As seen in , adherence to mammography screening guidelines significantly varied by ethnic group (p
0.001). Fewer Hispanic women than NHW women (42.3% vs. 44.6%) reported adhering to mammography screening guidelines as recommended by the ACS.2
Similarly, Hispanic women were more likely than NHW women (12% vs. 7%) to have never obtained a mammogram in their lifetime (data not shown).
Risk Factors, Social, Lifestyle, and Health-Related Behavior Characteristics of Non-Hispanic White and Hispanic Women
shows that among NHW participants, adherent and nonadherent women differed significantly from one another on four need and predisposing characteristics (age, family history of BC, number of live births, and HRT use), one lifestyle predisposing behavior (alcohol consumption), one medical behavior (aspirin use), and two social enabling characteristics (marital status and education). With the exception of family history, aspirin use, and marital status, adherent and nonadherent Hispanic women differed significantly on the same factors. In addition, adherent Hispanic women were more likely to be premenopausal/perimenopausal, use NSAIDS, practice regular BSE, and be more acculturated than nonadherent Hispanic women.
Findings from the multivariate logistic regression analysis of the determinants of mammography with minimally adjusted (only for age and study center) and more fully adjusted ORs and 95% CIs are shown in . The categories of nonadherent and never were considered separately (data not shown). When compared to the adherent category, the pattern of associations for adjusted ORs was similar for the nonadherent and never categories for both ethnic groups; therefore, those are combined into the nonadherent category. Although most of the described factors were associated with adherence among both Hispanic and NHW women in the minimally adjusted models, many of these associations were not significant in the fully adjusted models. Furthermore, not all the characteristics that were associated with adherence were the same for both ethnic groups. In the fully adjusted multivariable models (), within the need characteristics, NHW women and Hispanic women who were ≥60 years were less likely to be adherent to mammography screening than were women who were 50–59 years old. For both ethnic groups, women who had a family history of BC were more likely to be to mammography adherent than women who did not have a family history of BC. Of the predisposing characteristics, number of live births associated differently for the two groups. NHW women who had three or more births were less likely to be mammography adherent than were women who had one or two births. In contrast, Hispanic women who had not had any births were more likely to be adherent with mammography screening than were women who had one or two births.
Predictors of Adherence to Mammography Screening Guidelines by Non-Hispanic White and Hispanic Women (Adherent vs. Nonadherent)a
Another predisposing characteristic, BMI, was associated with mammography only among NHW women (). Obese (BMI
≥30) NHW women were more likely to be mammography adherent compared with women with normal weight (BMI
<25). HRT use was significantly associated with mammography adherence for both NHW and Hispanic women. Accordingly, women who were on HRT were almost twice as likely to be mammography adherent as were women who were not on HRT.
Lifestyle health behaviors that predispose women to develop BC were significantly associated with mammography adherence only among NHW women (). Compared with women who did not consume any alcohol, those who consumed between 5
g and 10
g/day and those who consumed >10
g/day were more likely to be adherent. NHW women who were current smokers were less likely to be mammography adherent compared with those who never smoked. No association with physical activity was observed for Hispanic women, but among NHW women, those who engaged in vigorous activity were more likely than women with low physical activity to be mammography adherent.
In contrast to NHW women, adherence was associated with various medical and disease preventive behaviors among Hispanic women only. For example, Hispanic women who take aspirin or use NSAIDs were more likely to be mammography adherent compared with those who did not. In addition, BSE was significantly associated with adherence among Hispanic women but not among NHW women.
Among the social enabling characteristics, marital status was the only variable that remained significant after all other variables were accounted for. NHW women who were not married were less likely to be adherent with mammography screening than were women who were married or living as married. No such association was observed for Hispanics.
In order to determine if the observed ethnic differences in the relationships between the described characteristics and mammography adherence were statistically significant, we evaluated the interaction between ethnicity and each factor in an ethnic-combined model (data not shown). Of the factors found significant in the ethnic-specific models (), marital status, NSAID use, and menopausal status were found to interact significantly with ethnicity (p
0.05, data not shown). In other words, the relationships between these characteristics and adherence are significantly different for Hispanic and NHW women. To determine if the evaluated characteristics explain the observed association between ethnicity and adherence, we compared the relationship between ethnicity and adherence in the minimally adjusted with the fully adjusted ethnic-combined model. In the minimally adjusted ethnic-combined model, Hispanic women were less likely than NHW women to be adherent (OR
0.84, 95% CI 0.70-1.00, p
0.05). When adjusting for the evaluated population characteristics in the ethnic-combined model, the relationship between ethnicity and mammography adherence was no longer apparent (OR
1.09, 95% CI 0.88-1.35).