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Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002-2003 (United States).

ABSTRACT: OBJECTIVE: To examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women. METHODS: Low-income, uninsured women aged 40-64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program. RESULTS: In 2002-2003, of all U.S. women aged 40-64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%. CONCLUSIONS: Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

SUBMITTER: Tangka FK

PROVIDER: S-EPMC1764594 | biostudies-other | 2006 Nov

REPOSITORIES: biostudies-other

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Project description:BACKGROUND:Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. METHODS/DESIGN:In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas-Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2) intervention or a comparison general breast cancer prevention informational intervention (C). CHWs will be armed with notebook computers loaded with our Healthy Living Kansas-Breast Health program and guide their peers through the program. Women in the MI2 condition will receive assistance with operationalizing their screening intentions and identifying and addressing their stated screening barriers with the goal of guiding them toward accessing screening services near their community. Outcomes will be evaluated at 120-days post randomization via self-report and will include mammography utilization status, barriers, and movement along a behavioral stages of readiness to screen model. DISCUSSION:This highly innovative project will be guided and initiated by AI/AN and Latina community members and will test the practical application of emerging behavioral theory among minority persons living in rural communities.

Project description:IntroductionSmokeless tobacco (SLT) use in the United States has remained constant or even increased slightly in recent years, whereas smoking has continuously decreased. Characterization of transitions between tobacco products is critical to understand the reasons behind the continuing use of smokeless tobacco.MethodsTwo longitudinal cohorts of Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 2002-2003 (n = 14996) and 2010-2011 (n = 18226), were used to examine transitions between cigarette and SLT use over 1-year periods. Weighted population percentages of four use categories (exclusive cigarette use, exclusive SLT use, dual use, and neither) were calculated for different demographic groups. Transition between use categories and quit rates by product were calculated for each cohort.ResultsRelative to 2002-2003, smoking quit rates of male exclusive smokers significantly increased in 2010-2011 (11.6% vs. 24.4%, p < .0001), but the corresponding SLT use quit rates remained stable (41.3% vs. 40.0%, p = .87). Similar patterns were found in females with smoking quit rates increasing considerably (12.3% vs. 24.2%, p < .0001). Smoking quit rates increased in most sociodemographic groups analyzed. Male SLT use quit rates were significantly lower in SLT exclusive users than in dual users in the 2010-2011 cohort (40.0% vs. 62.2%; p = .04), but smoking quit rates in exclusive smokers and in dual users were roughly equivalent (24.4% vs. 29.5%, p = .68).ConclusionsAlthough smoking quit rates doubled overall and increased in most sociodemographic groups, SLT quit rates remained constant with little transition between products. Longer-term prospective data examining polytobacco use are needed to better understand transitions between tobacco products.ImplicationsThis study uses two longitudinal surveys to investigate changes in switching behaviors between tobacco products. We found that quit rates of self-reported smoking doubled between 2002-2003 and 2010-2011 in most sociodemographic groups in the United States, whereas in contrast quit rates of self-reported Smokeless Tobacco (SLT) use remained roughly constant. This explains in part the opposing trends of tobacco use by product in the United States, with smoking continuing its decrease, whereas SLT use remains constant. Moreover, smokers were unlikely to switch to other forms of tobacco compared to SLT users. Lastly, smoking cessation for dual users was not significantly different from that of exclusive smokers. Understanding transitions between smoking and SLT use is critical to assess the potential long-term impact of SLT use, and potentially that of other alternative tobacco products, on tobacco-related health outcomes.

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Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002-2003 (United States).

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