Abstract B80: Perceived control over health and history of mammography screening in Hispanic/Latino women living in the Northeast United States
Authors: Jones Beth A. , Epstein Lianne , Genao Inginia , Nunez-Smith Marcella , Vila Hosanna Soler , Claus Elizabeth , Nappi Susan 
Published: October 2015

Background: Hispanic/Latinas (H/Ls) are more likely to be diagnosed with later staged breast cancer and to have poorer survival compared with White (W) women. Nationally, mammography screening rates in H/Ls are lower than reported for Whites or African Americans. However, little is known about cancer screening in H/Ls living in the Northeast, US. The goal of this prospective study is to identify predictors of adherence to mammography screening guidelines and associated outcomes over a 2-3 year period. Here, we report the role of perceived control over health on history of non-adherence to mammography guidelines as reported in the baseline interview. Methods: 1600 community-based Hispanic/Latinas, ages 40-75, seeking care at primary care clinics in 4 cities with the largest Hispanic populations in Connecticut and with no prior history of breast cancer or biopsy, were enrolled in this study between October, 2009 and March, 2011 (75% participation rate). Study participants provided extensive information on socio-demographic, medical care, psychosocial, acculturation factors, and health beliefs in a one hour telephone interview, generally conducted in Spanish (85%). Perceived control over one's health was assessed during the baseline interview with the following three questions: (a) “How much control do you feel you have over whether or not you will remain healthy?” (b) “How much control do you feel you have over whether or not you will develop cancer in your lifetime?” and (c) “How much control do you feel you have over whether or not you could recover from cancer if you had it?”. For all three items, responses ranged from least to most perceived control: (1) “No control”, (2) “A little control”, (3) “Some control”, (4) “A lot of control”, (5) “Don't Know”. A perceived control index was created by summing the responses for the three perceived control questions (Cronbach's alpha = 0.531). Although results were similar using different versions of the independent variable, perceived control, tertiles of the index variable (low, moderate, and high levels of perceived control) are the primary independent variables reported here. Bivariate analyses and multivariate stepwise logistic regression were performed. Odds ratios (OR) and 95% confidence intervals (CI) are reported.

Results: Adjusting for selected socio-demographic (age, education, marital status, household income), acculturation (foreign or Puerto-Rico born), self-assessed English language skill, access to care (insurance coverage, usual care provider), and self-rated health, participants who reported low (odds ratio [OR] 1.64,95% confidence interval [CI] 1.24, 2.17) or moderate levels (OR= 1.57, 95% CI 1.18, 2.08) of perceived control, as compared to women who had high levels of perceived control, were statistically significantly more likely to be non-adherent to mammography screening. These associations were unchanged when adjusted for participants' feelings of fatalism. Conclusions: Low to moderate versus high levels of perceived control over health contribute to lower levels of mammography screening according to guidelines. Identifying ways to address perceived control over health will be critical to increasing mammography screening adherence in this under-resourced population.

Citation Format: Beth A. Jones, Lianne Epstein, Inginia Genao, Marcella Nunez-Smith, Hosanna Soler Vila, Elizabeth Claus, Susan Nappi. Perceived control over health and history of mammography screening in Hispanic/Latino women living in the Northeast United States. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B80.