The underlying mechanisms for the persistent racial/ethnic and socioeconomic disparities in breast cancer mortality rates observed in the US are poorly understood. While many factors have been shown to influence these disparities, diagnosis at later stage of disease among African-Americans and women of low socioeconomic status (SES) continues to be a concern. Thus, the role of mammography screening, as delivered in the US health care system, has been an area of interest in explaining excess breast cancer deaths observed for African-American and low-SES women. While some studies show that African- American women are screened as often as White women, others have shown that African-American are less likely to receive adequate mammography services. Data have consistently shown that women with lower income, lower education levels, and no usual source of care are less likely to engage in repeat mammography screening. There is also evidence to show that SES exerts an impact on cancer screening at an ecologic level (e.g. county poverty levels). In addition to neighborhood socioeconomic conditions and resources, racial residential segregation has been shown to influence health outcomes. Yet to our knowledge, racial residential segregation has received little attention in terms of its effect on cancer prevention behavior. While administrative census data can yield insight into contextual neighborhood effects, the development and use of measures that extend beyond census data are necessary in order to identify mechanisms that can be identified for effective intervention efforts. Using a multilevel conceptual framework, I propose to: 1) Examine the influence of neighborhood factors (census tract level) and racial residential segregation on repeat mammography in a national sample;2) Conduct key informant interviews and focus groups to determine neighborhood factors of concern to women;3) Collect pilot data on neighborhood conditions in Jacksonville, FL;4) Develop a grant proposal for independent funding to conduct a study on neighborhood and mammography screening behavior. This proposal specifically addresses neighborhood level influences on cancer prevention behavior with the ultimate goal of offering insight into the multilevel mechanisms that can lead to effective neighborhood level interventions in the area of cancer control and prevention.
| Dailey, Amy B; Brumback, Babette A; Livingston, Melvin D et al. (2011) Area-level socioeconomic position and repeat mammography screening use: results from the 2005 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 20:2331-44 |
| Dailey, Amy B; Kasl, Stanislav V; Holford, Theodore R et al. (2010) Neighborhood- and individual-level socioeconomic variation in perceptions of racial discrimination. Ethn Health 15:145-63 |
| Brumback, Babette A; Dailey, Amy B; He, Zhulin et al. (2010) Efforts to adjust for confounding by neighborhood using complex survey data. Stat Med 29:1890-9 |
