Despite overall increases in mammography use over the past two decades, mammography remains underutilized in certain groups of women. In particular, women of color are less likely than white women to receive mammography and women of lower socioeconomic status are less likely to receive mammography. Psychosocial factors, such as stress and social support, are associated with socioeconomic status and race, and the importance of these psychosocial factors for addressing disparities in health is increasingly recognized. The prior research relating psychosocial factors to racial/ethnic disparities in mammography have primarily been retrospective in nature, among convenience samples of a single race/ethnic group, and focused on obtaining a screening rather than engaging in the recommended regular mammography. Therefore, little is known from prospective studies of multi-ethnic women about the relation between psychosocial factors and regular mammography. Research on psychosocial pathways to regular mammography is needed to enhance understanding of opportunities for intervention and reduce risk among appropriate subgroups of postmenopausal women. We propose to use data collected as part of the Women's Health Initiative Observational Study (WHI OS), a cohort study of 93,676 ethnically diverse post-menopausal women enrolled between 1993 and 1998. The central hypothesis to be tested in this research is that specific psychosocial variables are a barrier to the regular use of mammography after controlling for known correlates of mammography (e.g., demographic, socioeconomic factors, medical access and health behavior).
The specific aims of this study are to identify psychosocial factors associated with annual mammography in healthy postmenopausal women and evaluate the moderating effect of race on the relationship between psychosocial factors and regular mammography. The proposed research will expand on currently available breast cancer control research in underserved populations by examining intracultural, as well as intercultural, differences in psychosocial factors and regular mammography.
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