title: Predictors of regular mammography use among American Indian women in Oklahoma: a cross-sectional study.
abstract: BACKGROUND
  There are significant disparities in breast cancer screening and survivorship between American Indian (AI) and non-Hispanic white women. This study aimed to identify the salient beliefs AI women from Oklahoma have on regular mammography screening, and to determine which beliefs and health- related practices are associated with past mammography screening behavior.
  
  
  METHODS
  This study used an integrated model of the Theory of Planned Behavior as the guiding theoretical framework. Data were collected from 255 (mean age = 51 years, SD 7.64 years) AI women randomly selected from a rural Oklahoma medical clinic (response rate: 79%). Multivariate logistic regression was used to identify factors associated with self-reported past mammography within the last two years while controlling for demographic variables. Associations were summarized using odds ratios (OR), the ratio of the odds of past mammography per a 1-unit increase in continuous independent factor scales (subjective physician norm, cultural affiliation, fatalism, knowledge of mammography screening guidelines, and perceived behavior control barriers) or between groups defined by categorical variables, and 95% confidence intervals (CI).
  
  
  RESULTS
  Of the participants, 65% (n = 167) reported a screening mammogram within the last two years. After adjustment for age and educational status, women with a higher total subjective-norm physician score (OR = 1.15, 95% CI: 1.06-1.24), a higher knowledge of mammography screening guidelines (OR = 1.52, 95% CI: 1.00-2.31), a family history of breast cancer (OR = 9.97, 95% CI: 3.05-32.62), or reporting an annual versus none or a single physician breast examination (OR = 5.57, 95% CI: 1.79-17.37) had a higher odds of past mammography. On the other hand, women who were more culturally affiliated (OR = 0.42, 95% CI: 0.24-0.74), perceived more barriers (OR = 0.86, 0.78-0.94), or had higher fatalistic attitudes toward breast cancer (OR = 0.90, 95% CI: 0.82-0.99) had lower odds of past mammography.
  
  
  CONCLUSIONS
  In the development of culturally-appropriate interventions promoting mammography among AI communities, emphasis could be put on the following: a) promoting clinic-related practices (e.g. physician recommendation, physician breast examination); b) promoting community-related practices (e.g. knowledge about mammography while eliminating fatalistic attitudes); and c) reducing environmental barriers.
authors.affiliation: Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, CHB Rm, 473, P,O, Box 26901, 73126 Oklahoma City, OK, USA. eleni-tolma@ouhsc.edu.
authors.forename: Eleni L
authors.initials: EL
authors.lastname: Tolma
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stoner
authors.forename: Ji
authors.initials: J
authors.lastname: Li
authors.forename: Yoonsang
authors.initials: Y
authors.lastname: Kim
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Engelman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D016504:Breast Self-Examination / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009825:Oklahoma; D010808:Physical Examination / Q000706:statistics & numerical data