Residential Segregation and Racial Cancer Disparities: A Systematic Review.

BACKGROUND: This paper provides the first review of empirical studies of segregation and black-white cancer disparities. METHODS: We searched all years of PubMed (through May 2016) using these terms: racial segregation, residential segregation, neighborhood racial composition (first terms) and (second terms) cancer incidence, mortality, survival, stage at diagnosis, screening. The 17 (of 668) articles that measured both segregation and a cancer outcome were retained. RESULTS: Segregation contributed significantly to cancer and to racial cancer disparities in 70% of analyses, even after controlling for socioeconomic status and health insurance. Residing in segregated African-American areas was associated with higher odds of later-stage diagnosis of breast and lung cancers, higher mortality rates and lower survival rates from breast and lung cancers, and higher cumulative cancer risks associated with exposure to ambient air toxics. There were no studies of many types of cancer (e.g., cervical). Studies differed in their measure of segregation, and 40% used an invalid measure. Possible mediators of the segregation effect usually were not tested. CONCLUSIONS: Empirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.

Rural Shop-Based Health Program Planning: a Formative Research Approach Among Owners.

African American barbershops and beauty salons are settings that have been identified as a significant and culturally relevant venue to reach minority populations for health promotion activities. By being located in almost every town in the USA, this setting is a viable means to promote healthy lifestyles among African Americans. The purpose of this formative research project was to assess African American barbershop and beauty salon owners' perceptions of providing health promotion programming in their shops, as well as to obtain information on health topics of interest and strategies for implementation. Interviewees were recruited using snowballing among clientele and owner referrals, between November 2014 and August 2015. A total of 20 barbershop and salon owners, across 11 counties in eastern North Carolina, completed face-to-face interviews. Responses were stratified by barbershops and beauty salons. Across both groups, all owners stated it would be a good idea to have health programs/interventions within the shop setting. Most noted topics of interest included diet and nutrition, hypertension, and (wo)men's reproductive health. When asked further about these desired topics, both benefits and relevance to customers and the African American community were the reasons for their selections. In addition, across barbershops and salons, 90 % of owners stated interest in having a program implemented in their shop. This information will be used to guide the development of shop-based interventions, with the aid of a community advisory board composed of shop owners, individual barbers and stylists and customers.