Purpose: Screening mammography in minority-underserved and low income women has limited efficacy and is associated with poorer breast cancer outcomes. We hypothesized that the health attitudes, beliefs and habits of these women affect breast cancer screening practice. Methods: Minority-underserved and low income women who had recently completed treatment for breast cancer were interviewed, at the Stroger Hospital of Cook County, Minority-Based Community Clinical Oncology Program (MBCCOP), which serves the medically-indigent in Chicago. Data was collected using the Multidimensional Health Profile (PAR, Inc.) as an instrument for evaluation of health attitudes, beliefs and habits, and analysis was performed on the following areas: Negative Health Habits (NHH), Positive Health Habits (PHH), Professional Help (PRH), Spiritual Help (SPH), Self-Efficacy (EFF) and Hypochondriasis (HYP). Data on patterns of screening practice were obtained from clinical records and analysis was performed using logistic regression. Results: A total of 115 women age 45 and older were interviewed, and 71 (61.7%) were African-American (AA). Screening mammography was evident for only 48 (41.7%) women. Univariate analysis did not demonstrate correlation between screening practice and education level, marital status, body mass index, NHH (includes poor nutritional habits, lack of exercise, substance abuse, smoking, and excessive alcohol use), SPH and EFF. However, there was significant correlation with race, age, PHH, PRH and HYP. Multivariate analysis demonstrated that race was not a predicting factor for screening. However, women with increased PHH, PRH, and HYP scores were significantly more likely to screen (Odds Ratio/p-value 1.07/0.0001, 1.30/0.0028, and 1.06/0.0128 respectively). Women who had screening mammograms were more likely to be concerned about strenuous exercise (34.9%), food intake and monitoring of calories (32.4%), and reading material concerning health care (32.4%). These women were also very likely to follow medical advice (41.2%) and strongly agreed that they worry about health, despite physician reassurance (74.6%). AA women rated lower on the same questions (p=0.3). Conclusions: Adherence to screening mammography recommendations among minority-underserved and low income women is more likely to be observed when these women have positive health habits, believe in professional help, and maintain concern about their health status. Efforts to improve screening practice for these women need to incorporate methods to promote positive health attitudes, beliefs and habits.
[Proc Amer Assoc Cancer Res, Volume 46, 2005]