Embodied marginalization: Exploring the social determinants of cervical cancer disparities.

Abstract

In order to address the persistent unexplained disparity in cervical cancer rates among marginalized groups of women in the United States, a novel theoretical model of embodiment of social environment is proposed. The construct of embodiment, based on Nancy Krieger's eco-social model, is traced from feminist poststructural theory of the body and incorporated into a dynamic, theoretical framework. The physical manifestation of bodily health and illness is continually created by the dynamic interplay of the social environment, individual subjectivity and physiologic substrate. This proposed model was tested with the hypothesis that social environment and subjectivity affect health outcome and that they are mediated by physiologic substrate. A secondary data analysis was utilized of women going to colposcopy for abnormal Pap tests with measures of all the key proposed variables. Results. A total of 503 cases were available for analysis. The dataset represented a diverse population of women, over 70% of the cases reporting a self-defined minority racial/Ethnic affiliation. The sample was primarily poor (54.9% reported a household income less than $20,000/year) and single (59.6%). Cervical disease diagnosis indicated 45.8% with no treatable disease, 54.2% with disease requiring additional monitoring or treatment. Disease outcome was not predicted by the measures of either social environment or subjectivity. Only the presence of high-risk human papillomavirus predicted more severe cervical disease in a regression model (R<super>2</super> = .083, p<.001). However, aspects of social environment, particularly perceived discrimination (both major event and daily) and a history of abuse, had predictive value in a regression model for two known risk factors for cervical cancer: early age of onset of intercourse (R<super>2</super> = .097, p<.001) and lifetime number of sexual partners (R<super>2</super> = .120, p<.001). The effect of perceived discrimination on known risk factors is a novel finding and could reflect a potential important contributor to increased cervical cancer risk in marginalized populations. Further investigation in a more heterogeneous population, particularly one that includes women with and without a history of atypical Pap tests, is necessary to explore this theory. In addition, a mechanism of action and specific causes of perceived discrimination must be investigated.