title: Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population.
abstract: BACKGROUND
  Low-income, minority, and rural women face a greater burden with regard to cancer-related morbidity and mortality and are usually underrepresented in cancer control research. The Robeson County Outreach, Screening and Education Project sought to increase mammography use among low-income, minority, and rural women age > 40 years. The current article reports on racial disparities and barriers to screening, especially those related to knowledge, attitudes, and behaviors.
  
  
  METHODS
  A baseline survey was administered to 897 women age > 40 years who lived in rural Robeson County in North Carolina. The sample consisted of three principal racial groups: whites, African Americans, and Native Americans. Survey comparisons were made among racial groups with respect to knowledge, attitudes, and behaviors regarding breast and cervical carcinoma screening.
  
  
  RESULTS
  Overall, Native American and African-American women had lower levels of knowledge, more inaccurate beliefs, and more barriers to screening compared with white women. Among the notable findings were that 43% of the patient population did not mention mammograms and 53% did not mention Pap smears as breast and cervical carcinoma screening tests, respectively; furthermore, compared with white women, significantly fewer African-American and Native American women mentioned these tests (P < 0.001). Sixty-seven percent of all women reported that a physician had never encouraged them to receive a mammogram, although 75% reported having received a regular checkup in the preceding year.
  
  
  CONCLUSIONS
  Although all low-income rural women experienced significant barriers to receiving cancer screening tests, these barriers were more common for minority women compared with white women. More research is needed to identify ways to overcome such barriers, especially among Native American women. The results of the current study have important implications with respect to the designing of interventions aimed at improving cancer screening for all women.
authors.affiliation: Division of Epidemiology and Biometrics, School of Public Health, The Ohio State University, Columbus, Ohio, USA. paskett-1@medctr.osu.edu
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: Cathy
authors.initials: C
authors.lastname: Tatum
authors.forename: Julia
authors.initials: J
authors.lastname: Rushing
authors.forename: Robert
authors.initials: R
authors.lastname: Michielutte
authors.forename: Ronny
authors.initials: R
authors.lastname: Bell
authors.forename: Kristie Long
authors.initials: KL
authors.lastname: Foley
authors.forename: Marisa
authors.initials: M
authors.lastname: Bittoni
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dickinson
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007198:Indians, North American; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina; D010353:Patient Education as Topic; D011203:Poverty; D012424:Rural Population; D044465:White People