181636 Self-reported experience of racism when seeking medical care and adherence to mammography or Pap test screening

Monday, October 27, 2008

Christina A. Purpura, MPH Candidate 08 , Program in Public Health, Brown University, Westwood, MA
Deborah N. Pearlman, PhD , Research Faculty, Brown University, Program in Public Health, Brown University, Providence, RI
Daniela Quilliam, MPH , Department of Health, Division of Community Health, Family Health and Equity, Rhode Island Department of Health, Providence, RI
Sherry Weitzen, PhD , Division of Research, Women and Infants' Hospital of Rhode Island, Providence, RI
Background: Racial disparities in health outcomes are a persistent public health concern. Experiencing racial discrimination when seeking healthcare may negatively impact early detection of breast or cervical cancers.

Objective: We investigated the effect of experiencing racism when seeking healthcare on adherence to mammography or Pap test screening recommendations.

Methods: Our sample included Caucasian and African American women participating in the 2004 Behavioral Risk Factor Surveillance System, who had a known status for mammography and Pap test screening. Women 50+ having had mammography in the past year and women 18+ having had Pap test in the past year were considered adherent to recommendations. Perceived racial discrimination when seeking healthcare was measured with a question in an optional module administered in 7 states and DC. Associations between racism and non-adherence were estimated with odds ratios (OR) and 95% confidence intervals (CI). Confounders including insurance, education, income, and race, were controlled for in the final multivariable logistic regression models.

Results: Among those that reported experiencing racism, 54.2% (mammography) and 64.3% (Pap) were adherent to screening recommendations. In unadjusted analyses, perceived racism was negatively associated with having a recent mammogram (0.72 95% CI: 0.75-1.50) or Pap test (0.85 95% CI: 0.77-1.45). In a model adjusted for socioeconomic indicators the relationship between perceived racism and screening outcomes was no longer significant.

Conclusions: Findings from the multivariable model show that SES indicators and not perceived racism have an important effect on compliance with screening recommendations.

Learning Objectives:
By the end of the session, the participants will be able to understand the effects of perceived or real discrimination in the medical setting on routine mammography and Pap test screening for women in the United States and to develop new strategies/policies that address other structural barriers, like institutionalized discrimination/racism, to mammography and Pap test screening.

Keywords: Women's Health, Cancer Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I'm interested in understanding the reasons behind non-adherence to mammogram and Pap test screening in the United States to then create policies/strategies/interventions to reduce barriers to mammography and Pap test screening.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.