Objective
Healthcare system distrust (HCSD) has been linked to poor breast cancer outcomes. Previous HSCD analyses have focused on Black‐White disparities; however, focusing only on race ignores the complex set of factors that form identity. We quantified the contributions of race and sexual minority (SM) identity to HCSD among US women who had received breast cancer screening.
Methods
This cross‐sectional study used intersectionality decomposition methods to assess the degree to which racial and SM identity contributed to disparate responses to the validated 9‐item HCSD Scale. The sample included online survey participants identifying as a Black or White woman living in the US, with a self‐reported abnormal breast cancer screening result in the past 24 months and/or breast cancer diagnosis since 2011.
Results
Of 649 participants, 49.4% of Black SM women (n = 85) were in the highest HCSD tertile, followed by 37.4% of White SM women (n = 123), 24.4% of Black heterosexual women (n = 156), and 19% of White heterosexual women. Controlling for age, 72% of the disparity in HCSD between Black SM women and White heterosexual women was due to SM status, 23% was due to racial identity, and 3% was due to both racial and SM identity.
Conclusions
SM identity emerged as the largest driver of HCSD disparities; however, the combined racial and SM disparity persisted. Excluding sexual identity in HCSD studies may miss an important contributor. Interventions designed to increase the HCS's trustworthiness at the provider and system levels should address both racism and homophobia.
In 1972 Rosemary (Rosie) Casals, an established player in women’s tennis and winner of several doubles championships at Wimbledon, appeared on the court of the staid English event in a tennis dress with a purple design with a ‘VS’ (Virginia Slims – a cigarette brand marketed to a female audience) embroidered on her outfit. The next day she appeared on the number one court for the women’s doubles semi-final match with the cigarette insignia clearly displayed across the front of the athletic wear. Instructed to adhere to Wimbledon’s dress code of ‘predominantly’ white outfits, officials warned Casals would be banned from further play if she did not comply. Forced to obey Wimbledon dress codes, Casals conceded, though not without a verbal assault directed at tournament officials. In this paper we argue, analysing oral history as well as various press reports in the US and abroad, that Casals’ ensemble and the reaction by officials and those in the media symbolized far more than a perceived fashion faux pas by the tennis star. Rather, Casals’ attire and public reaction to it throw into sharp relief debates around equal rights and female independence that raged throughout society during the late 1960s and 1970s. Importantly, the discussions and tensions in relation to Casals’ tennis outfit did not simply mirror these broader conversations they contributed greatly to them. The dress, like Casals, challenged rules of conduct on the court – and social convention off it. The attire was, for her, a form of self-expression, which personified a style she was eager to portray to a public, some of whom were not necessarily similarly keen on its exhibition.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.