title: Determinants of mammography in women with intellectual disabilities.
abstract: BACKGROUND
  Women with intellectual disabilities have the same rate of breast cancer as other women but are less likely to undergo screening mammography. Characteristics associated with mammography for women with intellectual disabilities in the United States are unknown.
  
  
  METHODS
  This study was based on a secondary data analysis of the Massachusetts Department of Developmental Services database, comparing women who had a mammogram within 2 years with women who had not on variables related to the ecological model. Bivariate analyses, logistic regression, and assessment of interactions were performed.
  
  
  RESULTS
  The study sample's (n = 2907) mean age was 54.7 years; 58% lived in 24-hour residential settings, 52% received nursing health coordination, and more than 25% had clinical examination needs (eg, sedation). Residential setting, health coordination, and recent influenza vaccination were all associated with mammography. Having a guardian, higher level of activities of daily living needs, and examination needs (requiring sedation or limited wait time for examinations) were associated with lower rates. Interactions between health coordination and examination needs confirmed the potential of the nurse to ameliorate barriers to mammography.
  
  
  CONCLUSIONS
  Several system-level variables were significantly associated with mammography and, in some cases, seemed to ameliorate intrapersonal/behavioral barriers to mammography. Community agencies caring for intellectually disabled women have potential to impact mammography rates by using health coordination.
authors.affiliation: Department of Family Medicine, Boston University, Boston, MA 02118, USA. Joanne.Wilkinson@bmc.org
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Wilkinson
authors.forename: Emily
authors.initials: E
authors.lastname: Lauer
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008607:Intellectual Disability / Q000451:nursing; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D018802:Patient-Centered Care; D012112:Residential Facilities
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