Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
J Racial Ethn Health Disparities. 2024 Oct;11(5):2756-2765. doi: 10.1007/s40615-023-01738-8. Epub 2023 Aug 9.
Racism is a social determinant of health inequities and associated with poorer health and health behaviors. As a domain of racism, self-reported racial discrimination affects health through unhealthy behaviors (e.g., smoking) but the understudied impact of self-reported racial discrimination's relationship with healthy behaviors (e.g., cancer screening) precludes a comprehensive understanding of racism's impact on health inequities. Understanding how self-reported racial discrimination impacts healthy behaviors is even more important for those living in rural persistent poverty areas (poverty rates of 20% or more of a population since 1980), who have a higher disease burden due to poverty's interaction with racism. The distinct sociocultural context of rural persistent poverty areas may result in differential responses to self-reported racial discrimination compared to those in non-persistent poverty areas.
A community-engaged process was used to administer a survey to a convenience sample of 251 Black adults residing in 11 rural persistent poverty counties in the state of Arkansas. Self-reported racial discrimination, fruit and vegetable intake, colorectal cancer screening, cervical cancer screening, and screening mammography were assessed. Stress and religion/spirituality were also assessed as potential mediators or moderators in the relationship between self-reported racial discrimination and healthy behaviors.
In adjusted models, those reporting more self-reported racial discrimination had a higher probability of having had a test to check for cervical cancer (situation discrimination: OR = 1.23, 95% CI: 1.04-1.5; frequency discrimination: OR = 1.06, 95% CI: 1.02-1.12). Stress and religion/spirituality were not significant mediators/moderators.
Greater self-reported racial discrimination was associated with a higher odds of cervical cancer screening. Black adults residing in rural persistent poverty areas may have greater self-reported racial discrimination-specific coping and racial identity attitudes.
种族主义是健康不平等的社会决定因素，与较差的健康和健康行为有关。作为种族主义的一个领域，自我报告的种族歧视会通过不健康的行为（例如吸烟）影响健康，但自我报告的种族歧视与健康行为（例如癌症筛查）之间关系的影响研究不足，这使得人们无法全面了解种族主义对健康不平等的影响。了解自我报告的种族歧视如何影响健康行为对于那些生活在农村持久贫困地区（自 1980 年以来，人口中有 20%或以上的人处于贫困状态）的人来说更为重要，由于贫困与种族主义的相互作用，他们的疾病负担更高。农村持久贫困地区独特的社会文化背景可能导致对自我报告的种族歧视的反应与非持久贫困地区的反应不同。
采用社区参与的方式，对阿肯色州 11 个农村持久贫困县的 251 名黑人成年人进行了一项便利抽样调查。评估了自我报告的种族歧视、水果和蔬菜摄入量、结直肠癌筛查、宫颈癌筛查和乳房 X 光检查。压力和宗教/精神信仰也被评估为自我报告的种族歧视与健康行为之间关系的潜在中介或调节因素。
在调整后的模型中，报告自我报告的种族歧视较多的人进行宫颈癌检查的可能性更高（情况歧视：OR=1.23，95%CI：1.04-1.5；频率歧视：OR=1.06，95%CI：1.02-1.12）。压力和宗教/精神信仰不是显著的中介/调节因素。
更多的自我报告的种族歧视与更高的宫颈癌筛查几率相关。生活在农村持久贫困地区的黑人成年人可能具有更强的针对自我报告的种族歧视的特定应对和种族认同态度。
