RACISM AND CANCER PREVENTION: THE ROLE OF PERCEIVED RACISM AND RACE-BASED RESIDENTIAL SEGRETATION ON BEHAVIORAL CANCER RISK PROFILES
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Date
2008-04-24T14:44:03Z
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Johns Hopkins University
Abstract
Problem statement: Cancer is a significant public health problem in the United States;
since 1999 cancer has been the leading cause of death among those 85 years and younger.
Racial/ethnic disparities in cancer exist. Some groups have experienced decreases or a
leveling off with respect to their cancer burden while others have experienced increases.
Though there is evidence that lifestyle and screening behaviors may contribute to a
reduction in the cancer burden, they are not being fully utilized by all adults with
prevalence rates varying by racial/ethnic groups. Racism has been hypothesized as a
potential contributor to these disparities with limited research evaluating the relationship
between racism and cancer risk behaviors.
Methods: The purpose of this study is to evaluate the relationship between racism and
cancer risk profiles with data obtained primarily from the 2003 California Health
Interview Survey and the 2000 US Census. Racism measures included perceived racism
at the individual-level and race-based residential segregation at the county-level. Cancer
risk profiles were measured as a set of primary (e.g., tobacco use, physical inactivity) and
secondary (e.g., lack of participation in early detection) cancer risk behaviors. Analyses
included individual level and multilevel linear regression modeling.
Results: The prevalence of perceived racism varied by racial/ethnic groups with minority
groups having reported perceived racism experiences between 57% and 85%. In
individual-level analyses, perceived racism and cancer risk profiles were associated with
fixed effects that were moderated by gender, age, and education. Race/ethnicity-stratified
analyses showed that these relationships were not maintained across all groups.
Multilevel analyses demonstrated evidence of unexplained variance at the county-level
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for most racial/ethnic groups; after accounting for segregation and area correlates, for
secondary risk profiles no more unexplained variation remained by county.
Conclusion: This research underscores the importance of considering social determinants
of health behaviors and understanding not just individual characteristics that shape these
behaviors but also contextual effects. Further research into the association of racism and
cancer risk profiles is needed to establish causality, identify additional pathways, and to
begin to address some public health policy and practice solutions to prevent racism and
its negative consequences on health.
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Keywords
Perceived racism, Cancer prevention, Behavioral risk profiles, California Health Interview Survey (CHIS), Multi-racial/ethnic group comparisons, Segregation