Cancer prevention in context: interplay of perceived discrimination, neighborhood deprivation, and cancer-related risk and protective factors

BACKGROUND: Socio-environmental deprivation and discrimination are associated with poorer cancer outcomes, yet their combined impact remains understudied. This study examines the independent and combined impact of these factors on cancer-related outcomes. METHODS: Survey data (2018 to 2020) from 7,977 participants across six NCI-designated cancer centers assessed perceived discrimination (PD), area-level deprivation, lifestyle factors (smoking and obesity), and self-reported breast and colorectal cancer screening behaviors. Multivariate and multilevel logistic regression models estimated associations and the interclass correlation (ICC) quantified variation attributable to area-level factors. RESULTS: High PD was associated with 2.28 times higher odds of current smoking (95% CI: 1.71-3.05) and 1.33 times higher odds of obesity (95% CI: 1.03-1.72), compared to those with low PD. Living in socially deprived areas increased the odds of smoking by 1.51 (95% CI: 1.20-1.89), relative to socially privileged areas. ICC estimates that 4% of the variation in the association between high PD on smoking, and 2% of the variation between medium PD and obesity, were attributable to area-level factors. Neither PD nor neighborhood disadvantage were significantly associated with being up-to-date on cancer screenings. CONCLUSIONS: PD and neighborhood deprivation independently increase risk of smoking and obesity, both cancer risk factors, but were not significantly associated with screening behaviors. Area-level factors explain modest variation in these associations. IMPACT: Findings highlight the importance of integrating both social experience (PD) and structural conditions (neighborhood deprivation) in cancer prevention research. For practice and policy, results underscore the need for multilevel strategies and targeted prevention efforts to reduce behavioral cancer risk.