Does discrimination matter?: Effects of access to care, perceived discrimination, and distrust on cervical cancer prevention and control in South Carolina

Introduction:

The introduction of Pap tests contributed to reduced cervical cancer mortality. However, not all groups benefited equally. Perceived discrimination and distrust may contribute to health disparities. The study objective was to examine effects of access, experiences of discrimination, and health system distrust on cervical cancer prevention and control.

Methods:

A population-based telephone survey was administered to randomly selected adult English-speaking women (18-70) in South Carolina (n=986). Self-reported measures of access, experiences of discrimination, and health system distrust were measured. Screening was measured by a Pap test within three and five years of interview. Logistic regression analyses were conducted.

Results:

Over half (57.3%) of the sample reported no lifetime discrimination experiences. More African Americans reported high experiences of perceived discrimination (34.2%) than whites (4.0%) (p<.0001). Access was a greater predictor of appropriate cervical cancer screening than perceived discrimination or health system distrust. Women with a regular provider (OR=2.819 CI 1.449, 5.483; OR=2.356 CI 1.128, 4.920) and private health insurance (OR=2.970 CI 1.364, 6.469; OR=2.769 CI 1.146, 6.694) were more likely to report 3- and 5-year Pap tests. African American women with low perceived discrimination were less likely to report Pap tests within five years than those with no perceived discrimination (OR=0.239 CI 0.060, 0.949).

Conclusions:

The markedly higher odds of reporting perceived discrimination and distrust in African Americans may contribute to health disparities. However, access was the strongest predictor of screening. Improved access, especially to safety net health centers, could increase screening and ultimately lead to reduced cervical cancer mortality.