title: Individual, provider, and system risk factors for breast and cervical cancer screening among underserved Black, Latina, and Arab women.
abstract: BACKGROUND
  Socioeconomic and racial/ethnic disparities in breast and cervical cancer screening persist. An exploratory study was conducted to better understand co-occurring risk factors in underserved groups that could inform interventions to improve screening adherence. The objective of this study was to examine associations between breast and cervical cancer screening adherence and co-occurring risk factors in three racial/ethnic groups of underserved women.
  
  
  METHODS
  Black, Latina, and Arab women (N=514), ages 21 to 70 years, were enrolled into the Kin Keeper(SM) randomized controlled trial in communities around Detroit, Michigan. We used participant baseline assessments (e.g., demographic characteristics, health literacy) to explore screening risks using an additive approach and multivariate logistic analyses.
  
  
  RESULTS
  For black women, having more health literacy risks were associated with reduced odds of a clinical breast exam (CBE), mammogram, and Papanicolaou (Pap) test; more competing priorities were associated with reduced odds of a Pap test; lack of doctor mammogram recommendation was significantly associated with decreased odds of CBE. For Latina women, lack of doctor recommendations were significantly associated with decreased odds of CBE, mammogram, and Pap test. For Arab women, lack of doctor recommendations were significantly associated with decreased odds of CBE, mammogram, and Pap test; more competing priorities were significantly associated with reduced odds of CBE and Pap test. All results were significant at p<0.05.
  
  
  CONCLUSIONS
  Characteristics associated with breast and cervical screening adherence differs among Black, Latina, and Arab underserved women. Interventions to improve screening should be tailored for racial/ethnic groups with particular attention to competing survival priorities, health literacy risks factors, and provider recommendations.
authors.affiliation: 1 Obstetrics, Gynecology, and Reproductive Biology, Michigan State University , East Lansing, Michigan.
authors.forename: Leeanne
authors.initials: L
authors.lastname: Roman
authors.forename: Cristian
authors.initials: C
authors.lastname: Meghea
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ford
authors.forename: Louis
authors.initials: L
authors.lastname: Penner
authors.forename: Hiam
authors.initials: H
authors.lastname: Hamade
authors.forename: Tamika
authors.initials: T
authors.lastname: Estes
authors.forename: Karen Patricia
authors.initials: KP
authors.lastname: Williams
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D018912:Arabs / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008507:Medically Underserved Area; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D014626:Vaginal Smears; D014930:Women / Q000193:education / Q000523:psychology*