Journal of Urban Health

, Volume 86, Issue 6, pp 861–871 | Cite as

Cancer Prevention Behaviors in Low-Income Urban Whites: An Understudied Problem

  • Janice V. BowieEmail author
  • Hee-Soon Juon
  • Lisa C. Dubay
  • Lydie A. Lebrun
  • Barbara A. Curbow
  • Roland J. Thorpe
  • Thomas A. LaVeist


Low-income urban whites in the United States have largely gone unexamined in health disparities research. In this study, we explored cancer prevention behaviors in this population. We compared data on whites with low socioeconomic status (SES) from the 2003 Exploring Health Disparities in Integrated Communities Study in Southwest Baltimore, Maryland (EHDIC-SWB) with nationally representative data for low SES white respondents from the 2003 National Health Interview Survey (NHIS). Rates for health behaviors and health indicators for whites from the EHDIC-SWB study as compared to NHIS prevalence estimates were as follows: current cigarette smoking, 59% (31% nationally); current regular drinking, 5% (5% nationally); overweight, 26% (32% nationally); obesity, 30% (22% nationally); mammography in the past 2 years, 50% (57% nationally); Pap smear in the past 2 years, 64% (68% nationally); screening for colon cancer in the past 2 years, 41% (30% nationally); and fair or poor self-reported health, 37% (22% nationally). Several cancer prevention behaviors and health indicators for white EHDIC-SWB respondents were far from the Healthy People 2010 objectives. This study provides rare estimates of cancer-related health and health care measures in an understudied population in the United States. Findings illustrate the need for further examination of health behaviors in low SES white urban populations who may share health risks with their poor minority urban counterparts.


Urban health Socioeconomic status Preventive health Health disparities White 



This research was supported by grant# P60MD000214-01 from the National Center on Minority Health and Health Disparities (NCMHD) of the National Institutes of Health (NIH), and a grant from Pfizer, Inc. to Dr. LaVeist.


  1. 1.
    Agency for Healthcare Research and Quality. 2007 National Healthcare Disparities Report. Rockville: U.S. Department of Health and Human Services; 2008.Google Scholar
  2. 2.
    Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.Google Scholar
  3. 3.
    Long J, Chang V, Ibrahim S, Asch D. Update on the health disparities literature. Ann Intern Med. 2004; 141: 805-812.PubMedGoogle Scholar
  4. 4.
    Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000; 57: 108-145.PubMedGoogle Scholar
  5. 5.
    Thomas SB, Quinn SC. Poverty and elimination of urban health disparities: challenge and opportunity. Ann N Y Acad Sci. 2008; 1136: 111-125.CrossRefPubMedGoogle Scholar
  6. 6.
    Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contributions of major diseases to disparities in mortality. N Engl J Med. 2002; 347: 1585-1592.CrossRefPubMedGoogle Scholar
  7. 7.
    Adler N, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff. 2002; 21: 60-76.CrossRefGoogle Scholar
  8. 8.
    Edwards BK, Brown ML, Wingo PA, et al. Annual report to the nation on the status of cancer, 1975–2002. Featuring population-based trends in cancer treatment. J Natl Cancer Inst. 2005; 97: 1407-1427.PubMedCrossRefGoogle Scholar
  9. 9.
    Fagan P, Moolchan ET, Lawrence D, Fernander A, Ponder PK. Identifying health disparities across the tobacco continuum. Addiction. 2007; 102(Suppl. 2): 5-29.CrossRefPubMedGoogle Scholar
  10. 10.
    Feinstein J. The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993; 71: 279-322.CrossRefPubMedGoogle Scholar
  11. 11.
    Fleischman AR, Barondess JA. Urban health: a look out our windows. Acad Med. 2004; 79: 1130-1132.CrossRefPubMedGoogle Scholar
  12. 12.
    Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med. 2008; 23: 834-840.CrossRefPubMedGoogle Scholar
  13. 13.
    Lantz PM, Lynch JW, House JS, et al. Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors. Soc Sci Med. 2001; 53: 29-40.CrossRefPubMedGoogle Scholar
  14. 14.
    U.S. Department of Health and Human Services. Task Force on Black and Minority Health. Report of the Secretary’s Task Force on Black and Minority Health. Washington, DC: U.S. Department of Health and Human Services; 1985.Google Scholar
  15. 15.
    Fiscella K, Williams DR. Health disparities based on socioeconomic inequalities: implications for urban health care. Acad Med. 2004; 79: 1139-1147.CrossRefPubMedGoogle Scholar
  16. 16.
    Wilson WJ. The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy. Chicago: University of Chicago Press; 1987.Google Scholar
  17. 17.
    Census Bureau, Population Division. Population by Metropolitan-Nonmetropolitan Residence, Sex, Hispanic Origin, and Race, with Percent Distribution by Hispanic Origin and Race: March 2000. Washington, DC: Census Bureau; 2003.Google Scholar
  18. 18.
    U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
  19. 19.
    LaVeist T, Thorpe R, Bowen-Reid T, et al. Exploring health disparities in integrated communities: overview of the EHDIC study. J Urban Health. 2008; 85: 11-21.CrossRefPubMedGoogle Scholar
  20. 20.
    National Center for Health Statistics. National Health Interview Survey, 2003 description (machine readable data file and documentation). Hyattsville: Public Health Services, Centers for Disease Control and Prevention, US Department of Health and Human Services; 2004.Google Scholar
  21. 21.
    U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. Rockville: Agency for Healthcare Research and Quality; 2002.Google Scholar
  22. 22.
    StataCorp. Stata statistical software: release 9.0. College Station: StataCorp; 2005.Google Scholar
  23. 23.
    Arnold CL, Davis TC, Berkel HJ, Jackson RH, Nandy I, London S. Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women. Prev Med. 2001; 32: 313-320.CrossRefPubMedGoogle Scholar
  24. 24.
    Burns EK, Levinson AH, Lezotte D, Prochazka AV. Differences in smoking duration between Latinos and Anglos. Nicotine Tob Res. 2007; 9: 731-737.CrossRefPubMedGoogle Scholar
  25. 25.
    Flint AJ, Novotny TE. Trends in black/white differences in current smoking among 18- to 24-year-olds in the United States, 1983–1993. Am J Prev Med. 1998; 14: 19-24.CrossRefPubMedGoogle Scholar
  26. 26.
    Jesse ED, Graham M, Swanson M. Psychosocial and spiritual factors associated with smoking and substance use during pregnancy in African American and White low-income women. J Obstet Gynecol Neonatal Nurs. 2006; 35: 68-77.CrossRefPubMedGoogle Scholar
  27. 27.
    Kiefe CI, Williams OD, Lewis CE, Allison JJ, Sekar P, Wagenknecht LE. Ten-year changes in smoking among young adults: are racial differences explained by socioeconomic factors in the CARDIA study? Am J Public Health. 2001; 91: 213-218.CrossRefPubMedGoogle Scholar
  28. 28.
    Mulia N, Ye Y, Zemore SE, Greenfield TK. Social disadvantage, stress, and alcohol use among black, Hispanic, and white Americans: findings from the 2005 U.S. National Alcohol Survey. J Stud Alcohol Drugs. 2008; 69: 824–833PubMedGoogle Scholar
  29. 29.
    Nelson TL, Hunt KJ, Rosamond WD, et al. Obesity and associated coronary heart disease risk factors in a population of low-income African-American and white women: the North Carolina WISEWOMAN project. Prev Med. 2002; 35: 1-6.CrossRefPubMedGoogle Scholar
  30. 30.
    Cui Y, Peterson NB, Hargreaves M, et al. Mammography use in the Southern Community Cohort Study (United States). J Health Care Poor Underserved. 2007; 18: 102-117.CrossRefPubMedGoogle Scholar
  31. 31.
    Makuc DM, Breen N, Freid V. Low income, race, and the use of mammography. Health Serv Res. 1999; 34: 229-239.PubMedGoogle Scholar
  32. 32.
    Paskett ED, Tatum C, Rushing J, et al. Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population. Cancer. 2004; 101: 2650-2659.CrossRefPubMedGoogle Scholar
  33. 33.
    Cronan TA, Villalta I, Gottfried E, Vaden Y, Ribas M, Conway TL. Predictors of mammography screening among ethnically diverse low-income women. J Womens Health (Larchmt). 2008; 17: 527-537.CrossRefGoogle Scholar
  34. 34.
    Coughlin SS, Thompson TD, Seeff L, Richards T, Stallings F. Breast, cervical, and colorectal carcinoma screening in a demographically defined region of the southern U.S. Cancer. 2002; 95: 2211-2222.CrossRefPubMedGoogle Scholar
  35. 35.
    Harlan LC, Bernstein AB, Kessler LG. Cervical cancer screening: who is not screened and why? Am J Public Health. 1991; 81: 885-890.CrossRefPubMedGoogle Scholar
  36. 36.
    Paskett ED, Rushing J, D’Agostino R Jr, Tatum C, Velez R. Cancer screening behaviors of low-income women: the impact of race. Womens Health. 1997; 3: 203-226.PubMedGoogle Scholar
  37. 37.
    Owusu GA, Eve SB, Cready CM, et al. Race and ethnic disparities in cervical cancer screening in a safety-net system. Matern Child Health J. 2005; 9: 285-295.CrossRefPubMedGoogle Scholar
  38. 38.
    Vlahov D, Ahern J, Vazquez T, et al. Racial/ethnic differences in screening for colon cancer: report from the New York cancer project. Ethn Dis. 2005; 15: 76-83.PubMedGoogle Scholar
  39. 39.
    Cronan TA, Devos-Comby L, Villalta I, Gallagher R. Ethnic differences in colorectal cancer screening. J Psychosoc Oncol. 2008; 26: 63-86.CrossRefPubMedGoogle Scholar
  40. 40.
    Felix-Aaron K, Moy E, Kang M, Patel M, Chesley FD, Clancy C. Variation in quality of men's health care by race/ethnicity and social class. Med Care. 2005; 43: I72-I81.CrossRefPubMedGoogle Scholar
  41. 41.
    McAlearney AS, Reeves KW, Dickinson SL, et al. Racial differences in colorectal cancer screening practices and knowledge within a low-income population. Cancer. 2008; 112: 391-398.CrossRefPubMedGoogle Scholar
  42. 42.
    Eberhardt MS, Ingram DD, Makuc DM, et al. Urban and Rural Health Chartbook Health, Health United States 2001. Hyattsville: National Center for Health Statistics; 2001.Google Scholar

Copyright information

© The New York Academy of Medicine 2009

Authors and Affiliations

  • Janice V. Bowie
    • 1
    • 2
    Email author
  • Hee-Soon Juon
    • 2
  • Lisa C. Dubay
    • 1
    • 3
  • Lydie A. Lebrun
    • 3
  • Barbara A. Curbow
    • 4
  • Roland J. Thorpe
    • 1
    • 3
  • Thomas A. LaVeist
    • 1
    • 3
  1. 1.Center for Health Disparities SolutionsJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleUSA

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