Abstract IA15: Neighborhood factors and changes in mammography screening rates in response to promotora intervention in Latinas
Authors: Beresford Shirley A.A. , Molina Yamile , Plascak Jesse J. , Patrick Donald L. , Coronado Gloria D. 
Published: February 2019

Abstract
Latinas have relatively low rates of mammography screening participation, which may contribute to later stage of breast cancer at diagnosis for Latinas, and also higher mortality rates following cancer diagnosis. We conducted a multilevel intervention study (¡Fortaleza Latina!) to increase breast cancer screening among Latinas in Western Washington who seek care at a safety net health center. We were also interested in discovering if and how neighborhood factors may be associated with Latinas' barriers to or uptake of cancer screening, including mammography. We examined neighborhood racial/ethnic composition and socioeconomic status in relation to these factors.
The study enrolled 536 Latinas ages 42 to 74 who had a primary care clinic visit in the previous 5 years and had not obtained a mammogram in the previous 2 years. Participants were block randomized within clinic to either (i) a control arm (usual care) or (ii) a promotora-led, motivational interviewing intervention that included a home visit and telephone follow-up. At the clinic level, two of four participating clinics were provided additional mammography services delivered by a mobile mammography unit. Barriers to obtaining mammography were categorized into knowledge, psychocultural, and economic. American Community Survey (2007-2011) data were used to calculate four neighborhood measures: socioeconomic-based concentration, socioeconomic-based segregation, Latino-based concentration, and Latino-based segregation.
Rates of screening mammography one year post-randomization were 19.6% in the intervention group and 11.0% in the usual care group (P &lt; 0.01), based on medical record data. No significant differences in participants' mammography screening were observed in clinics assigned to additional mammography services versus usual care (15.8% vs. 14.4%; P = 0.68). Thirty-five percent and 31% of women attributed failure to complete mammography screening to knowledge-based or economic reasons, respectively. These attribution percentages varied significantly by Latino-based segregation (P&lt;0.05). In addition, relative to women residing in areas with greater concentration of Latinos, women in areas with the lowest concentrations were less likely to report knowledge-based reasons for not obtaining a mammogram (p ≤ 0.05).
In conclusion, the multilevel intervention of promotora-delivered motivational interviewing and free mammography services modestly raised rates of participation in breast cancer screening among Latinas. Future research might examine the mediating role of neighborhood characteristics in the efficacy of mammography screening interventions.
Citation Format: Shirley A.A. Beresford, Yamile Molina, Jesse J. Plascak, Donald L. Patrick, Gloria D. Coronado. Neighborhood factors and changes in mammography screening rates in response to promotora intervention in Latinas [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA15.