title: Racial/Ethnic Differences Affecting Adherence to Cancer Screening Guidelines Among Women.
abstract: BACKGROUND
  Race/ethnicity has been shown to modify the effects between obesity and cancer screening among women. The purpose of this article is to update the literature with recent data to examine how the association between different characteristics, including body mass index (BMI), and cancer screening compliance varies by race/ethnicity in a national sample of women.
  
  
  METHODS
  Three cycles of the Health Information National Trends Survey (HINTS) were combined for this cross-sectional study. Weighted descriptive statistics were evaluated using chi-square tests. Multivariable logistic regression evaluated associations between women with underweight or normal (<25), overweight (25-29.9), and obese (>30) BMIs and cancer screening concordant with guidelines (Papanicolaou [Pap] testing ≤3 years, ages 21+ years; mammography ≤2 years, ages 40+ years) in analyses stratified by race/ethnicity. We also assessed variance between racial/ethnic groups in how age, income, and insurance status were associated with cancer screening compliance.
  
  
  RESULTS
  This study included 4992 women who were evaluated for Pap testing and 3773 for mammography. In analyses stratified by race/ethnicity, whites with a higher household income were more likely to report having a Pap test (adjusted prevalence ratio [aPR] 2.16, 95% confidence interval [95% CI] 1.38-3.40) and a mammogram (aPR 1.63, 95% CI 1.04-2.55) compared to lower income white women. Black women with BMIs between 25 and 30 were less likely to receive a Pap test (aPR 0.38, 95% CI 0.19-0.76) than black women with BMIs <25, while no association was observed among the other groups. Insurance was associated with increased likelihood of Pap testing among white and black women. Insurance coverage was positively associated with mammography only among white and Hispanic women.
  
  
  CONCLUSIONS
  We found variations in adherence to cancer screening guidelines by age, insurance coverage, and income between racial/ethnic groups. Little evidence was observed for variations in screening by BMI.
authors.affiliation: Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Hirth
authors.affiliation: Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas.
authors.forename: Tabassum Haque
authors.initials: TH
authors.lastname: Laz
authors.affiliation: Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas.
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas.
authors.forename: Abbey B
authors.initials: AB
authors.lastname: Berenson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D017408:Guidelines as Topic; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000208:ethnology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult