In late 1987, a total of 852 Rhode Island women ages 40 and older were interviewed by telephone (78 percent response rate) to measure their use of breast cancer screening and to investigate potential predictors of use. Predictors included the women's socioeconomic status, use of medical care, a provider's reported recommendations for screening, and the women's health beliefs about breast cancer and mammography. The Health Belief Model guided the construction of the interview questions and data analysis. Logistic regression was used to identify leading independent predictors of breast cancer screening according to contemporary recommendations: reporting that a medical provider had ever recommended a screening mammogram (odds ratio [OR] = 18.77), having received gynecological care in the previous year (OR = 4.92), having a regular source of gynecological care (OR = 2.63), having ever had a diagnostic mammogram (OR = 2.32), and perceiving mammography as safe enough to have annually (OR = 1.93). The findings suggest that programs intended to increase the use of breast cancer screening should include "inreach" and "outreach" elements; inreach to patients with established patient-provider relationships, by assuring that physicians recommend screening to all eligible patients, and outreach to all eligible women, by helping them overcome barriers to effective primary care, and by promoting mammography, emphasizing its effectiveness and safety. The findings also suggest that socioeconomically disadvantaged women, who are less likely to be screened than other women, should become special targets of inreach and outreach interventions.

Adult↗

PubMedDate not supplied

Agreement of occupation and industry data on Rhode Island death certificates with two alternative sources of information.

There is increasing interest in documenting the putative health effects of occupational hazards, prompting Federal and State efforts that rely primarily on occupational information obtained from the death certificate. Previous studies have assessed the agreement of occupational data on death certificates with actual lifetime employment by using current employment data from census records for comparisons. Such analyses have largely been confined to males. We compared lifetime occupational information obtained from a panel survey for both sexes with death certificate data for 446 deceased panel members. After adjusting for inadequate information, the occupation recorded on the death certificates of the men agreed with the occupation recorded in the survey 66 percent of the time. The comparable percentage for the industry where the deceased had been employed was 78 percent. Among the women's records, agreement on occupation was 65 percent, and on industry, 69 percent. Using another sample of death certificates, comparisons of the information for 322 decedents with city directory data produced similar results. The higher level of agreement for women was due in part to the large number who were reported as "housewives." In a separate analysis, the agreement rate for nonhousewives declined. Suggestions for improvements in the recording of occupational data and the constraints imposed by the use of death certificate data in occupational epidemiology are presented.

Data Collection↗

PubMedDate not supplied

Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women.

A telephone survey of a random sample of Rhode Island women ages 40 and older residing in minority low-income census tracts--census tracts in the lowest quartile of a variety of socioeconomic indicators in which at least 5 percent of the population was classified as Hispanic or non-Hispanic black--was conducted in 1991, focusing on breast cancer screening. Hispanic women were found to have about half the breast cancer screening rate (20 percent, according to current screening guidelines) of other respondents (37 percent). Determinants of screening were explored to suggest reasons for this difference. The Health Belief Model was used to identify and compare determinants of breast cancer screening (sociodemographics, health care utilization, perceived susceptibility to breast cancer, perceived seriousness of breast cancer, cues to screening such as a provider's recommendation, and the perceived benefits and costs of screening) among Hispanics, non-Hispanic whites, and non-Hispanic blacks. Hispanics were younger, less educated, and had lower family incomes than other women residing in minority low-income census tracts, were less likely to receive medical care, to perceive themselves as susceptible to breast cancer, and to perceive breast cancer as curable. Logistic regression analyses revealed the importance of use of health care, cues for screening, and perceptions of mammography to explain the screening behavior of Hispanics and non-Hispanics alike. Access to medical care is a significant problem in the Rhode Island Hispanic community, related to recent immigration, undocumented immigration, and low income characteristics of its members. Efforts to increase long-term screening for breast cancer in this community should focus on access while paying attention to its unique perceptions of breast cancer.

Adult↗