Associations between perceived racial discrimination, racial residential segregation, and cancer screening adherence among low-income African Americans: a multilevel, cross-sectional analysis

ABSTRACT

Objectives

African Americans suffer disproportionately from cancer compared to their White counterparts. Racism may be an important determinant, but the literature on its association with cancer screening is limited. We examine associations between racism and cancer screening among a sample of African Americans.

Design

Guided by the Public Health Critical Race Praxis and the Behavioral Model of Health Services Use, we conducted a multilevel, cross-sectional study using cancer risk assessment data collected from 405 callers to the 2-1-1 Texas helpline. We merged these data with contextual data from the U.S. Census Bureau. We assessed perceived racial discrimination using the Experiences of Discrimination Scale and racial residential segregation using the Location Quotient for Racial Residential Segregation. We used multilevel regression models to test hypothesized associations between each indicator of racism and four cancer screening adherence outcomes (Pap test, mammography, colorectal cancer screening [CRCS], and any cancer screening).

Results

Participants were 18–83 years old (mean = 45 years). Most (81%) were non-adherent to at least one recommended screening. Approximately 42% reported experiencing discrimination and 73% lived in a segregated neighborhood. Discrimination was non-significantly related to lower odds of mammography (aOR = 0.68; 95%CI: 0.38-1.22), CRCS (aOR = 0.79; 95%CI: 0.41-1.52), and any cancer screening adherence (aOR = 0.88; 95%CI: 0.59-1.32). Segregation was related to greater odds of mammography (non-significant; aOR = 1.43; 95%CI: 0.76-2.68) and CRCS (significant; aOR = 2.80; 95%CI: 1.21-6.46) but not associated with any cancer screening. Neither indicator of racism was associated with Pap test screening adherence.

Conclusions

Racism has a nuanced association with cancer screening among low-income, medically underserved African Americans. Specifically, discrimination appears to be associated with lower odds of screening, while segregation may be associated with higher odds of screening in certain situations. Future research is needed to better explicate relations between indicators of racism and cancer screening among African Americans.

KEYWORDS:

• Cancer screening
• racism
• discrimination
• segregation
• African Americans
• critical race theory

Acknowledgements

We would like to thank our partners at the United Way of Greater Houston 2-1-1 Texas Helpline Program for their collaboration. We would also like to thank John S. Atkinson, DrPH at the UTHealth School of Public Health for his technical assistance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Human subject protection statement

This study received approval for all study procedures from the Committee for the Protection of Human Subjects at The University of Texas Health Science Center at Houston (Study HSC-SPH-10-0241; Study HSC-SPH-20-1103).

Additional information

Funding

This research was funded through the Cancer Prevention Research Institute of Texas (#PP100077 and #PP120086, PI: M.E. Fernandez). Lynn Ibekwe was supported through a predoctoral fellowship, the UTHealth School of Public Health-NCI Cancer Control Research Training Program (National Cancer Institute/NIH, 2T32CA057712-26, MPI: P.D. Mullen, M.E. Fernandez, S.W. Vernon) and partially funded by the Department of Health Promotion and Behavioral Sciences and the Center for Health Promotion and Prevention Research at the UTHealth School of Public Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.