Integrating an Interdisciplinary Paradigm and Community Voice to Advance Equity in Cancer Prevention

Abstract

Background: Cancer disparities among Black populations remains a persistent public health challenge despite advances in cancer prevention and control. Despite growing recognition of structural racism as a determinant of health, there are important gaps in how it is conceptualized, measured, and translated into cancer prevention research. The use of an interdisciplinary approach can expand how social determinants of equity are understood. Nursing science offers a holistic understanding of person-environment relationships, while Public Health Critical Race Praxis (PHCRP) provides an anti-racism framework for interrogating racism. Integrating these paradigms provides a comprehensive approach for understanding how structural racism operates as an environmental factor (i.e., laws and policies) to influence health. Layering both nursing science and anti-racism lenses onto cancer prevention frameworks will provide a more comprehensive conceptualization of socio-ecologic mechanisms affecting cancer outcomes. Purpose: The overall purpose of this dissertation is to advance understanding of how structural racism influences cancer prevention and control among Black Americans through an anti-racism framework that integrates evidence synthesis, community knowledge, and policy analysis. Rather than examining structural racism from a single perspective, this dissertation employs three complementary studies that collectively address multiple dimensions of structural racism. Together, these studies generate evidence across different levels of inquiry and contributes to a more comprehensive understanding of how structural racism shapes cancer prevention opportunities. Specific Aims: The aims of this dissertation are as follows: (1) conduct a scoping review to assess the degree to which anti-racism frameworks or theories are applied in cancer prevention and control; (2) analyze existing community-generated data reports using anti-racism principles to name mechanisms and describe impacts of structural racism and community resilience on Black health and well-being among adults; and (3) examine associations between state-level policies indicative of structural racism and receipt of cancer screening among a representative sample of United States (U.S.) Black adults. Methods: This study utilizes a mixed methods approach to address each research question. Aim 1 is a qualitative scoping review of three health sciences databases. Aim 2 used qualitative documents analysis and the Rapid Group Analysis Process (Rap-GAP) to examine community-generated reports. Aim 3 conducted a secondary analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to examine associations between state-level policies structural racism-related policies and cancer screening among Black adults using logistic regression analyses. Importance: This dissertation informs anti-racism strategies for equitable cancer prevention, and contributes to the growing body of knowledge on anti-racism principles as salient to Nursing Science while growing the evidence of anti-racism approaches to health services research. This study also bridges academic and community knowledge about Black health and well-being and emphasizes the importance of utilizing community expertise to generate recommendations for desired change.