Uterine fibroids are a common gynecological condition among women. African American women, however, are particularly susceptible to developing fibroids; in fact, approximately 80-90% of African American women are diagnosed with the condition by age 50. Left untreated, these benign tumors can reduce fertility and increase the risk of pregnancy complications. Despite the high prevalence of uterine fibroids among African American women and the detrimental effects they may have on reproductive health, little is known about the risk factors associated with fibroid development among this demographic.

To address this gap in the literature, the proposed study used data collected from 699 African American women in the southern region of the United States. This study was guided by an adapted racism and health framework as well as an expanded ABC-X model that includes elements of the mundane extreme environmental stress theory. Structural equation modeling was used to examine the relationship between perceived and internalized racism, the interaction between the two racism variables, and uterine fibroid diagnosis among African American women. The study also investigated depressive symptomology and body mass index as mediators of the proposed relationships. Results revealed a direct effect between perceived racism and the likelihood of a uterine fibroid diagnosis (β = .172, SE = .05, p < .001, OR = 1.19 [95% CI = 1.08, 1.31]). There was not a direct effect, however, between internalized racism and fibroid diagnosis, or the racism interaction variable and fibroid diagnosis. Perceived racism (β = .214, SE = .03, p < .001), internalized racism (β = .108, SE = .04, p < .01), and the racism interaction term (β = .067, SE = .03, p < .05) were positively and significantly associated with depressive symptomology. There was no evidence of full or partial mediation through the proposed mediators. The present study is among the first to examine two forms of racism as critical psychosocial risk factors for an adverse reproductive health outcome that differentially impacts African American women. The findings have important implications for clinical practice and policy that may aid in the effort to address racial disparities related to uterine fibroid development.