title: If we gave away mammograms, who would get them? A neighborhood evaluation of a no-cost breast cancer screening program.
abstract: BACKGROUND
  Low- and no-cost mammography programs have become a widespread strategy to increase access to breast cancer screening in low-income populations. However, rigorous evaluations of who remains unscreened in communities with these programs are lacking. We conducted a case-control study of African American older women in East Baltimore, Maryland, comparing attendees at a no-cost program to friends and neighbors not using no-cost venues.
  
  
  METHODS
  We recruited 288 women ages 50 and older, who attended a no-cost program at Johns Hopkins Hospital, to complete a 1(1/2) h home interview, answering semistructured and open-ended questions about cancer and health and a wide range of social and psychological items. For each case, we recruited one friend or neighbor, within 5 years of age, not receiving no-cost screening, to complete a similar control interview. Matched case-control analyses were used to compare program attendees to nonattendees within the target community.
  
  
  RESULTS
  Women using the no-cost program at least once were generally more poorly screened than their neighborhood control prior to the program, but had better recent screening history 3 years after the program began. In multivariate analyses, program attendees were more likely to have <10,000 dollars annual income (OR = 2.34, 95% CI 1.55,3.61), more likely to have had more children (OR = 1.13, 95% CI 1.04,1.24), and less likely to have health insurance (OR = 0.42, 95% CI 0.25,0.68). They were more likely to see a female primary care provider (OR = 1.82, 95% CI 1.24,2.70) and to see multiple providers (OR = 3.38, 95% CI 1.52,8.60).
  
  
  CONCLUSIONS
  Low-cost screening intervention programs reach women who might otherwise not receive screening. However, within target communities, improved partnerships with specific types of primary care providers could reach additional women.
authors.affiliation: School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland 21205, USA. aklassen@jhsph.edu
authors.forename: Ann C
authors.initials: AC
authors.lastname: Klassen
authors.forename: Ann L M
authors.initials: AL
authors.lastname: Smith
authors.forename: Helen I
authors.initials: HI
authors.lastname: Meissner
authors.forename: James
authors.initials: J
authors.lastname: Zabora
authors.forename: Barbara
authors.initials: B
authors.lastname: Curbow
authors.forename: Jeanne
authors.initials: J
authors.lastname: Mandelblatt
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002391:Catchment Area, Health; D005260:Female; D017048:Health Care Costs; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D008327:Mammography / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D012959:Socioeconomic Factors; D017664:Uncompensated Care; D016387:Women's Health