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      Differences in Knowledge of Breast Cancer Screening Among African American, Arab American, and Latina Women

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          Abstract

          Introduction

          We examined differences in knowledge and socioeconomic factors associated with 3 types of breast cancer screening (breast self-examination, clinical breast examination, and mammogram) among African American, Arab, and Latina women.

          Methods

          Community health workers used a community-based intervention to recruit 341 women (112 Arab, 113 Latina, and 116 African American) in southeastern Michigan to participate in a breast cancer prevention intervention from August through October 2006. Before and after the intervention, women responded to a previously validated 5-item multiple-choice test on breast cancer screening (possible score range: 0 to 5) in their language of preference (English, Spanish, or Arabic). We used generalized estimating equations to analyze data and to account for family-level and individual correlations.

          Results

          Although African American women knew more about breast cancer screening at the baseline (pretest median scores were 4 for African American, 3 for Arab and 3 for Latina women), all groups significantly increased their knowledge after participating in the breast cancer prevention intervention (posttest median scores were 5 for African American and 4 for Arab and Latina women). Generalized estimating equations models show that Arab and Latina women made the most significant gains in posttest scores ( P < .001).

          Conclusion

          Racial/ethnic differences in knowledge of breast cancer screening highlight the need for tailored information on breast cancer screening for African American, Arab, and Latina women to promote adherence to breast cancer screening guidelines.

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          Most cited references32

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          Racial and ethnic disparities in breast cancer mortality: are we doing enough to address the root causes?

          Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over the last two decades. Other ethnic minorities also suffer from disproportionately high breast cancer mortality rates. This review discusses the causes of racial and ethnic disparities in breast cancer mortality and describes the most common approaches to reducing these disparities. The literature suggests that outcome disparities are related to patient-, provider-, and health system-level factors. Lack of insurance, fear of testing, delay in seeking care, and unfavorable tumor characteristics all contribute to disparities at the patient level. At the provider level, insufficient screening, poor follow-up of abnormal screening tests, and nonadherence to guideline-based treatments add to outcome disparities. High copayment requirements, lack of a usual source of care, fragmentation of care, and uneven distribution of screening and treatment resources exacerbate disparities at the health system level. Although pilot programs have increased breast cancer screening among select populations, persistent disparities in mortality suggest that changes are needed at the policy level to address the root causes of these disparities.
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            American Cancer Society guidelines for the early detection of cancer, 2006.

            Each January, the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, including guideline updates, emerging issues that are relevant to screening for cancer, and a summary of the most current data on cancer screening rates for US adults. In 2005, there were no updates to ACS guidelines. In this issue of the journal, we summarize the guidelines, discuss recent evidence and policy changes that have implications for cancer screening, and provide an update of the most recent data pertaining to participation rates in cancer screening by age, sex, and insurance status from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System.
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              Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual's county of residence.

              Although the majority of studies examining racial/ethnic disparities in health care have focused on the characteristics of the individual, more recently there has been growing attention to the notion that an individual's health practices could be influenced by the characteristics of the place where they reside. The objective of this study was to examine whether access to care for individuals of different racial/ethnic groups varies by the prevalence of blacks and the prevalence of Latinos in their county of residence. We conducted a cross-sectional cohort. Individuals from the 1996 Medical Expenditure Panel Survey, a nationally representative sample of U.S. households, who described their race/ethnicity as white, black, or Latino, and who resided in 1 of 677 counties (n = 14740) were studied. Counties were assigned to 6 groups based on the prevalence of blacks and Latinos who resided there ( or=40% referred to as "high prevalence" separately for both blacks and Latinos). Outcomes included whether during the past year any family members: 1). experienced difficulty obtaining any type of health care, delayed obtaining care, or did not receive health care they thought they needed (referred to as "difficulty obtaining care"); or (2). did not receive a doctor's care or a prescription medication because the family needed money to buy food, clothing, or pay for housing (referred to as "financial barriers"). After controlling for other individual and area-level covariates, blacks reported lower rates of both outcome variables when they lived in a county with a high prevalence of blacks compared with blacks who lived in a county with a low prevalence of blacks (difficulty obtaining care: 4.3% vs. 18.8%, P <0.005; financial barriers: 1.6% vs. 10.5%, P <0.005). There was a similar association for Latinos by the prevalence of Latinos in the county for difficulty obtaining care (high: 5.0% vs. low: 13.4%, P <0.05), but not the financial barriers outcome (high: 2.2% vs. low: 2.4%, P = 0.90). Whites who lived in an area with a high prevalence of Latinos were more likely to report both outcomes compared with whites who lived in a county with a low prevalence of Latinos (difficulty obtaining care: 17.7% vs. 9.4%, P <0.05; financial barriers: 8.5% vs. 3.2%, P <0.005) . Blacks and Latinos may perceive fewer barriers to care when they live in a county with a high prevalence of people of similar race/ethnicity. Conversely, whites may perceive more difficulty receiving care when they live in an area with a high prevalence of Latinos. Diminishing disparities in access to health care may require interventions that extend beyond the individual.
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                Author and article information

                Contributors
                Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University
                ,
                Michigan State University, East Lansing, Michigan
                Michigan State University, East Lansing, Michigan
                Arab Community Center for Economic and Social Services, Dearborn, Michigan
                Arab Community Center for Economic and Social Services, Dearborn, Michigan
                Detroit Department of Health and Wellness Promotion, Detroit, Michigan
                Detroit Department of Health and Wellness Promotion, Detroit, Michigan
                Community Center for Health and Social Services, Inc, Detroit, Michigan
                University of Maryland, College Park, Maryland
                Journal
                Prev Chronic Dis
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                January 2011
                15 December 2010
                : 8
                : 1
                : A20
                Affiliations
                Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University
                Michigan State University, East Lansing, Michigan
                Michigan State University, East Lansing, Michigan
                Arab Community Center for Economic and Social Services, Dearborn, Michigan
                Arab Community Center for Economic and Social Services, Dearborn, Michigan
                Detroit Department of Health and Wellness Promotion, Detroit, Michigan
                Detroit Department of Health and Wellness Promotion, Detroit, Michigan
                Community Center for Health and Social Services, Inc, Detroit, Michigan
                University of Maryland, College Park, Maryland
                Article
                PCDv81_09_0185
                3044031
                21159232
                034cfc15-0cee-4e1b-8693-ca989ad035af
                History
                Categories
                Original Research
                Peer Reviewed

                Health & Social care
                Health & Social care

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