The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70232

Gloria Marroquin, MD¹, Nathaniel C. Briggs, MD, MSc¹, Janice S. Emerson, MA², Baqar A. Husaini, PhD², Rubens J. Pamies, MD³, and Robert S. Levine, MD¹. (1) Division of Preventive Medicine, Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd - Box 52A, Nashville, TN 37208, 615-327-6782, gloriamd23@prodigy.net, (2) Center for Health Research, Tennessee State University, Box 9580, 3500 John A. Merritt Blvd., Nashville, TN 37209, (3) Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN 37208

Regular mammography screening effectively reduces breast cancer mortality. However, low-income, minority, and urban women have screening rates below those of the general population. Because income may bear little relation to actual material circumstances, we examined direct material hardship measures as predictors of repeat mammography screening for 223 low-income African American, Hispanic and White women attending a primary care clinic in Nashville, Tennessee in 2000-2001. Altogether, 62 (28%) women reported that >1 year elapsed since their last mammogram, compared with 161 (72%) who had mammograms within one year. Logistic regression was used to calculate association odds ratios (OR) and 95% confidence intervals (CI) for monthly income, ability to meet monthly bills, and stress induced by reflecting on financial circumstances in relation to likelihood of yearly mammography, adjusted for age and race/ethnicity. Less difficulty meeting monthly bills was associated with a significant three-fold increase in likelihood of mammography within the preceding year (ORadj: 3.1: 95% CI: 1.6, 6.1; p-value: <0.001). Less stress when contemplating financial circumstances was associated with a modestly significant two-fold increase in likelihood of mammography in the previous year (ORadj: 2.2: 95% CI: 1.0, 4.8; p-value: 0.04). In contrast, a higher monthly income was not significantly associated with mammography during the preceding year (ORadj: 1.7: 95% CI: 0.9, 3.4). These findings indicate that direct measures of economic need, such as the ability to meet monthly bills, are better predictors of preventive screening behavior practices among low-income women than the indirect measure of money income that is conventionally used.

Learning Objectives:

• State the relation between income and mammography screening rates among women in the U.S.;
• Explain the difference between direct and indirect measures of material hardship. Give an example of each type of measure.;
• Describe the relative strength of association for direct and indirect measures of material hardship in relation to predicting mammography screening behaviors among low-income women in the U.S.

Keywords: Breast Cancer, Low-Income

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.