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Self-reported Racial Discrimination and Healthy Behaviors in Black Adults Residing in Rural Persistent Poverty Areas

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Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.

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Funding

This work was supported by Roswell Park Comprehensive Cancer Center Grant P30CA016056 from the National Cancer Institute, and NIH:NCI 3P30CA016056-44S2.

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Authors and Affiliations

  1. Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA

    Karen H. Kim Yeary & Han Yu

  2. University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA

    Don E. Willis, Beverly Johnson & Pearl A. McElfish

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  1. Karen H. Kim Yeary
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  2. Don E. Willis
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  3. Han Yu
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  5. Pearl A. McElfish
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Contributions

KY, DW, and PM contributed to study conception and design. BJ led data collection efforts. HY conducted all of the statistical analyses. KY wrote and initial draft of the paper and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Karen H. Kim Yeary.

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Ethics Approval

The study was approved by the University of Arkansas for Medical Sciences (UAMS) and Roswell Park Comprehensive Cancer Center IRBs.

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Informed consent was obtained from all individual participants included in the study.

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Not applicable. The manuscript does not contain any individual person’s data in any form.

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The authors declare no competing interests.

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Yeary, K.H.K., Willis, D.E., Yu, H. et al. Self-reported Racial Discrimination and Healthy Behaviors in Black Adults Residing in Rural Persistent Poverty Areas. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01738-8

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  • DOI: https://doi.org/10.1007/s40615-023-01738-8

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