approach to systematically assess how multiple predisposing factors may intersect to shape health care behaviors until lately (see e.g., Wilkins [2022] on vaccination inequities jointly shaped by sexual and racial-ethnic identities).…”

“…However, limited evidence suggests that bisexual individuals have lower flu vaccination rates than their heterosexual and gay/lesbian counterparts (Srivastav et al 2019), but this vaccination gap may depend on gender or race-ethnicity. For example, bisexual women but not bisexual men had lower vaccination rates than their heterosexual counterparts (Polonijo and Vogelsang 2023), and bisexual individuals of Asian non-Hispanic background but not other racial-ethnic background had higher vaccination rates than their heterosexual counterparts (Wilkins 2022). The mixed findings on HPV and flu vaccination may be the result of differences in the target populations for certain health services (e.g., many programs focus on encouraging sexual minorities to use selected sexual health care) and focal age groups (e.g., HPV vaccination research focuses on adolescents and young adults).…”

“…A nascent group of studies has begun to address inequities in health care experiences via an intersectional lens (Agénor et al 2015; Hsieh and Mirzoyan 2021; Quinn et al 2019; Wilkins 2022). However, most of these studies focus on sexual/reproductive health care or examine the intersection of only two inequity dimensions.…”

“…For example, qualitative research on Black sexual minority people has shown that racism and heterosexism from health care providers intertwine to hinder the use of PrEP and cervical cancer screening (Agénor et al 2015; Quinn et al 2019). Quantitative research has found that race-ethnicity complicates the variation in flu vaccination by sexual orientation (Wilkins 2022) and that sexual minority women experience less culturally competent care than both heterosexual women and sexual minority men (Hsieh and Mirzoyan 2021). The current study is one of the first to investigate vaccination inequities at the intersection of sexuality, gender, and race-ethnicity using a nationally representative data set.…”