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Underutilizers of mammography screening today: Characteristics of women planning, undecided about, and not planning a mammogram

  • Empirical Articles
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Annals of Behavioral Medicine

Abstract

Using concepts from the Precaution Adoption Process Model, we identified behavioral factors, sociodemographic and psychosocial variables, and beliefs about breast cancer that discriminated among women at different stages with regard to their intention to obtain mammography screening. An independent survey company conducted telephone interviews with 2,507 women aged 50 to 80 who were identified as underutilizers of mammography screening. Each underutilizer was assigned to one of three stages with regard to intention to get a mammogram: (a) definitely planning, (b) thinking about, and (c) not planning. Estimated actual risk of breast cancer, perceived risk to breast cancer, worry about breast cancer, and fear of learning from a mammogram that one has breast cancer were variables found to be significantly associated with intention to obtain a mammogram for several subgroups of underutilizing women. There are significant behavioral and psychosocial variables, beliefs and feelings about breast cancer, and demographic characteristics that distinguish underutilizing women at various stages with regard to intention to obtain mammography screening. Our findings provide new information that could help the health care professional motivate women who are not planning to utilize this preventive health measure to become regular utilizers.

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References

  1. Kerlikowske K, Grady D, Rubin SM, Sandcrock C, Ernster VL: Efficacy of screening mammography.Journal of the American Medical Association. 1995,273(2): 149–154.

    Article  PubMed  CAS  Google Scholar 

  2. Centers for Disease Control and Prevention: Use of mammography-United States, 1990.Morbidity and Mortality Weekly Report. 1990,39(36): 621–630.

    Google Scholar 

  3. Martin LM, Calle E, Wingo PA, Heath, CW: Comparison of mammography and pap test use from the 1987 and 1992 National Health Interview Surveys: Are we closing the gaps?American Journal of Preventive Medicine. 1996,12: 82–90.

    PubMed  CAS  Google Scholar 

  4. Hedegarrd HB, Davidson AJ, Wright RA: Factors associated with screening mammography in low-income women.American Journal of Preventive Medicine. 1996,12: 51–56.

    Google Scholar 

  5. Zapka JG, Stoddard AM, Costanza ME, Greene HL: Breast cancer screening by mammography: Utilization and associated factors.American Journal of Public Health. 1989,79: 1499–1502.

    PubMed  CAS  Google Scholar 

  6. Costanza ME: The extent of breast cancer screening in older women.Cancer. 1994,74(7 Suppl.): 2046–2050.

    Article  PubMed  CAS  Google Scholar 

  7. Rakowski W, Pearlman D, Rimer B, Ehrich B: Correlates of mammography among women with low and high socioeconomic resources.Preventive Medicine. 1995,24: 149–158.

    Article  PubMed  CAS  Google Scholar 

  8. Lerman C, Rimer B, Engstrom PF: Reducing avoidable cancer mortality through prevention and early detection regimens.Cancer Research. 1989,49(18): 4955–4962.

    PubMed  CAS  Google Scholar 

  9. Rakowski W, Rimer BK, Bryant SA: Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.Public Health Report. 1993,108(5): 605–624.

    CAS  Google Scholar 

  10. NCI Breast Cancer Screening Consortium: Screening mammography: A missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Studies.Journal of the American Medical Association. 1990,264(1): 54–58.

    Article  Google Scholar 

  11. Zapka JG, Hosmer D, Costanza ME, Harris DR, Stoddard AM: Changes in mammography use: Economic, need, and service factors.American Journal of Public Health. 1992,82(10): 1345–1351.

    PubMed  CAS  Google Scholar 

  12. Curry SJ, Emmons KM: Theoretical models for predicting and improving compliance with breast cancer screenings.Annals of Behavioral Medicine. 1994,16(4): 302–316.

    Google Scholar 

  13. Coyne CA, Hohman K, Levinson A: Reaching special populations with breast and cervical cancer public education.Journal of Cancer Education. 1992,7: 293–303.

    Article  PubMed  CAS  Google Scholar 

  14. Rosenstock IM: Historical origins of the Health Belief Model.Health Education Monographs. 1974,2: 1–8.

    Google Scholar 

  15. Becker MH: The Health Belief Model and personal health behavior.Health Education Monographs. 1974,2: 324–508.

    Google Scholar 

  16. Becker MH, Rosenstock IM: Comparing social learning theory and the Health Belief Model. In Ward WB (ed),Advances in Health Education and Promotion (Vol. 2). Greenwich, CT: JAI Press, 1987.

    Google Scholar 

  17. Montano DE, Thompson B, Taylor VM, Mahloch J: Understanding mammography intention and utilization among women in an inner city public hospital clinic.Preventive Medicine. 1997,26: 817–824.

    Article  PubMed  CAS  Google Scholar 

  18. Phillips KA, Kerlikowske K, Baker LC, Chang SW, Brown ML: Factors associated with women’s adherence to mammography screening guidelines.Health Services Research. 1998,33: 29–53.

    PubMed  CAS  Google Scholar 

  19. Aiken LS, West SG, Woodward CK, Reno RR: Health beliefs and compliance with mammography—Screening recommendations in asymptomatic women.Health Psychology. 1994,13: 122–129.

    Article  PubMed  CAS  Google Scholar 

  20. Hynes DM, Bastian LA, Rimer BK, Sloane R, Feussner JR: Predictors of mammography use among women veterans.Journal of Women’s Health. 1998,7: 239–247.

    PubMed  CAS  Google Scholar 

  21. Simon MS, Gimotty PA, Coombs J, et al: Factors affecting participation in a mammography screening program among members of an urban Detroit health maintenance organization.Cancer Detection and Prevention. 1998,22(1): 30–38.

    Article  PubMed  CAS  Google Scholar 

  22. Cole SR, Bryant CA, McDermott RJ, Sorrell C, Flynn M: Beliefs and mammography screening.American Journal of Preventive Medicine. 1997,13: 439–443.

    PubMed  CAS  Google Scholar 

  23. Meischke H, Andersen R, Bowen D, Kuniyuki A, Urban N: A health priorities model: Application to mammography screening.Health Education and Behavior. 1998,25: 383–395.

    Article  PubMed  CAS  Google Scholar 

  24. Rakowski W, Dube CE, Marcus BH, et al: Assessing elements of women’s decisions about mammography.Health Psychology. 1992,11: 111–118.

    Article  PubMed  CAS  Google Scholar 

  25. Rakowski W, Fulton JP, Feldman JP: Women’s decision-making about mammography: A replication of the relationship between stages of adoption and decisional balance.Health Psychology. 1993,12: 209–214.

    Article  PubMed  CAS  Google Scholar 

  26. Weinstein ND: The precaution adoption process.Health Psychology. 1988,7: 355–386.

    Article  PubMed  CAS  Google Scholar 

  27. Weinstein ND, Sandman PM: A model of the precaution adoption process: Evidence from home radon testing.Health Psychology. 1992,11: 170–180.

    Article  PubMed  CAS  Google Scholar 

  28. Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: Toward an integrative model of change.Journal of Consulting and Clinical Psychology. 1983,51: 390–395.

    Article  PubMed  CAS  Google Scholar 

  29. Weinstein ND, Rothman AM, Sutton SR: Stage theories of health behavior: Conceptual and methodological issues.Health Psychology. 1998,17: 290–299.

    Article  PubMed  CAS  Google Scholar 

  30. Prochaska JO, DiClemente CC: Common processes of self-change in smoking, weight control, and psychological distress. In Shiffman S, Wills TA (eds),Co** and Substance Use. San Diego, CA: Academic Press, 1985, 345–363.

    Google Scholar 

  31. Harrison JA, Mullen PD, Green LW: A meta-analysis of studies of the Health Belief Model with adults.Health Education Research. 1992,7: 107–116.

    Article  PubMed  CAS  Google Scholar 

  32. Janz NK, Becker MH: The health belief: A decade later.Health Education Quarterly. 1984,11: 1–47.

    PubMed  CAS  Google Scholar 

  33. Rakowski W, Stoddard AM, Rimer BK, et al: Confirmatory analysis of opinions regarding the pros and cons of mammography.Health Psychology. 1997,16(5): 433–441.

    Article  PubMed  CAS  Google Scholar 

  34. Stoddard AM, Rimer BK, Lane D, et al: Underusers of mammogram screening: Stage of adoption in five U.S. subpopulations.Preventive Medicine. 1998,27: 478–487.

    Article  PubMed  CAS  Google Scholar 

  35. Rakowski W, Fulton JP, Feldman JP: Women’s decision-making about mammography: A replication of the relationship between stages of adoption and decisional balance.Health Psychology. 1993,12(3): 209–214.

    Article  PubMed  CAS  Google Scholar 

  36. Rimer B, Conaway M, Lyna P, et al: Cancer screening practices among women in a community health center population.American Journal of Public Health. 1996,12(5): 351–357.

    CAS  Google Scholar 

  37. Gail MH, Brinton LA, Byar DP, et al: Projecting individualized probabilities of develo** breast cancer for White females who are being examined annually.Journal of the National Cancer Institute. 1989,81: 1879–1886.

    Article  PubMed  CAS  Google Scholar 

  38. Hosmer DW, Lemeshow S:Applied Logistic Regression. New York: Wiley, 1989.

    Google Scholar 

  39. SAS Institute, Inc:SAS/STAT Statistical Software, Version 6.10. Cary, NC: 1989–1993.

  40. Stata Corporation:Stata Statistical Software: Release 5.0. College Station, TX: 1996.

  41. Lipkus IM, Rimer B, Strigo T: Relationships among objective and subjective risk for breast cancer and mammography stages of change.Cancer Epidemiology and Biomarkers Prevention. 1996,5: 1005–1011.

    CAS  Google Scholar 

  42. Rimer BK, Trock B, Engstrom PF, Lerman C, King E: Why do some women get regular mammograms?American Journal of Preventive Medicine. 1991,7(2): 69–74.

    PubMed  CAS  Google Scholar 

  43. Siegler IC, Feaganes JR, Rimer B: Predictors of adoption of mammography in women under age 50.Health Psychology. 1995,14(3): 274–278.

    Article  PubMed  CAS  Google Scholar 

  44. Costanza ME, Stoddard A, Gaw V, Zapka JG: The risk factors of age and family history and their relationship to screening mammography utilization.Journal of the American Geriatric Society. 1992,40: 774–778.

    CAS  Google Scholar 

  45. Smith RA, Haynes S: Barriers to screening for breast cancer.Cancer. 1992,69(7): 1968–1978.

    Article  PubMed  CAS  Google Scholar 

  46. Lerman C, Rimer BK, Trock B, Balshem A, Engstrom PF: Factors associated with repeat adherence to breast cancer screening.Preventive Medicine. 1990,19: 279–290.

    Article  PubMed  CAS  Google Scholar 

  47. Weinstein ND: Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide, sample.Journal of Behavioral Medicine. 1987,10: 481–500.

    Article  PubMed  CAS  Google Scholar 

  48. Sox CH, Dietrich AJ, Tosteson TD, Winchell CW, Lebaree CE: Periodic health examinations, and the provision of cancer prevention services.Archives of Family Medicine. 1997,6: 223–230.

    Article  PubMed  CAS  Google Scholar 

  49. Elmore EG, Barton MB, Moceri VM, et al: Ten-year risk of false positive screening mammograms and clinical breast examinations.New England Journal of Medicine. 1998,338: 1089–1096.

    Article  PubMed  CAS  Google Scholar 

  50. King E, Rimer BK, Trock B, Balshem A, Engstrom P: How reliable are mammography self reports?American Journal of Public Health. 1990,80: 1386–1388.

    PubMed  CAS  Google Scholar 

  51. Zapka JG, Bigelow C, Hurley T, et al: Mammography use among sociodemographically diverse women: The accuracy of self-report.American Journal of Public Health. 1996,86: 1016–1021.

    Article  PubMed  CAS  Google Scholar 

  52. Clemow LP, Luckmann R, Mitchell M, Savegeau J, Costanza ME: Telephone counseling to promote mammography utilization: For whom is it successful?Annals of Behavioral Medicine. 1999,21(Suppl.): 120.

    Google Scholar 

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Authors and Affiliations

  1. University of Massachusetts Medical School, Massachusetts, USA

    Lynn Clemow, Mary E. Costanza, William P. Haddad, Roger Luckmann, Mary J. White & Deborah Klaus

  2. University of Massachusetts, Massachusetts, USA

    Anne M. Stoddard

Authors
  1. Lynn Clemow
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  2. Mary E. Costanza
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  3. William P. Haddad
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  4. Roger Luckmann
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  5. Mary J. White
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  6. Deborah Klaus
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  7. Anne M. Stoddard
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Additional information

Preparation of this manuscript was supported in part by a grant from the National Institutes of Health, National Cancer Institute (Grant Number CA60130-05). The data collection was part of a joint effort with the National Cancer Institute’s Breast Cancer Screening Consortium.

The authors wish to thank Dr. Neil Weinstein for his feedback concerning the precaution adoption process model, Karen Lenehan for her help in the preparation of the manuscript, and Sharon Longo for help with the data analysis.

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Clemow, L., Costanza, M.E., Haddad, W.P. et al. Underutilizers of mammography screening today: Characteristics of women planning, undecided about, and not planning a mammogram. ann. behav. med. 22, 80–88 (2000). https://doi.org/10.1007/BF02895171

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