Disparities in Cancer Screening: The Role of County-Level Metropolitan Status and Racial Residential Segregation

Mortality from cervical and colorectal cancers can be reduced through routine screening, which can often be accessed through primary care. However, uptake of screening in the US remains suboptimal, with disparities observed across geographic characteristics, such as metropolitan status or level of racial residential segregation. Little is known about the interaction of metropolitan status and segregation in their relationship with cancer screening. We conducted a quantitative survey of 474 women aged 45–65 in central Pennsylvania. The survey collected county-level characteristics and participant-level demographics, beliefs, cancer screening barriers, and cervical and colorectal cancer screening. We used bivariate and multivariable logistic regression to analyze relationships between metropolitan status and segregation with screening. For cervical cancer screening, 82.8% of participants were up-to-date, which did not differ by county type in the final analysis. Higher healthcare trust, higher cancer fatalism, and reporting cost as a barrier were associated with cervical cancer screening. For colorectal cancer screening, 55.4% of participants were up-to-date, which differed by county type. In metropolitan counties, segregation was not associated with colorectal cancer screening, but in non-metropolitan counties, segregation was associated with greater colorectal cancer screening. The relationship between metropolitan status and being up-to-date with colorectal, but not cervical, cancer screening varied by segregation. Other important beliefs and barriers to screening varied by county type. This research can guide future cancer screening interventions in primary care settings in underserved communities.



Work Title Disparities in Cancer Screening: The Role of County-Level Metropolitan Status and Racial Residential Segregation
Open Access
  1. Jennifer L. Moss
  2. Madyson Popalis
  3. Sarah I. Ramirez
  4. Alexis Reedy-Cooper
  5. Mack T. Ruffin
  1. Metropolitan status
  2. Racial residential segregation
  3. Cancer screening
  4. Cervical cancer
  5. Colorectal cancer
  6. Health behavior
License In Copyright (Rights Reserved)
Work Type Article
  1. Journal of Community Health
Publication Date September 22, 2022
Publisher Identifier (DOI)
  1. https://doi.org/10.1007/s10900-021-01035-7
Deposited August 05, 2022




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Work History

Version 1

  • Created
  • Added 2022_Moss_JCH_cancer-screening-metro-seg.pdf
  • Added Creator Jennifer L. Moss
  • Added Creator Madyson Popalis
  • Added Creator Sarah I. Ramirez
  • Added Creator Alexis Reedy-Cooper
  • Added Creator Mack T. Ruffin
  • Published
  • Updated Keyword, Publication Date Show Changes
    • Metropolitan status, Racial residential segregation, Cancer screening, Cervical cancer, Colorectal cancer, Health behavior
    Publication Date
    • 2022-02-01
    • 2022-09-22