Racism and Cancer Screening among Low-Income, African American Women: A Multilevel, Longitudinal Analysis of 2-1-1 Texas Callers

Abstract

Although racism is increasingly being studied as an important contributor to racial health disparities, its relation to cancer-related outcomes among African Americans remains unclear. The purpose of this study was to help clarify the relation between two indicators of racism—perceived racial discrimination and racial residential segregation—and cancer screening. We conducted a multilevel, longitudinal study among a medically underserved population of African Americans in Texas. We assessed discrimination using the Experiences of Discrimination Scale and segregation using the Location Quotient for Racial Residential Segregation. The outcome examined was “any cancer screening completion” (Pap test, mammography, and/or colorectal cancer screening) at follow-up (3–10 months post-baseline). We tested hypothesized relations using multilevel logistic regression. We also conducted interaction and stratified analyses to explore whether discrimination modified the relation between segregation and screening completion. We found a significant positive relation between discrimination and screening and a non-significant negative relation between segregation and screening. Preliminary evidence suggests that discrimination modifies the relation between segregation and screening. Racism has a nuanced association with cancer screening among African Americans. Perceived racial discrimination and racial residential segregation should be considered jointly, rather than independently, to better understand their influence on cancer screening behavior.

Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care

“…A recent simulation study demonstrated that CRC incidence differences between Black and White populations are driven by screening disparities [ 11 ]. Experiences of discrimination [ 12 ] and low trust due to historical medical racism are often cited by Black individuals as a barriers to timely CRC screening and any necessary follow-up care [ 13 , 14 ].…”

Breast and cervical cancer screenings across gender identity: results from the Behavioral Risk Factor Surveillance System before and during the COVID-19 pandemic

“…Additionally, problems with health insurance coverage, physical discomfort, and experiences of dysphoria can deter patients from having cancer screenings[8] , [9]. We know that structural systems of oppression like racism [10] , [11] , [12] and transphobia [13] , [14], have decreased the quality and number of healthcare encounters that individuals with marginalized identities experience, and that the COVID-19 pandemic exacerbated these inequities. The pandemic has limited access to cancer screenings among cisgender individuals [15] , [16] and screening disparities between cisgender and TGD populations have likely only widened in recent years because of the differential impact of COVID-19.…”

Interventions to reduce cancer screening inequities: the perspective and role of patients, advocacy groups, and empowerment organizations

“…Interventions that aim to increase screening uptake are an important approach for tackling inequity. The reasons underlying differences in cancer screening uptake are multifaceted [14] and cover a wide range of themes from perceived racial discrimination and racial residential segregation to stigma and sociodemographic and cultural factors, as well as medical mistrust and perceived susceptibility, benefits, and barriers [24][25][26][27][28]. Therefore, attempts to address health inequities and increase screening uptake can be multifaceted.…”