Hispanic women's beliefs about breast cancer and mammography

Cancer risk perception predictors for total body skin examinations: a cross-sectional study using Health Information National Trends Survey (HINTS) 2017 data

BACKGROUND

Despite the lack of national skin cancer screening recommendations, a total body skin examination by a healthcare provider may detect skin cancer earlier, allowing for more effective treatment and better outcomes.

OBJECTIVE

Examine prevalence, demographic, and cancer risk perceptions of adults who have had a skin examination performed by a healthcare provider.

METHODS

Retrospective, cross-sectional analysis of a nationally representative sample of U.S. adults using the Health Information National Trends Survey (HINTS). Logistic regressions were performed to identify associations between having a skin examination, risk perceptions, and demographic variables.

RESULTS

Approximately 46% of the sample reported having a skin examination. Females, college graduates, those with a history of skin cancer, people who check their skin for signs of skin cancer, and adults over the age of 45 were more likely to have a skin examination. The people least likely to be screened were those not wanting to know their chances of getting cancer.

LIMITATIONS

HINTS is a cross-sectional survey which provides only a glimpse of predictors.

CONCLUSIONS

The findings are consistent with other studies that people sometimes avoid cancer risk information. An educational intervention focused on the benefits of early cancer detection would benefit people who report not wanting to know their chances of getting cancer.

Barriers to mammography screening among racial and ethnic minority women

RATIONALE

Breast cancer is the second leading cause of cancer death among women. Disparities in breast cancer mortality rates adversely affect racial/ethnic minority women. Mammography screening is the most effective early detection method and means of reducing mortality rates. Yet, barriers prevent racial/ethnic minority women from participating in regular screening.

OBJECTIVE

This review aimed to summarize self-reported barriers to mammography screening in racial/ethnic minority women in studies using open-ended assessments and closed-ended assessments.

METHOD

Literature searches were conducted in two databases, PsycINFO and PubMed. Barriers were detailed in full by barrier type (psychological/knowledge-related, logistical, cultural/immigration-related, and social/interpersonal) and summarized briefly by race/ethnicity (African American/Black, Asian/Pacific Islander, Hispanic, American Indian/Native American, and Middle Eastern).

RESULTS

Twenty-two open-ended and six closed-ended studies were identified as eligible for this review. Overall, racial/ethnic minority women identified common logistical and psychological/knowledge-related barriers. Additionally, women reported cultural/immigration-related and social/interpersonal barriers that were closely tied to their racial/ethnic identities.

CONCLUSIONS

It was concluded that cultural/immigration-related barriers may be the only barrier type that is unique to racial/ethnic minority women. Thus, designing studies of barriers around race and ethnicity is not always appropriate, and other demographic factors are sometimes a more important focus. The variability in 'barrier' definitions, how data were collected and reported, and the appropriateness of closed-ended measures were also examined. This literature may benefit from detailed and strategically designed studies that allow more clear-cut conclusions and better comparison across studies as well as improving closed-ended measures by incorporating insights from investigations using open-ended inquiry.

Sociodemographic correlates of cancer fatalism and the moderating role of religiosity: Results from a nationally-representative survey

In general, it has been found that cancer fatalism is negatively associated with important cancer prevention and control behaviors, whereas religiosity is positively associated with these behaviors. Yet, the notion that religiosity gives rise to fatalistic beliefs that may discourage health behaviors is deeply ingrained in the public health literature. In addition, racial/ethnic group membership is associated with higher reports of cancer fatalism, though this association may be confounded by socioeconomic status (SES). A better understanding of the relationships between racial/ethnic group membership, SES, and religiosity may contribute to the development of effective interventions to address cancer fatalism and improve health behaviors. In this study, we examined associations between racial/ethnic group membership, SES, and cancer fatalism as the outcome. In addition, we tested whether religiosity (as measured by religious service attendance) moderated these relationships.

Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population

INTRODUCTION

Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites.

METHOD

The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed.

RESULTS

Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle.

CONCLUSION

Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.

Repeat Mammography Screening among Low-Income and Minority Women: A Qualitative Study

Regular mammography screening can reduce breast cancer mortality, yet low-income African American and Hispanic women underutilize mammography screening and are often diagnosed at a later stage, resulting in increased mortality. We used qualitative research methods to identify factors influencing regular breast cancer screening among African American and Hispanic women. Predisposing factors (including fear of mastectomy and lack of knowledge), enabling factors (including cost and social support) and a reinforcing factor were identified and categorized utilizing the PRECEDE framework. The study identified factors associated with the decision to complete regular mammography screening, and examined differences between African American and Hispanic women who participated in the interviews. Future research should seek to better understand the influence of family/friends, risk perception, and fatalistic beliefs on the decision to obtain regular mammograms.

The influence of fatalistic beliefs on health beliefs among diabetics in Khartoum, Sudan: a comparison between Coptic Christians and Sunni Muslims

Although there are many studies assessing the influence of religious beliefs on health they do not agree on whether the impact is positive or negative. More so, there is no consensus in the available literature on the definition of fatalism and what it means to individuals. In this phenomenological study we attempt to define what religious fatalism means to people living with diabetes in Khartoum, and how it affects their health beliefs, and how those beliefs affect their sense of coherence and generalized resistance resources, since salutogenesis is the guiding theory in this study. Three Copts and five Sunnis living with diabetes were interviewed, as well as a Coptic clergyman and a Sunni scholar. The semi-structured interviews were recorded and transcribed verbatim for analysis. Thematic network analysis was used to code salient concepts into basic themes, organizing themes and global themes. The empirical findings are thus structured as the three global themes: (1) fatalism and free will; (2) health responsibility; (3) acceptance and coping. Fatalism was defined as events beyond an individual's control where it is then the individual's free will to seek healthy behavior. Thus health responsibility was stressed upon by the participants in this study as well as the clergyman and scholar. There is also the concept of 'God doesn't give one what one cannot handle' that the participants relate to coping and acceptance. This study finds that the meaning of religious fatalism held by participants and religious clergy is not disempowering. The participants believe that they are responsible for their health. The meaning derived from fatalism is related to how they can accept what is beyond their control and cope with their health condition. Religious fatalism contributed to comprehensibility, manageability and meaningfulness in our participants' response to diabetes.

The Association of English Functional Health Literacy and the Receipt of Mammography among Hispanic Women Compared to Non-Hispanic U.S.-Born White Women

BACKGROUND

Breast cancer is a leading cause of cancer death among Hispanic women in the U.S., and mammography is the recommended screening for early diagnosing and preventing breast cancer. Several barriers exist to influence mammography utilization including poor health literacy. However, it is unclear whether the effect of health literacy on mammography utilization is consistent between Hispanic women and non-Hispanic White women. The main objective of this study was to examine association between functional health literacy and the receipt of mammography among Hispanic women compared to non-Hispanic White women in the U.S.

METHODS

A cross-sectional design using participants engaged in the National Assessment of Adult Literacy. Study sample comprised of 4,249 Hispanic and non-Hispanic U.S.-born White women ≥ 40 years of age who completed the functional health literacy assessment. Regression analyses were performed to test the association between health literacy and receipt of mammography. Among Hispanic women, analyses considered the influence of language-preference acculturation.

RESULTS

Equal percentages of Hispanic (59.3%) and non-Hispanic White (60.6%) women received mammography. After adjusting for covariates, health literacy was positively associated with receiving mammography among U.S.-born White women (β = 0.14, p<0.001), but negatively associated with mammography among Hispanic women (β = -0.13, p<0.001). Analyses stratified by acculturation status revealed that higher health literacy was associated with lower mammography among language-preference acculturated Hispanic women (β = -0.48, p<0.001), yet an opposite result among less acculturated Hispanic women (β = 0.08, p<0.001).

CONCLUSION

Functional health literacy has different associations with mammography depending upon ethnicity. Language-preference acculturation may explain the differing association.

What do people fear about cancer? A systematic review and meta-synthesis of cancer fears in the general population

Background

Cancer has long inspired fear, but the effect of fear is not well understood; it seems both to facilitate and to deter early diagnosis behaviours. To elucidate fear's behavioural effects, we systematically reviewed and synthesised qualitative literature to explore what people fear about cancer.

Methods

We searched Medline, Embase, PsycInfo, Web of Science, AnthroSource, and Anthrobase for studies on cancer fear in breast, cervical, and colorectal cancer screening and analysed 102 studies from 26 countries using thematic synthesis.

Results

Fears of cancer emanated from a core view of cancer as a vicious, unpredictable, and indestructible enemy, evoking fears about its proximity, the (lack of) strategies to keep it at bay, the personal and social implications of succumbing, and fear of dying from cancer.

Conclusions

This view of cancer as ‘an enemy’ reprises the media's ‘war on cancer’ theme and may affect the acceptance of cancer early detection and prevention messages, since cancer's characteristics influenced whether ‘fight’ or ‘flight’ was considered appropriate.

Work-Related Pain in Mexican American Custodial Workers

Mexican American janitors and custodians are at risk for developing work-related musculoskeletal injuries. These injuries may render them physically disabled, unable to provide for themselves and their families, and dependent on an already strained public health care system. Despite this growing health crisis and the United States's growing Latino population, no research has been published examining musculoskeletal pain among Mexican American custodial workers. In this article, the authors examine the working and social conditions of Mexican American service workers, as well as the reasons why there is so little research on this population. The authors present results from a study they conducted and discuss the implications of their findings for future research with this population.

A Breast Cancer Fear Scale: Psychometric Development

Fear of breast cancer has been inversely associated with participation in screening. However, investigators have generally used only one item or global scales to measure fear. This report describes development of a fear scale specific to breast cancer. Data from a large study involving mammography adherence were used to test the breast cancer fear scale for validity and reliability. Construct validity was verified through factor analysis and regression analysis predicting mammography. All items loaded on a single factor and theoretical relationships were verified by linear and logistic regression. The Cronbach alpha for the scale was .91.

Feeling Indecent: Breast Cancer Screening Resistance of Mexican-descent Women

This grounded theory study investigated how Mexican-descent women's traditional cultural beliefs, values, and norms regarding the propriety of their behavior and that of their health care providers influence their decision to participate in breast cancer screening. Thirty-four women (aged 49–81 years old) were interviewed in five focus groups using theoretical sampling across levels of acculturation and socioeconomic status. We discovered that the women's basic social-psychological problem is that screening is an insensitive procedure that violates their cultural standards by requiring inappropriate behavior. The risk involved is ‘feeling indecent’ since both touching one's breast and breast exposure to health care providers is prohibited according to cultural norms for respectable female behavior. Thus, women resist participating in breast cancer screening to avoid feeling indecent.

The Concepts of Health and Preventive Health Practices of Chinese Australian Women in Relation to Cancer Screening

Despite an emphasis on mammographic screening in Australia, Chinese Australian women have low participation rates. This qualitative study investigated how concepts of health and health promotion influence Chinese Australian women's decisions to participate in cancer screening, which is an important issue for nurses who work with multicultural populations. In-depth interviews were conducted with 20 Chinese Australian women. Using thematic data analysis, the findings showed that health and illness are taken-for-granted experiences of everyday life. When they were asymptomatic, most informants saw no reason to suspect that they may have diseases. Consistent with these health beliefs, the women focused on preserving and promoting health and overall well-being in everyday life rather than attempting to detect hidden disease by screening. These ideas and practices influenced behavior in relation to cancer diagnosis and in particular toward mammography.

Health care access and breast cancer screening among Latinas along the California-Mexican border

Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic-community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization.

Purpose-in-Life and Breast Health Behavior in Hispanic and Anglo Women

Hispanic and Anglo women differ in their practice of breast health behavior. A likely factor is differences in purpose-in-life (PIL) that influence motivation to achieve goals. To determine the relationship between PIL and breast health behavior, the PIL Test was modified and translated into Spanish, and the Breast Health Behavior Questionnaire (BHBQ) was generated. Both Spanish and English versions of the PIL Test and the BHBQ were measured in 40 Spanish and 40 Anglo women ages 20 to 49. Cronbach’s alpha for the PIL Test were .86 for the English version and .72 for the Spanish; Cronbach’s alpha for the BHBQ were .78 for the English and .70 for the Spanish version. There was a significant relationship between PIL and breast health behaviors in Anglo women but not in Hispanic women. Findings suggest further study of PIL in Hispanic women and may indicate a need for teaching the benefits of self-regulation to maintain health.

Socioecological determinants of mammography screening in Mexican rural areas

Purpose

– The purpose of this paper is to determine which socioecological factors encourage rural women to participate in mammographies rather than avoiding taking the test.

Design/methodology/approach

– The study mainly uses data from the 2007 Rural Households Evaluation Survey (ENCEL-2007). These crossover data are analyzed using the framework proposed in the Spatial-Interaction Model of Mammography Use (SIMMU), through a three-level logistic regression model to examine the likelihood that a woman will choose to participate in a mammography.

Findings

– At the woman-household level, the completion of the Pap smear and the asset index is the strongest determinant of mammography participation. Obtaining preventive medicine services or being enrolled in the Popular Insurance System prevent women from undergoing screening. At the interpersonal level, the probability of screening use decreases with lower social coverage. At the intermediate level, availability of health centers is negatively related to the use of screening.

Research limitations/implications

– The study fails to take into account the fact that women’s propensity to have a mammography may vary over time relatively to life changes. Moreover, findings were restricted to women ages from 40 to 49 and limited due to the lack of published data or data quality issues.

Practical implications

– The results of this research can give health planners, policymakers and social marketers a platform for how to approach social change and promote the cancer screening health behavior through the marketing mix (price, place, promotion and product) in the design of their programs.

Originality/value

– In addition to be informative and persuasive with people to change their behavior, this paper also seeks to provide a direction for using commercial marketing tools through social marketing to “sell” the health behavior. Due to target population variation, this paper addresses the health behavior change strategy by audience segmentation, regarded as essential to successful health communication campaigns.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.

Religion, fatalism, and cancer control: a qualitative study among Hispanic Catholics

OBJECTIVES

To assess cancer perceptions among churchgoers and to examine the potential influence of fatalism and religious beliefs on the use of cancer screening tests.

METHODS

Eight semi-structured focus groups were conducted among 67 Hispanic Catholics in Massachusetts.

RESULTS

In this sample, there were few references to fatalistic beliefs about cancer and nearly universal endorsement of the utility of cancer screening for cancer early detection. Most participants reported that their religious beliefs encouraged them to use health services, including cancer-screening tests. Although participants agreed that God plays an active role in health, they also affirmed the importance of self-agency in determining cancer outcomes.

CONCLUSIONS

Our findings challenge the assumption that fatalism is an overriding perspective among Hispanics. Catholic religious beliefs may contribute to positive health attitudes and behaviors.

Breast cancer knowledge, attitude and screening behaviors among Hispanics in South Texas colonias

This study examines breast cancer knowledge, attitudes and screening behaviors of Hispanic women living in the South Texas colonias of Maverick and Val Verde Counties. We used the Health Belief Model to analyze the effects of HBM constructs on clinical breast exam (CBE) and mammogram screening. Using a multistage systematic sampling approach we interviewed women living within these colonias. Logistic regression analysis was used to predict CBE and mammography screening behaviors. The results indicate that knowledge, susceptibility, barriers and source of health information were statistically significant in predicting CBE among these women. In addition, background variables such as marital status and health insurance were also significant in predicting CBE. Findings further indicate that source of health information, barriers, and health insurance significantly predicts mammography screening behaviors. Results suggest that for women living in colonias along the South Texas Border socio-demographic variables play a significant role in CBE and mammography utilization.

Perilous Uncertainty: Situating Women's Breast-Health Seeking in Northern Peru

Breast cancer rates in Peru, as in other low- and middle-income countries, continue to rise, and survival rates are poor, in part because many women are diagnosed with late-stage disease. As part of a pilot project to improve breast cancer screening and diagnostic services in remote regions of Peru, the Program for Appropriate Technology in Health (PATH) partnered with Peruvian organizations to train community health workers in breast health promotion and providers in clinical breast exam (CBE). To inform these strategies, we undertook a qualitative study to determine factors that influence Peruvian women's decisions to seek CBE. Anthropological approaches incorporating the PRECEDE/PROCEED public health model guided our conversations with providers and women living in the region of the pilot intervention. Grounded theory analysis helped us uncover a central theme of uncertainty, a state of doubt and insecurity that created a sense of impotent worry and impeded clinical health-seeking behaviors.

Applying the Fuzzy Delphi Method for determining socio-ecological factors that influence adherence to mammography screening in rural areas of Mexico

In Mexico, regular participation in mammography screening is low, despite higher survival rates. The objective of our research is to highlight healthcare procedures to be optimized and target areas to encourage investment and to raise awareness about the benefits of early diagnosis. Those socio-ecological factors (community, interpersonal and individual) were collected through a review of literature and based on the spatial interaction model of mammography use developed by Mobley et al. The opinion of diverse groups of experts on the importance of those factors was collected by survey. The Fuzzy Delphi Method helped to solve the inherent uncertainty of the survey process. Our findings suggest that population health behaviors, proximity-density to facilities/ physicians and predisposing factors are needed to increase the screening rate. Variations in expert group size could affect the accuracy of the conclusions. However, the application of the enhanced aggregation method provided a group consensus that is less susceptible to misinterpretation and that weighs the opinion of each expert according to their clinical experience in mammography research.

Health Behaviors, Disparities and Deterring Factors for Breast Cancer Screening of Immigrant Women - A Challenge to Health Care Professionals

Background

This literature review was made to provide comprehensive to provide comprehensive understanding of health disparities as well as factors and barriers to cancer screening of immigrant women in multicultural societies.

Methods:

Published articles from 1990–2013 were searched using databases such as CINAHL, MEDLINE, PubMed and Science Direct showing evidence of contributing factors and barriers to breast cancer screening practices of immigrant women in developed and developing countries. Based on the inclusion criteria, a total of 45 qualified articles were included in the review process.

Results:

Articles included were quantitative and qualitative, written in English for publication, and subjects were middle-aged, married immigrant women. The identified influential factors and barriers that prevent immigrant women from cancer screening were categorized as individual, socio-cultural and behavioral factors. Socioeconomic status, education level and knowledge, availability of health insurance and acculturation were among the individual factors. Presence of social support and recommendation from health care professionals were strongly associated with compliance with cancer screening. Cultural beliefs and practices as well as behavioral factors were among the barriers that deter women from participating in cancer screening.

Conclusion:

To alleviate the negative factors and barriers that affect the participation of high-risk immigrant women, a client-centered assessment and intervention approach with specific regard to cultural beliefs and practices should be considered by health care professionals. Joint effort of individuals, community, health care professionals and government institutions are recommended to further address the continuous rise of breast cancer mortality worldwide.

"Would a man smell a rose then throw it away?" Jordanian men's perspectives on women's breast cancer and breast health

BACKGROUND

Breast cancer is the most common malignancy afflicting women, and the most common cancer overall in Jordan. A woman's decision to go for screening is influenced by her social support network. This study aims to explore Jordanian men's individual and contextual perspectives on women's breast cancer and their own role in the breast health of the females within their families.

METHODS

An explorative qualitative design was used to purposively recruit 24 married men aged 27 to 65 years (median 43 years) from four governorates in Jordan. Data in the form of interviews transcriptions was subjected to qualitative content analysis.

RESULTS

Three themes were identified: a) Supporting one's wife; b) Marital needs and obligations; c) Constrained by a culture of destiny and shame. The first theme was built on men's feelings of responsibility for the family's health and well-being, their experiences of encouraging their wives to seek health care and their providing counselling and instrumental support. The second theme emerged from men's views about other men's rejection of a wife inflicted by breast cancer, their own perceptions of diminished femininity due to mastectomy and their own concerns about protecting the family from the hereditary risk of breast cancer. The third theme was seen in men's perception of breast cancer as an inevitable act of God that is far away from one's own family, in associating breast cancer with improper behaviour and in their readiness to face the culture of Eib (shame).

CONCLUSIONS

Jordanian men perceive themselves as having a vital role in supporting, guiding and encouraging their wives to follow breast cancer early detection recommendations. Breast health awareness campaigns could involve husbands to capitalize on family support.

Breast and cervical cancer screening among rural midwestern latina migrant and seasonal farmworkers

BACKGROUND

While cancer control and prevention efforts are well documented, limited information on this topic exists for Latina farmworkers in the rural Midwest. This study sought to examine correlates of breast cancer and cervical cancer screening practices of English- and Spanish-speaking Latina farmworkers in Michigan.

METHODS

Survey and anthropometric data were collected from a community-based cross-sectional sample of 173 Latina agricultural laborers in Michigan. Psychosocial-cultural and socioeconomic variables were examined as predictors of mammography and Papanicolaou screening.

FINDINGS

Results showed that individual characteristics that were significantly associated with having a Papanicolaou examination in the last 12 months included having higher language-based acculturation (odds ratio = 3.81), having ever done a breast self-examination (odds ratio = 2.82), and having health insurance (odds ratio = 5.58).

CONCLUSIONS

Acculturation, insurance, and performance of breast self-examination were key correlates of recent cervical cancer screening among Midwest Latina farmworkers. Findings suggest that education and targeted outreach strategies for Spanish-speaking Latina farmworker women in rural settings are urgently needed.

Colorectal cancer educational intervention targeting latino patients attending a community health center

OBJECTIVE

Colorectal cancer (CRC) is the third leading cause of cancer death for Latino men and women; and Latinos are more likely to be diagnosed at a later stage, which is most likely due to underutilization of CRC preventive screening. The purpose of this study was to determine whether a brief, clinic-based intervention by a community health advisor (CHA) would increase CRC knowledge compared with traditional educational methodologies (eg, use of print materials).

METHODS

Latino adults 50 years and older attending a San Diego community health center were recruited while waiting for their primary care provider routine visit and were randomly assigned to receive 1 of 3 CRC educational interventions: community health advisor (CHA) plus CRC educational brochure (CHA intervention group), CRC educational brochure (minimal intervention group), or 5-a-day nutrition brochure (usual care). CRC knowledge was assessed before and after the primary care provider visit for 130 participants.

RESULTS

Results demonstrate that the CRC educational brochure (minimal intervention group) was effective at increasing CRC screening knowledge as compared to usual care.

CONCLUSIONS

Future research is needed to explore innovative health education strategies that improve knowledge and subsequent CRC screening behaviors among low-income, low-literacy, unacculturated Latinos.

Cancer screening barriers for community-based older Hispanics and Caucasians

Despite advances in screening and early detection, ethnic minority populations, ages 65 and older, are less likely than Caucasians to participate in cancer screening services. Empirical research indicates that older ethnic minorities have cultural values that influence their behaviors. Addressing culturally relevant communication to better understand those values may increase participation in cancer screening. The study reported is a secondary analysis of qualitative data gathered from focus groups. Utilizing an interdisciplinary analytical lens, we compared older Hispanic and Caucasian's cultural values and their screening behaviors. Suggested psychosocial interventions are discussed to assist providers in their ongoing efforts to promote cancer screening.

The impact of family history of breast cancer on knowledge, attitudes, and early detection practices of Mexican women along the Mexico-US border

Rates of breast cancer (BC) have increased in Mexico, with the highest incidence and mortality rates observed in the northern Mexican states. This study aimed to describe the BC knowledge, attitudes and screening practices among Mexican women with and without a family history of BC residing along the Mexico-US border, and identify factors associated with screening behaviors. One hundred and twenty eight Mexican women aged 40 and older completed an interviewer-administered questionnaire on sociodemographic characteristics, knowledge, family history, and screening practices. There were no significant differences between Mexican women with and without a family history. Over 60% of women in both groups had never had a mammogram/breast ultrasound, and more than 50% had never obtained a clinical breast exam. Age, marital status, insurance, and breast cancer knowledge significantly influenced BC screening behaviors among Mexican women. Further research is needed to examine other key factors associated with screening utilization, in effort of improving BC rates.

Trends in cancer screening among Hispanic and white non-Hispanic women, 2000-2005

BACKGROUND

Hispanics are the largest and fastest growing ethnic group in the United States. Compared with white non-Hispanic women, however, Hispanic women have significantly lower cancer screening rates. Programs designed to increase cancer screening rates, including the national Screen for Life campaign, which specifically promoted colorectal cancer (CRC) screening, regional educational/research programs, and state cancer control programs, have been launched. Screen for Life and some of these other intervention programs have targeted Hispanic populations by providing educational materials in Spanish in addition to English.

METHODS

The objective of this study was to compare changes in colorectal, breast, and cervical cancer screening rates from 2000 to 2005 among Hispanic and white non-Hispanic women, using data from the National Health Interview Survey (NHIS). The age ranges of study subjects and the definitions of cancer screening were site specific and based on the American Cancer Society (ACS) screening recommendations.

RESULTS

Although overall screening rates were found to be lower among Hispanic women, CRC screening increased about 1.5-fold among both Hispanic and white non-Hispanic women, mainly driven by endoscopic screening, which increased 2.1-fold and 2.9-fold, respectively, from 2000 to 2005 (p < 0.01). Fecal occult blood testing (FOBT) for CRC declined among white non-Hispanic women and remained stable among Hispanic women during the same period. Mammogram and Pap smear screening tended to decline during the study period for both ethnic groups, especially white non-Hispanic women.

CONCLUSION

Although cancer screening rates may be affected by multiple factors, culturally sensitive and linguistically appropriate national educational programs may have contributed to the increase in endoscopic CRC screening compliance.

The Latina Breast Cancer Screening Sacle: beliefs about breast cancer and breast cancer screening

The Latina Breast Cancer Screening (LBCS) was developed to measure Latinas' culturally-shared health beliefs about breast cancer and breast cancer screening. A 60-item LBCS scale was tested with 288 participants and reduced to 35 items using principal components analyses. The 35-item LBCS scale and other measures were administered to a second sample of 147 participants to establish the scale's validity and reliability. A six-factor solution suggested six LBCS sub-scales. The LBCS in its entirety displayed strong internal consistency (alpha =.93) with adequate estimates of convergent, discriminant, and predictive validity. The LBCS scale appears to be a valid and reliable measure.

Menopausal symptom experience of Hispanic midlife women in the United States

Using a feminist approach, we examined the menopausal symptom experience of Hispanic midlife women in the United States This was a qualitative online forum study among 27 Hispanic midlife women in the United States. Seven topics related to menopausal symptom experience were used to administer the 6-month online forum. The data were analyzed using thematic analysis. Four themes were identified: (a) "Cambio de vida (change of life)," (b) "being silent about menopause," (c) "trying to be optimistic," and (d) "getting support." More in-depth studies with diverse groups of Hispanic women are needed while considering family as a contextual factor.

Influence of birthplace on breast cancer diagnosis and treatment for Hispanic women

Research has shown that Hispanic women in the United States are diagnosed with breast cancer at more advanced stages and initiate treatment later than non-Hispanic white women. We investigated whether stage at breast cancer diagnosis and receipt of primary therapy differ by ethnicity and birthplace among US-born Hispanic, foreign-born Hispanic, and white women. We studied 31,012 Hispanic women and 372,313 white women with a first diagnosis of invasive breast cancer during 1988 and 2005 living in a SEER area. We used multinomial logistic regression to assess the association of ethnicity and birthplace with stage at diagnosis and, among women with stage I or II cancers, primary therapy [mastectomy, breast-conserving surgery (BCS) with radiation, BCS without radiation], adjusting for other patient and tumor characteristics. Rates of stage at diagnosis differed significantly by race/ethnicity and birthplace (P < 0.001). Foreign-born Hispanics had lower adjusted rates of stage I breast cancer at diagnosis (35.4%) than US-born Hispanics (40.6%), birthplace-unknown Hispanics (42.3%), and whites (47.4%). Receipt of primary therapy also differed significantly by race/ethnicity and birthplace (P < 0.001). Foreign-born Hispanics and birthplace-unknown Hispanics had lower rates of BCS with radiation (34.9%, 30.7%) than US-born Hispanics (41.5%) and whites (38.8%). Foreign-born Hispanic women in the United States have a lower probability of being diagnosed at earlier stages of breast cancer and, for women with early-stage disease, of receiving radiation following BCS compared to US-born Hispanics and whites. Identifying factors mediating these disparities may help in developing culturally and linguistically appropriate interventions and improving outcomes.

Celebremos la Salud: a community-based intervention for Hispanic and non-Hispanic white women living in a rural area

The evaluation for Celebremos La Salud, a community randomized trial of Hispanic cancer prevention found no differences in mammography screening rates between intervention and control communities. The goal of the present study was to determine reasons for the intervention's lack of effectiveness. In the first aim, we assessed reach of the intervention. In the second, we assessed which intervention activities were associated with mammography use. In the third, we examined whether factors related to health care access, education level, or age modified the effect of the intervention. Data were used from a post-intervention survey of 20 rural communities in Washington State. Hispanic (N = 202) and non-Hispanic White (N = 389) women, over age 40 formed the sample. Reporting having awareness of or having participated in intervention activities was positively associated with Hispanic ethnicity and intervention group and negatively associated with lack of health insurance and having a lower education level. Only one intervention activity was associated with screening use. Having participated in presentations at organizations was positively associated with having had a mammogram in the previous 2 years for Hispanic women. No individual level modifiers influenced the intervention's effectiveness. Heavily targeting the intervention to Hispanic women and not reaching as many White women may have contributed to the lack of intervention effect. Increasing mammography screening rates among women living in a rural area may require improved access to health care and reaching women with lower education levels and lack of health insurance.

Barriers and facilitators related to mammography use among lower educated Mexican women in the USA

This study explores barriers to and facilitators of breast cancer screening and how people in a woman's social network influence these screening behaviors. A total of 40 semi-structured qualitative interviews were conducted in rural Washington State (USA) among Mexican women aged 50 and over. Eligible women reported either having had a mammogram within the last two years, over two years ago, or never. We found that lack of health insurance, the perception that the mammogram is painful, and fear of finding cancer were cited as barriers to participation in mammography screening. Women who had lived in the US for a shorter period were more likely to report never having had a mammogram than women who had lived in the US for a longer period. Women often cited daughters and female friends as those from whom they received advice or encouragement to receive a mammogram. Few differences were found related to network size and mammography use among the groups. These findings may be useful in designing interventions to promote mammography use. Including daughters in intervention activities may help facilitate mammography use among Mexican women.

Effects of a culturally sensitive education program on the breast cancer knowledge and beliefs of Hispanic women

PURPOSE/OBJECTIVES

To determine the effectiveness of a multifaceted, culturally sensitive, and linguistically appropriate breast cancer education program for Hispanic women.

DESIGN

Experimental (post-test only, control-group design).

SETTING

The parish hall of a Roman Catholic Church in northeastern Arkansas.

SAMPLE

31 Hispanic women aged 25-56 residing in northeastern Arkansas.

METHODS

The experimental group received a multifaceted, culturally sensitive, and linguistically appropriate breast cancer education program; the control group received general nutritional information. Both groups completed the Breast Cancer Knowledge Test and Breast Cancer Screening Belief Scales so that the researchers could measure dependent variables. Data were analyzed with t tests.

MAIN RESEARCH VARIABLES

Knowledge of and beliefs about breast cancer.

FINDINGS

The experimental group scored significantly higher on the Breast Cancer Knowledge Test than did the control group. The control group scored significantly higher than the experimental group on the barriers to mammography scale and the benefits of breast self-examination scale of the Breast Cancer Screening Belief Scales.

CONCLUSIONS

The multifaceted, culturally sensitive, and linguistically appropriate breast cancer education program appeared to be responsible for increased knowledge of breast cancer and reduced barriers to mammography.

IMPLICATIONS FOR NURSING

Education may change Hispanic women's knowledge and beliefs about breast cancer. An intervention designed and implemented by nurses can play a significant role in meeting the strong need for culturally sensitive and linguistically appropriate breast cancer educational programs for Hispanic women. Such programs should focus on helping Hispanic women understand their personal risks related to breast cancer and reduce barriers they perceive to early screening and detection.

Fatalism or destiny? A qualitative study and interpretative framework on Dominican women's breast cancer beliefs

BACKGROUND

A growing literature on Latino's beliefs about cancer focuses on the concept of fatalismo (fatalism), despite numerous conceptual ambiguities concerning its meaning, definition, and measurement. This study explored Latina women's views on breast cancer and screening within a cultural framework of destino ("destiny"), or the notion that both personal agency and external forces can influence health and life events.

METHODS

Semi-structured interviews were conducted with 25 Latinas from the Dominican Republic aged 40 or over.

RESULTS

Respondents reported complex notions of health locus of control that encompassed both internal (e.g., individual action) and external (e.g., the will of God) forces shaping breast cancer prevention efforts. Furthermore, women actively participated in screening because they believed that cancer could become a death sentence if diagnosed late or left untreated.

DISCUSSION

In contrast to simplistic notions of "fatalism", our analysis suggests complex strategies and beliefs regarding breast cancer and cancer screening that speak of resiliency rather than hopelessness.

Factors associated with pesticide safety practices in farmworkers

BACKGROUND

Farmworkers and their families are exposed to pesticides through multiple pathways. Few studies have examined the frequency with which farmworkers engage in pesticide safety practices and the factors associated with their adoption.

METHODS

Using a large sample of farmworkers (n = 554), we evaluated relationships between pesticide safety behaviors and farmworkers' beliefs, training history, handling of pesticides at work, perceived occupational exposure, and employers' provision of personal protective equipment.

RESULTS

Performing behaviors at work was determined largely by whether personal protective equipment was provided. For home behaviors, female gender, living in a labor camp, being trained in the last 5 years, handling pesticides directly, and not perceiving organizational barriers to protecting oneself were associated with taking more precautions.

CONCLUSIONS

These findings call for interventions that involve and engage multiple stakeholders to increase adoption of pesticide safety behaviors and reduce pesticide exposure in farmworkers.

The pain experience of Hispanic patients with cancer in the United States

PURPOSE/OBJECTIVES

To explore Hispanic patients' cancer pain experience from a feminist perspective to find explanations for inadequate pain management.

DESIGN

A qualitative online forum study.

SETTING

Internet and community settings.

SAMPLE

15 Hispanic patients with cancer recruited using a convenience sampling method.

METHODS

A six-month online forum was conducted using nine discussion topics, and the data were processed using a thematic analysis.

MAIN RESEARCH VARIABLES

Cancer pain experience.

FINDINGS

Four major themes emerged related to the following findings. The first was a lack of communication with healthcare providers regarding undermedication. The second was that women and men were enduring pain because of traditional gender roles guiding their behaviors. Third, participants placed the highest priority on family during the diagnosis and treatment process, thus setting aside their needs for pain management. The fourth theme was that participants were enduring inconvenience and unfair treatment in the U.S. healthcare system while simultaneously appreciating the treatment they had received.

CONCLUSIONS

Because of cultural factors and marginalized status in the United States as Hispanics and as immigrants, most of the participants could not adequately describe and manage their pain.

IMPLICATIONS FOR NURSING

Findings suggest a need for further investigation of the influences of multiple factors, including financial issues, cultural norms, and gender stereotypes, on cancer pain experience among diverse subgroups of Hispanic patients with cancer.

The greater Denver Latino Cancer Prevention/Control Network. Prevention and research through a community-based approach

The Latino/a Research & Policy Center (LRPC), at the University of Colorado (UC) at Denver and Health Sciences Center built the Greater Denver Latino Cancer Prevention Network, a successful cancer prevention network, in 6 Denver metro area counties. The Network consisted of 23 Latino community-based organizations, health clinics, social service agencies, faith-based groups, and employee-based organizations; 2 migrant health clinics; and 14 scientific partners including the UC Comprehensive Cancer Center, the Colorado Department of Public Health and Environment, and the American Cancer Society. The Network focused on 5 significant cancers: breast, cervical, lung, colorectal, and prostate cancer. The Steering Committee initiated a review process for junior researchers that resulted in 5 NCI-funded pilot projects. Pilot projects were conducted with various Latino populations. The Network developed community education and health promotion projects including the bilingual outreach play The Cancer Monologues. The Network's partnership also started and held 2 annual health fairs, Dia de la Mujer Latina/Day of the Latina Woman, and annual health prevention summits. The Special Population Network (SPN) adapted and revised a clinical trials education outreach module that reached Network community partners. SPN partners recruited Latino/a students to cancer research through a6-week NCI training program held yearly at the UCHSC campus. The Network methodology of bringing together the Latino community with the scientific community increased the level of awareness of cancer in the Latino community and increased cancer research and the level of engagement of the scientific partners with the Latino community. Cancer 2006. (c) 2006 American Cancer Society.

The role of culture in breast health practices among Chinese-Australian women

OBJECTIVE

Exploring how cultural meanings of the breast impact on perceived images of breast cancer and breast health practices.

METHODS

In-depth interviews were conducted with 20 Chinese-Australian women in their native language (Cantonese).

RESULTS

The findings revealed that the meanings of the breast are constructed within the women's social and cultural context where breasts are associated with sex; and talking about, being concerned with or expressing curiosity about breasts is considered inappropriate. These views have a significant impact on (1) the way the informants viewed breast cancer; (2) perceptions of breast health practices; and (3) the explanations of breast cancer and associated risk perception.

CONCLUSION

Understanding the nature of culturally-based barriers to utilization of breast cancer screening is the first step to discovering solutions for making screening tests more acceptable to women from other cultures.

PRACTICE IMPLICATIONS

This study provides insight about obstacles for breast health promotion practices and for developing culturally appropriate health education programs and counselling strategies.

Chinese-Australian women's beliefs about cancer: implications for health promotion

Ethnicity and culture play significant roles in determining how an individual is likely to understand and explain cancer, which, in turn, is posited to have an impact on cancer screening behavior. Chinese women in Western countries are consistently reported to have low participation rates in mammographic screening. This may be related to the fact that women of Chinese ancestry have different images and beliefs about cancer, which can have implications for participation in health promotion programs regarding cancer prevention and early detection. To investigate this issue, a qualitative study involving in-depth interviews with 20 Chinese-Australian women was conducted. Embedded in the women's images of cancer were notions associated with fear, mystery, contagion, and stigma. Based on information provided by the women who participated in this study, 6 domains of folk explanations about the causes of cancer were identified: lifestyle, stress, environment, genes, unknown causes, and destiny. These beliefs should be considered in the design of breast health promotion programs because they are likely to have a bearing on Chinese-Australian women's attitudes regarding the value they perceive of cancer screening.

Women's knowledge about breast cancer risk and their views of the purpose and implications of breast screening--a questionnaire survey

OBJECTIVES

To assess women's knowledge and perception of breast screening, including its benefits and disadvantages, and explore whether demographic and other personal characteristics are associated with accurate knowledge.

DESIGN

Questionnaire survey of a random sample of 1000 women aged between 49 and 64 years registered with GPs in Oxfordshire.

RESULTS

Thirty-six per cent of women knew the lifetime risk of developing breast cancer, and the interpretation of numeric risks varied among women. There was an association between inaccurate knowledge and lower formal education (P = 0.05). Forty-five per cent of women believed that screening prevents breast cancer. Women were of the opinion that screening helps early detection, could result in less invasive treatment and reassured them. Sixty-three per cent had no concerns about breast screening. The main causes of concern were that they would not be invited for further screening (exclusively women in their 60s), screening is not offered earlier or more frequently, painful mammography and effects of radiation. A minority of women were concerned that the pressure exerted on the breasts during mammography may itself trigger cancer by displacing and spreading cancer cells.

CONCLUSIONS

Women's knowledge about breast screening was variable and sometimes incorrect, and those with less formal education were more likely to have inaccurate knowledge.

Mammograms and healthcare access among US Hispanic and non-Hispanic women 40 years and older

Compared to non-Hispanic women, Hispanic women have disproportional mortality rates due to breast cancer. Mammographic screening detects breast cancer in its early stages and reduces mortality. We examined data obtained from the 2002 Behavioral Risk Factor Surveillance System questionnare using logistic regression analyses to study the relationships between demographic and healthcare factors and mammography use among Hispanic and non-Hispanic White women 40 years and older. Overall, the odds of ever having had a mammogram were similar among Hispanic and non-Hispanic White women (odds ratio = 1.2; 95% confidence interval = 0.9, 1.6), when adjusted for age, employment status, and other demographic variables. Having a personal physician and the type of healthcare facility typically used were associated with mammography use, regardless of Hispanic ethnicity. Although associations between mammography use and demographic factors were similar between ethnic groups, larger proportions of Hispanics had demographic characteristics that were negatively associated with mammography use. Establishing policies and mechanisms to provide all women with regular access to a personal physician or healthcare professional for their preventive and nonemergency healthcare needs may improve mammography use among both Hispanic and non-Hispanic White women. Similarly, reaching out to women who are uninsured and who use facilities other than physicians' offices for their healthcare needs may increase the use of mammography among both ethnic groups.

Factors associated with mammographic decisions of Chinese-Australian women

BreastScreen (a free breast cancer screening service) has been implemented in Australia since 1991. Surveys conducted overseas consistently report that women of Chinese ancestry have low participation rates in breast cancer screening. Although Chinese women's use of breast cancer screening services has been investigated abroad, to date there are few studies of mammographic screening behavior among Chinese-Australian women. The purpose of this study is to explore and investigate the factors associated with mammographic decisions of Chinese-Australian women. Using a qualitative approach, in-depth interviews were conducted with 20 Chinese-Australian women. These were augmented by additional data from ethnographic observations. The findings show two facilitators: organizational factors (an invitation letter from BreastScreen and seniors' clubs arrangements) and the influence of 'significant others'. Barriers identified were fear perceptions of mammography, modesty and fear of stigmatization. This study provides a useful framework for designing and implementing mammographic screening services for Chinese-Australian women that may improve their participation rates.

Acculturation and cancer screening among Latinas: results from the National Health Interview Survey

BACKGROUND

Although early detection of breast and cervical cancer is one of the most effective means of assuring timely treatment and survival, the cultural hypothesis proposes that traditional norms, values, and beliefs deter Latinas from being screened.

PURPOSE

We assessed whether acculturation is associated with Latinas' receipt of a recent mammogram, clinical breast examination (CBE), and Papanicolaou (Pap) test, and the contribution of acculturation to screening after adjusting for sociodemographic variables.

METHODS

We used data from the Health Promotion and Disease Prevention Supplement of the 1991 National Health Interview Survey. The sample for analyses of Pap test utilization included 1,370 Latinas age 18 and over, and for mammography and CBE, 525 Latina women age 40 and over.

RESULTS

Acculturation was associated with a higher likelihood of having had a recent mammogram, but this effect was not significant when controlling for sociodemographic factors. In both adjusted and unadjusted analyses, acculturation did not predict recent Pap smears. Acculturation was associated with greater likelihood of recent CBE, controlling for sociodemographic factors.

CONCLUSIONS

The association between acculturation and cancer screening is inconsistent. Theoretical models are needed to explain the mechanisms involved in the association (or lack thereof) between acculturation and screening.

Where's Maria? A video to increase awareness about breast cancer and mammography screening among low-literacy Latinas

BACKGROUND

The need exists to educate and motivate medically disadvantaged Latinas to engage in regular mammography screening to reduce their high breast cancer (BC) mortality risk due to the illness' late detection.

METHODS

Qualitative research methods [e.g., focus groups, key informants] were primarily used during the basic and formative research phases in preproducing and producing a breast cancer educational video for low-literacy Latinas.

RESULTS

An 8-min video was created in an Entertainment-Education soap opera format. The purpose of the video is to create awareness about breast cancer and to motivate low-literacy Latinas who are at the precontemplation stage of behavior change to consider engaging in mammography screening. Thus, the video presents a compelling story of a Latina with whom the target audience can identify and become involved with the unfolding events of her story as she realizes her risk for breast cancer and struggles with the decision to engage in mammography. The content and format of the video include culturally relevant clues and modeling to influence Latinas' cognitive and subjective processes involved in making the decision to change.

CONCLUSIONS

Complex attitudinal and behavioral issues can be effectively targeted to decrease the influence that psychological barriers exert in Latinas low breast cancer screening rates.

Socio-cultural influences on Chinese women's attendance for cervical screening

BACKGROUND

Compared with other countries, Hong Kong has a relatively high rate of cervical cancer. Much of this morbidity should be avoidable with cervical screening, but uptake rates for screening in Hong Kong are low. In programmes to promote cervical screening attendance, it is essential that aspects of the socio-cultural system be taken into account to provide appropriate preventive health strategies.

AIM

This paper outlines an investigation of the cultural and social factors contributing to Chinese women's attendance for cervical screening.

METHOD

A mixed methods design was employed, combining and comparing two data sets. The initial data set was drawn from 10 focus groups involving both screened and unscreened Chinese women (n = 54). The second data set was drawn from a total population of Hong Kong doctors, and involved face-to-face semi-structured interviews (n = 28).

RESULTS

Thematic analysis of the data from women indicated that the social factors of cost, educational base, knowledge of risk, the social value of early detection and cultural issues such as modesty and embarrassment contributed to screening attendance. The doctors perceived a cultural tendency towards fatalism, as well as seeing the gender, interpersonal and interprofessional skills of the practitioner to be important in influencing levels of Chinese women's shyness and discomfort, and hence affecting attendance. The lay and practitioner data sets varied in the perceptions of women's pain, embarrassment and risk factors.

CONCLUSION

Programmes providing services for Chinese women need to ensure that the philosophy of the staff and the approach and materials used are culturally relevant. Recommendations are that nurses equipped with relevant social and cultural knowledge of population groups should have a central role in health promotion and screening services.

A concept analysis of susceptibility: application of the hybrid model

TOPIC

Choosing to obtain a screening mammogram is often determined by a woman's perceived susceptibility.

PURPOSE

To establish the importance of susceptibility to breast cancer in rural women in southeast Louisiana, using concept analysis as the hybrid model.

SOURCES

Through this analysis, findings from the literature were compared to women's actual perceptions from the field.

CONCLUSIONS

The author concludes that rural women in Louisiana do not view breast cancer as a potential harm, nor is there a belief that they have control over the decision to have a screening mammogram; therefore, rural women do not perceive themselves susceptible.

Barriers to breast cancer screening for low-income Mexican and Dominican women in New York City

The proportion of Mexican and Dominican women has increased rapidly in New York City and in other urban areas, and breast cancer screening rates continue to be lower for Latina women as a whole, but particularly for some nationality subgroups. The current analysis explored the reasons why Mexican and Dominican women from medically underserved communities in New York City do not seek breast cancer screening. Data were collected through interviews with 298 Mexican and Dominican women aged 40-88 years; the interviews included an open-ended question on the barriers women face in seeking screening. The three most commonly cited barriers were not taking care of oneself (descuido) (52.3%), lack of information (49.3%), and fear (44.6%). Women who had been screened cited fear, pain, or other personal barriers more often, but women who had never had a mammogram cited cost or other logistical barriers. Responses from Dominican and Mexican women were significantly different, with Mexican women more often citing shame or embarrassment and Dominican women more often citing fear. The dependent variable, barriers to screening, was grouped into major categories. When sociodemographic factors were controlled for, the effect of ethnicity disappeared. Multivariate logistic regression revealed that women with a source of health care were less likely to cite any logistical barriers, but significantly more likely to report only personal barriers (such as fear or descuido). The analysis indicated that personal barriers were very prevalent in the communities studied. It may not be sufficient merely to increase access to breast cancer screening services for low-income Latinas: even when women have a source of health care, personal barriers may prevent many women from seeking screening. Outreach programs need to be tailored to the target communities as there are significant differences among groups of Latinas. Targeted outreach programs must work in tandem with programs to increase access to ensure that both personal and logistical barriers to screening are addressed.