Women In Mississippi Research Articles

Abstract 1014: Disparities of triple negative breast cancer in Mississippi

Abstract Background: Triple-negative breast cancer (TNBC) accounts for about 10-15% of all breast cancers nationwide with disparities of incidence and outcomes among races, geographic locations, and other factors. This study is aimed to analyze the differences in the rate of TNBC, patient conditions at time of diagnosis, and death from TNBC among women in Mississippi. Methods: A retrospective study was conducted to serially review breast cancer cases diagnosed in the University of Mississippi Medical Center during May 2016 to May 2023. The entire breast cancer population was then stratified by race. The rate of TNBC, age and BMI at time of diagnosis, the rate of expiration were compared between African American (AA) and Caucasian American (CA) women with breast cancer. Two-tailed Student’s T-test was used to calculate the difference in mean values, and Chi-Square Test was used to compare the difference in rates or percentages. The significant p value was set at p<0.05. Results: In total 291 women with breast cancer, AA patients were 195 (67.01%), CA patients were 88 (30.24%), and other were 8 (2.75%). The mean age of all patients was 58.3 years-old (ranged 24-97). The mean BMI was 31.19. The patients with TNBC were 109 (37.46%) in entire studied population. A total of 32 (1.6%) patients, including 14 TNBC and 18 non-TNBC were expired with an average age of 61.84 and an average survival time of 20 months from diagnosis to expiration. As compared to CA patient population, AA breast cancer patients had onset at younger age (58.08±0.88 vs. 59.18±1.36), had a higher BMI (31.79±0.62 vs. 28.25±1.05, p=0.017), higher percentage of TNBC (41.54% vs. 30.68%, p=0.082 and OR=1.605), and higher rate of expiration (11.28% vs, 9.1%). Also, as compared to CA expired patients with breast cancer, AA expired patients had higher BMI (29.57 vs. 28.61), shorter survival time (17.5 months vs. 19.4 months), and died at younger age (61.84-year old vs. 66.38-year old) with a higher proportion of TNBC subtype (54.6% vs 12.5%, p=0.045, OR=9.6). Conclusions: Breast cancer is greatly disparate racially between AA and CA and geographically between Mississippi and US national average. The disparities are manifested in the proportion of TNBC subtype, age at onset of breast cancer, BMI at time of diagnosis, and death rate. Citation Format: Navdeep Kaur, Javaria A. Khan, Jinghe Mao, Diva Melvin, Muhammad M. Hassan, Xinchun Zho. Disparities of triple negative breast cancer in Mississippi [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1014.

"Blocks for Freedom": Sewing for Voting in Post-Jim Crow Mississippi

Abstract: This article examines a voting rights campaign known as "Blocks for Freedom" that was launched in 1966 to help a group of rural African American women in Clay County, Mississippi, protect their right to vote. These Black women faced significant obstacles to vote even after the passage of the 1965 Voting Rights Act. Local white vigilantes and county administrators used violence and the threat of informal economic sanctions to punish Black citizens who registered to vote. "Blocks for Freedom" sought to circumvent these limitations by creating jobs for Black women that would offer a living wage and protect their ability to cast ballots. Led by poor women in Mississippi and civil rights advocates in New York City, this innovative campaign shows how grassroots activists encountered voter suppression techniques employed to dilute the Black vote after the Civil Rights Movement.

Navigating the Maze: Facilitators and Barriers to Substance Use Treatment for Pregnant and Parenting Women in Mississippi

There are significant hurdles to placing pregnant and parenting women (PPW) with a substance use disorder into treatment programs. This study uses qualitative analysis of case notes collected by a linkage to care expert (patient navigator) from over 50 Mississippi PPW client cases. The analysis identified facilitators and barriers in the referral to treatment process. We group the observed patterns into three general categories: (1) individual factors such as motivation to change and management of emotions; (2) interpersonal relationships such as romantic partner support or obstruction; and (3) institutional contexts that include child welfare, judicial, and mental health systems. These factors intersect with one another in complex ways. This study adds to prior research on gender-based health disparities that are often magnified for pregnant and parenting women.

Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid

Mississippi has one of the highest rates of severe maternal morbidity (SMM) in the US, and SMMs have been reported to be more frequent among Medicaid-insured women. A substantial proportion of pregnant women in Mississippi are covered by Medicaid; hence, there is a need to identify potential risk factors for SMM in this population. To examine the associations of health care access and clinical and sociodemographic characteristics with SMM events among Mississippi Medicaid-enrolled women who had a live birth. A nested case-control study was conducted using 2018 to 2021 Mississippi Medicaid administrative claims database. The study included Medicaid beneficiaries aged 12 to 55 years who had a live birth and were continuously enrolled throughout their pregnancy period and 12 months after delivery. Individuals in the case group had SMM events and were matched to controls on their delivery date using incidence density sampling. Data analysis was performed from June to September 2022. Risk factors examined in the study included sociodemographic factors (age and race), health care access (distance from delivery center, social vulnerability index, and level of maternity care), and clinical factors (maternal comorbidity index, first-trimester pregnancy-related visits, and postpartum care). The main outcome of the study was an SMM event. Adjusted odds ratio (aORs) and 95% CIs were calculated using conditional logistic regression. Among 13 485 Mississippi Medicaid-enrolled women (mean [SD] age, 25.0 [5.6] years; 8601 [63.8%] Black; 4419 [32.8%] White; 465 [3.4%] other race [American Indian, Asian, Hispanic, multiracial, and unknown]) who had a live birth, 410 (3.0%) were in the case group (mean [SD] age, 26.8 [6.4] years; 289 [70.5%] Black; 112 [27.3%] White; 9 [2.2%] other race) and 820 were in the matched control group (mean [SD] age, 24.9 [5.7] years; 518 [63.2%] Black; 282 [34.4%] White; 20 [2.4%] other race). Black individuals (aOR, 1.44; 95% CI, 1.08-1.93) and those with higher maternal comorbidity index (aOR, 1.27; 95% CI, 1.16-1.40) had higher odds of experiencing SMM compared with White individuals and those with lower maternal comorbidity index, respectively. Likewise, an increase of 100 miles (160 km) in distance between beneficiaries' residence to the delivery center was associated with higher odds of experiencing SMM (aOR, 1.14; 95% CI, 1.07-1.20). The study findings hold substantial implications for identifying high-risk individuals within Medicaid programs and call for the development of targeted multicomponent, multilevel interventions for improving maternal health outcomes in this highly vulnerable population.

Mortality Trends in Alzheimer's Disease in Mississippi, 2011-2021.

This paper reviews the risk factors, mortality trends, etiology, and prognosis of Alzheimer's in Mississippi with a focus on prevention. The southern diet with foods high in sugar and sodium, along with sedentary and poor lifestyle choices, increases mortality risk from Alzheimer's disease for women in Mississippi, specifically due to women over 65 having higher rates of obesity and hypertension. Understanding the epidemiology and risk factors of Alzheimer's in Mississippi will help inform communities, policies, and programs to prevent disease occurrence.

The Impact of Race on Healthcare Coverage for Women in Louisiana and Mississippi

It is crucial to confront the problem of health inequity that Black women are experiencing. Black women have a higher risk of pregnancy-related complications and experience worse outcomes in cardiovascular diseases, diabetes, high blood pressure, and mental health. Even with the Affordable Care Act, Black women still may not have access to affordable health insurance. This study examines the impact of race on healthcare coverage for women in Louisiana, which expanded Medicaid, and Mississippi, which did not. The study uses a quasi-experimental analysis to compare insurance coverage across states using publicly available data from the 2010 and 2021 American Community Survey. A chi-squared test determined a significant correlation between race and insurance type in both states. Insurance coverage for Black women increased in Louisiana. Women in Mississippi made slight gains even without Medicaid expansion. Despite these gains, racial disparity among women persists. Policymakers should strive for affordable healthcare for all women, regardless of race and geography.

Prenatal, Delivery and Postpartum Care Experiences among Black Women in Mississippi during COVID-19 Pandemic 2020–2021

The COVID-19 pandemic has presented challenges for countries to maintain high-quality, essential maternal health services, altering pregnancy experiences for women. This qualitative study aims to explore the impact of COVID-19 mitigation strategies on self-reported prenatal, delivery, and postpartum care experiences among Black women in Mississippi. Postpartum Black women who gave birth between March 2020 and March 2021 were recruited from a Federally Qualified Health Clinic that serves three Mississippi counties. Using a semi-structured interview guide, 10 postpartum women were interviewed, and their responses were analyzed utilizing the thematic content analysis approach. Major themes identified were stress related to COVID-19, disruption of social life/support, disruption of expected healthcare services, uncertainty and fear about coronavirus, COVID-19 mitigation strategies, and associated poor maternal health outcome. COVID-19 mitigation strategies exacerbated normal maternity-related stress. Postpartum women reported increased anxiety, fear, frustration, emotional stress, and lack of social support resulting in what was described as depression and feelings of loneliness. The results of this qualitative study of 10 Black women who gave birth during COVID-19 suggest the importance of stress-informed care.

Contraceptive care experiences and preferences among Black women in Mississippi: A qualitative study

ObjectivesSexual and reproductive health (SRH) equity requires engagement with anti-Black racism's impact on contraceptive care experiences, and prioritization of Black women's needs in program and policy design. To date, such efforts have been limited. We explored contraceptive care experiences and preferences of Black women in Mississippi. Study designWe conducted 34 in-depth interviews and 6 focus group discussions (with a total of 35 participants) with adult Black women who had used contraception in the last 2 years. We recruited in community settings throughout Mississippi and used the Person-Centered Contraceptive Care Framework as a guide to explore experiences and preferences. We applied the 4 Person-Centered Contraceptive Care Framework elements – Outreach and trust building, Access, Quality, and Follow-up support – to identify and interpret themes. ResultsSchools and churches as sources of support for adolescent SRH was the most salient theme within Outreach and trust building. Cost and difficulties obtaining appointments without private insurance were identified as barriers to Access. The need for more comprehensive contraceptive counseling, including side effect information, and the experience of racism and other discrimination by providers and clinic staff emerged as prominent themes around Quality. Finally, desire for more proactive clinical outreach and respect for discontinuation emerged related to Follow-up support. ConclusionsBarriers and facilitators to high quality contraceptive care and information identified among Black women in this study offer insights for interventions to improve access to high quality contraceptive care and address historical and ongoing inequities. ImplicationsIn an era of increasing prioritization of person-centeredness and equity in contraceptive access efforts, our findings suggest the critical need to expand information and support through churches and schools, develop an anti-racist, trustworthy health care workforce, improve counseling, and address appointment and follow-up care barriers.

Assessing the impact of a statewide effort to improve breastfeeding rates: A RE-AIM evaluation of CHAMPS in Mississippi.

Communities and Hospitals Advancing Maternity Practices (CHAMPS) is a public health initiative, operating in Mississippi since 2014, to improve maternal and child health practices and reduce racial disparities in breastfeeding. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, this study assessed CHAMPS, which used a Quality Improvement intervention at hospitals, and engaged intensively with local community partners. The study team assessed outcomes through quantitative data (2014–2020) from national sources, Mississippi hospitals, community partners and CHAMPS programme records, and qualitative data from focus groups. With 95% of eligible Mississippi hospitals enrolled into CHAMPS, the programme reached 98% of eligible birthing women in Mississippi, and 65% of breastfeeding peer counsellors in Mississippi's Special Supplemental Nutrition Programme for Women, Infants and Children. Average hospital breastfeeding initiation rates rose from 56% to 66% (p < 0.05), the proportion of hospitals designated Baby‐Friendly or attaining the final stages thereof rose from 15% to 90%, and 80% of Mississippi Special Supplemental Programme for Women, Infants, and Children districts engaged with CHAMPS. CHAMPS also maintains a funded presence in Mississippi, and all designated hospitals have maintained Baby‐Friendly status. These findings show that a breastfeeding‐focused public health initiative using broad‐based strategic programming involving multiple stakeholders and a range of evaluation criteria can be successful. More breastfeeding promotion and support programmes should assess their wider impact using evidence‐based implementation frameworks.

\u201cPrEP\u2019s just to secure you like insurance\u201d: a qualitative study on HIV pre-exposure prophylaxis (PrEP) adherence and retention among black cisgender women in Mississippi

BackgroundPre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); however, national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S. regions and white women. This study applied intersectionality and PrEP multilevel resilience frameworks to assess how socio-structural and clinical contexts shaped PrEP persistence among Black cisgender women in Mississippi.MethodsSemi-structured interviews were conducted with eight Black cisgender women in Jackson, Mississippi. This sample was purposively recruited to include PrEP-initiated Black cisgender women.ResultsSix themes identified that shaped PrEP care among Black cisgender women: (1) internal assets, (2) sole responsibility to HIV prevention, (3) added protection in HIV serodifferent relationships, (4) financial issues, (5) trust and distrust in the medical system, and (6) side effects. Black cisgender women reported that PrEP persistence increased control over their sexual health, reduced anxiety about HIV, and promoted self-care. Black cisgender women also indicated that medication assistance programs increased PrEP affordability resulting in continued persistence.ConclusionsIn addition to preventing HIV, PrEP may yield secondary positive impacts on the health and relationships of Black cisgender women. However, very few Black cisgender women in the South are using PrEP given intersectional barriers and thus necessitates adaptive strategies to support PrEP initiation and persistence. Efforts aimed at increasing the coverage of PrEP among Black cisgender women should consider implementation strategies responsive to lived realities of Black women.

Review: The Blues Comes to Texas: Paul Oliver and Mack McCormick’s Unfinished Book, by Paul Oliver and Mack McCormick

Review: <i>The Blues Comes to Texas: Paul Oliver and Mack McCormick’s Unfinished Book</i>, by Paul Oliver and Mack McCormick

Insurance Churn and Inconsistent Access to Reproductive Health Care among Abortion Patients in Mississippi

Changes in health insurance coverage, or insurance churn, is common in the months surrounding pregnancy, but there has been limited study of how churn affects women's experiences with reproductive health care. We conducted in-depth interviews with women seeking abortion care in Mississippi in 2016. We coded interview transcripts relating to experiences accessing reproductive health care before pregnancy and organized the codes into themes. Of the 38 women interviewed, one-third were uninsured and half described recent changes in their health insurance. This contributed to inconsistent care, as women shifted from private clinicians while insured to health department clinics while uninsured. For several women, these shifts created barriers to contraceptive use and were closely related to their unintended pregnancy. Insurance churn and associated disruptions in contraceptive use were common among Mississippi women seeking abortion in this study. Policies should support women's reproductive autonomy by facilitating consistent coverage and reliable access to contraception.

Birthing Knowledge Production as Resistance

ABSTRACT&#x0D; How does risk of mortality during childbirth become internalized and embodied in Black communities? While mainstream news articles aim to bring attention to inadequacies in Black maternal healthcare, few ethnographies elucidate the effect that these risk factors have on Black women’s psychosocial health and the support networks they turn to in order to mitigate risk.&#x0D; My ethnography analyzes the effects of institutional racism on maternal mortality risk factors, specifically toxic stress and grounds Black maternal health in the context of a burgeoning doula movement in Mississippi. Through tracing the psychosocial and emotional support networks of single Black mothers on WIC and working Black mothers, I elucidate several inadequacies in healthcare models of maternal care. I identify the framework of medicalization in pregnancy care that arose in Mississippi in 1920, as a way to dismantle existing Black birth work communities, mitigate infant mortality risk, and subsequently stratified birthing knowledge production. Through an analysis of midwifery and doula work in Mississippi, this article traces the displacement of Black midwives and other nonmedical Black birth workers in Mississippi and the distrust these communities harbor towards hospitals in the present-day.&#x0D; My article primarily aims to bring equity to Black birth workers modes of knowledge production. It explores intergenerational distrust and fear in the context of Black maternal health in Mississippi. First, I trace the unequal landscape of birthing care for Black women in Mississippi from the development of public health in 1920 to the current locales of clinical care. Next, I emphasize intergenerational trauma as contributing to stress for Black expectant mothers and the need for psychosocial support. Finally, I present findings that recommend integration and standardization of doulas in the healthcare system and centering maternal psychosocial support in communities.

P74 Contraceptive care experiences and preferences among Black women in Mississippi: A multi-method qualitative study

P74 Contraceptive care experiences and preferences among Black women in Mississippi: A multi-method qualitative study

Racial Disparities in Reproductive Healthcare among Parous and Nulliparous Women in Mississippi.

Long-standing racial disparities exist in reproductive healthcare and have been associated with negative health outcomes among minority women. This study aimed to analyze the racial disparities in reproductive healthcare among Mississippi women, particularly as it related to contraception access, usage, setting, provider type, and payer. A two-stage stratified probability design was employed -95 of the 1500 licensed childcare facilities across the state were randomly selected, and then two to three classrooms were randomly selected within each facility. The children were the means to obtaining a weighted sample of parous women of childbearing age (15-44). Once a parous woman completed the study, she could invite a nulliparous friend of similar age, race, and socioeconomic background to also participate in the study. Racial disparities were found in the reproductive healthcare of both the parous and nulliparous groups. Overall, black women were less likely to receive services from an obstetrics and gynecology. Parous and nulliparous black women were more likely to receive their reproductive healthcare at the health department and less likely to use the most effective methods of contraception. Low use of the most effective methods of contraception, despite high levels of general contraceptive use and high insurance coverage, hints at additional barriers to full access for black women in Mississippi. More equitable access to effective family planning counseling and contraception can have meaningful impact on the lives of black women in our state.

Abstract B030: See, Test, and Treat: Engaging vulnerable populations in cancer screening

Abstract Background: The breast cancer and cervical cancer mortality rates among women in Mississippi are higher than the national averages. Early detection and early treatment are associated with longer survival rates among women who are diagnosed with breast cancer or cervical cancer. However, the percentage of women in Mississippi who report having regular mammograms and in cervical cancer screenings is lower than the national average. Purpose: Clinicians and investigators at UMMC are actively working within transdisciplinary teams to implement evidence-based interventions aimed at reducing breast and cervical cancer mortality disparities in the state. Methods: See, Test, and Treat was a community-based cancer screening event that occurred on June 1, 2019 at the UMMC Cancer Center and Research Institute. The UMMC team provided breast, cervical and oral cancer screenings to 103 women. Healthy cooking and exercise demonstrations, were conducted to actively engage patients in health education activities. Participants completed a brief exit survey that was used to gather data on the effect of the program on the patients’ knowledge and attitudes towards cancer screenings, and intentions to changed cancer related health behaviors. Results: The short-term outcomes showed that 21 patients had abnormal mammograms. All of the patients with abnormal mammograms were immediately linked to follow-up care. No Pap tests were returned with abnormal results. However, the clinicians diagnosed 8 patients with Trichomonas. The majority of the patients indicated that their knowledge of and attitudes towards breast and cervical cancer screening changed positively and the majority intended to change their cancer related health behaviors. Conclusion: See, Test, and Treat is an effective community-based activity that can increase access to breast, cervical and oral cancer screenings by uninsured and underinsured women. Citation Format: Michelle S Williams, Jimmie Wells, Roy Duhe, Timothy Allen. See, Test, and Treat: Engaging vulnerable populations in cancer screening [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B030.

Women's Postabortion Contraceptive Preferences and Access to Family Planning Services in Mississippi.

Women's preferences for postabortion contraceptive care vary, and some may experience difficulties realizing their preferences owing to health systems-level barriers. We assessed Mississippi women's interest in postabortion contraceptive counseling and method use and the extent to which their method preferences were met. In 2016, women ages 18 to 45 completed a self-administered survey at their abortion consultation visit in Mississippi and a follow-up phone survey 4-8weeks later. Thirty-eight participants were selected for in-depth interviews. We computed the percentage of women who were interested in contraceptive counseling, initiating a method, and who obtained a method at the clinic. We also calculated the percentage who were using their preferred method after abortion and the main reasons they were not using this method. We analyzed transcripts using a theme-based approach. Of 323 women enrolled, 222 (69%) completed the follow-up survey. Of those completing follow-up, more than one-half (58%) reported that their consultation or abortion visit was the best time for contraceptive counseling, and 69% wanted to initiate contraception at the clinic. Only 10% obtained a method on site, and in-depth interview respondents reported they could not afford or did not like the options available. At the follow-up survey, 23% of respondents were using their preferred method. Women cited cost or lack of insurance coverage and difficulties scheduling appointments with community clinicians as reasons for not using their preferred method. Mississippi women have a large unmet demand for postabortion contraception. Policies that support on-site provision of contraception at abortion facilities would help women to realize their contraceptive preferences.

Critical Discourse Analysis of an ilocutive agent of the Novel The Help by Kathryn Stockett

The black feminist ideology in literary discourse is the object of study of this research, which is aiming at determining how the discourse of an ilocutive agent reflects the change of ideology of Southern African-American women in the 1960s. Then, the characterization of the ilocutive agent as valuating subject is carried out. This research analyzes the novel The Help. Written by Kathryn Stockett, this novel describes the situation of African- American women in Mississippi during the Civil Rights Movement. An ilocutive agent of the novel was chosen to critically analyze her discourse. Theory involving discourse, Critical Discourse Analysis, black feminist ideology, and modality was presented in the research. The methodology included a literary review, the historical- logical, the inductive-deductive, analytic-synthetic methods, a literary analysis and a Critical Discourse Analysis. The results have shown that the ilocutive agent has positive and assertive self-valuations as a member of the community, whereas regarding her marriage the valuations are negative. The valuations are also negative and the ilocutive agent is gushing when she says her opinion on the context she is living.

"We don’t treat your kind": Assessing HIV health needs holistically among transgender people in Jackson, Mississippi

HIV disproportionately impacts transgender communities and the majority of new infections occur in the Southern United States. Yet, limited data exists on contextual realities of HIV vulnerability and healthcare needs among transgender individuals in the Deep South. Addressing this gap in the literature, we assess the health needs, including barriers and facilitators to accessing healthcare, including and beyond HIV, from the perspective of transgender men and women in Mississippi. Between June-August 2014, in-depth, semi-structured qualitative interviews (n = 14) were conducted with adult transgender persons at an LGBT healthcare setting in Jackson, Mississippi. In-depth interviews lasted between 60–90 minutes and followed semi-structured format (themes probed: HIV vulnerability, healthcare needs, and availability of gender-affirming medical care). Audio files were transcribed verbatim and analyzed using Dedoose (v.6.1.18). Among participants (mean age = 23.3 years, standard deviation = 4.98), 43% identified as a transgender man or on a transmasculine spectrum, 43% as Black, and 21% self-reported living with HIV. HIV-related services were frequently described as the primary gateway to accessing healthcare needs. Nonetheless, participants’ primary health concerns were: gender affirmation processes (hormones, silicone, binding/packing); mental health; and drug/alcohol use. Stigma and discrimination were commonly reported in healthcare settings and health-related information was primarily attained through social networks and online resources. Results highlight gender identity alongside race and pervasive marginalization as key social determinants of transgender health in Mississippi. As Mississippi is one of several states actively debating transgender access to public accommodations, findings underscore the need to treat transgender health as a holistic and multidimensional construct, including, but moving beyond, HIV prevention and care.

Self-collected vaginal swabs for HPV screening: An exploratory study of rural Black Mississippi women.

ObjectivesTo determine the post-procedure acceptability of self-collecting a vaginal swab for HPV testing among a highly impoverished and geographically isolated population of medically underserved Black women residing in the Mississippi Delta. Further, to test correlates of reporting that self-collection is preferred over Pap testing. Finally, to determine the prevalence of any of 13 high-risk HPV types among this population and the correlates of testing positive.MethodsEighty-eight women were recruited from two churches located in different towns of the Mississippi Delta. After completing a survey, women were provided instructions for self-collecting a cervico-vaginal swab and completing a post-collection survey. Specimens were tested for 13 oncogenic HPV types. Due to the exploratory nature of the study, significance was defined by a 0.15 alpha-level.ResultsComfort levels with self-collection were high: 78.4% indicated a preference for self-collecting a specimen compared to Pap testing. Overall, 24 women (28.7%) tested positive for one or more of the 13 HPV types. Significant associations with testing positive were found for women having sex with females (P = 0.09), those never having an abnormal Pap (P = 0.06), younger women (P = 0.10), those with greater fatalism scores (P = 0.006), and those having less trust in doctors (P = 0.001).ConclusionsBlack rural women from the deep-south are generally comfortable self-collecting cervico-vaginal swabs for HPV testing. Given that nearly 30% tested positive for oncogenic HPV, and that fatalism as well a lack of trust in doctors predicted prevalence, a reasonable screening alternative to Pap testing may be community-based testing for HPV using self-collected vaginal swabs.