Annals of Behavioral Medicine

, Volume 21, Issue 3, pp 193–200 | Cite as

The relationship between social network characteristics and breast cancer screening practices among employed women

  • Jennifer Dacey Allen
  • Glorian Sorensen
  • Anne M. Stoddard
  • Karen E. Peterson
  • Graham Colditz


This study examined the relationship between social network characteristics and breast cancer screening practices among employed women. We hypothesized that larger social networks, higher levels of support from networks, and stronger social influences to undergo screening would be positively associated with regular utilization of mammograms and clinical breast examinations. Data were collected from women aged 52 and over who were employed in 27 worksites (N=1,045). Social network characteristics, breast cancer screening practices, and sociodemographic factors were assessed in a self-administered survey. Bivariate analyses revealed that social influences were significantly associated with regular screening; social support was only marginally associated with regular screening; and social network size was not at all associated. In multivariate analyses, only the perception that screening is normative among one’s peers was predictive of regular screening. Provider recommendation was the single most potent predictor of regular screening. These findings provide support for the importance of social norms in motivating women to adhere to screening guidelines. In addition, they underscore the potent impact of provider recommendations on women’s screening practices.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. (1).
    American Cancer Society:Cancer Facts and Figures-1998. Atlanta, GA: American Cancer Society, 1998.Google Scholar
  2. (2).
    Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL: Efficacy of screening mammography.Journal of the American Medical Association. 1995,273:149–154.PubMedCrossRefGoogle Scholar
  3. (3).
    U.S. Preventive Services Task Force:Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore, MD: Williams & Wilkins, 1996.Google Scholar
  4. (4).
    National Cancer Institute: NCI adopts new mammography screening guidelines for women.Journal of the National Cancer Institute. 1997,89:538–540.CrossRefGoogle Scholar
  5. (5).
    Anderson LM, May DS: Has the use of cervical, breast, and colorectal cancer screening increased in the United States?American Journal of Public Health. 1995,85:840–842.PubMedGoogle Scholar
  6. (6).
    Centers for Disease Control and Prevention: State and sex-specific prevalence of selected characteristics—Behavioral Risk Factor Surveillance System, 1994 and 1995.Morbidity and Mortality Weekly Report. 1997,46(SS03):1–29.Google Scholar
  7. (7).
    Rimer BK: Understanding the acceptance of mammography by women.Annals of Behavioral Medicine. 1992,14:197–203.Google Scholar
  8. (8).
    Calle EE, Miracle-McMahill HL, Moss RE, Health CW: Personal contact from friends to increase mammography usage.American Journal of Preventive Medicine. 1994,10:361–366.PubMedGoogle Scholar
  9. (9).
    Clover K, Redman S, Forbes J, Sanson-Fisher R, Callaghan T: Two sequential randomized trials of community participation to recruit women for mammographic screening.Preventive Medicine. 1996,25:126–134.PubMedCrossRefGoogle Scholar
  10. (10).
    Davis DT, Bustamante A, Brown CP, et al: The urban church and cancer control: A source of social influence in minority communities.Public Health Reports. 1994,109:500–506.PubMedGoogle Scholar
  11. (11).
    Earp JL, Altpeter M, Mayne L, Viadro CI, O’Malley MS: The North Carolina Breast Cancer Screening Program: Foundations and design of a model for reaching older, minority, rural women.Breast Cancer Research and Treatment. 1995,35:7–22.PubMedCrossRefGoogle Scholar
  12. (12).
    Eng E: The Save Our Sisters Project: A social network strategy for reaching rural Black women.Cancer. 1993,72:1071–1077.PubMedCrossRefGoogle Scholar
  13. (13).
    Eng E, Smith J: Natural helping functions of lay health advisors in breast cancer education.Breast Cancer Research and Treatment. 1995,35:23–29.PubMedCrossRefGoogle Scholar
  14. (14).
    List MA, Lacey L, Hopkins E, Burton D: The involvement of low literate elderly women in the development and distribution of cancer screening materials.Journal of Family and Community Health. 1994,17:42–55.Google Scholar
  15. (15).
    Morisky DE, Fox SA, Murata PJ, Stein JA: The role of needs assessment in designing a community-based mammography education program for urban women.Health Education Research. 1989,4:469–478.CrossRefGoogle Scholar
  16. (16).
    Suarez L, Nichols DC, Brady CA: Use of peer role models to increase Pap smear and mammogram screening in Mexican-American and Black women.American Journal of Preventive Medicine. 1993,9:290–296.PubMedGoogle Scholar
  17. (17).
    Sung JF, Coates RJ, Williams JE, et al: Cancer screening intervention among Black women in inner-city Atlanta—Design of a study.Public Health Reports. 1992,107:381–388.PubMedGoogle Scholar
  18. (18).
    Urban N, Taplin SH, Taylor VM, et al: Community organization to promote breast cancer screening among women ages 50–75.Preventive Medicine. 1995,24:477–484.PubMedCrossRefGoogle Scholar
  19. (19).
    Rimer BK: Mammography use in the U.S.: Trends and the impact of interventions.Annals of Behavioral Medicine. 1994,16:317–326.Google Scholar
  20. (20).
    Montano DE, Taplin SH: A test of an expanded Theory of Reasoned Action to predict mammography participation.Social Sciences in Medicine. 1991,32:733–741.CrossRefGoogle Scholar
  21. (21).
    Brown RL, Baumann LJ, Helberg CP, et al: The simultaneous analysis of patient, physician, and group practice influences on annual mammography performance.Social Science in Medicine. 1996,43:315–324.CrossRefGoogle Scholar
  22. (22).
    Calnan M: Patterns in preventive behavior: A study of women in middle age.Social Science in Medicine. 1985,20:263–268.CrossRefGoogle Scholar
  23. (23).
    Kang SH, Bloom JR: Social support and cancer screening among older Black Americans.Journal of the National Cancer Institute. 1993,85:737–742.PubMedCrossRefGoogle Scholar
  24. (24).
    Kang SH, Bloom JR, Romano PS: Cancer screening among African-American women: Their use of tests and social support.American Journal of Public Health. 1994,84:101–103.PubMedGoogle Scholar
  25. (25).
    Kruse J, Phillips DM: Factors influencing women’s decision to undergo mammography.Obstetrics and Gynecology. 1987,70:744–748.PubMedGoogle Scholar
  26. (26).
    Suarez L, Lloyd L, Weiss N, Rainbolt T, Pulley L: Effect of social networks on cancer-screening behavior of older Mexican-American women.Journal of the National Cancer Institute. 1994,86:775–779.PubMedCrossRefGoogle Scholar
  27. (27).
    Sutton S, Bickler G, Sancho-Aldridge J, Saidi G: Prospective study of predictors of attendance for breast screening in inner London.Journal of Epidemiology and Community Health. 1994,48:65–73.PubMedCrossRefGoogle Scholar
  28. (28).
    Zapka JG, Stoddard AM, Costanza ME, Greene HL: Breast cancer screening by mammography: Utilization and associated factors.American Journal of Public Health. 1989,79:1499–1502.PubMedGoogle Scholar
  29. (29).
    Glanz K, Resch N, Lerman C, et al: Factors associated with adherence to breast cancer screening among working women.Journal of Occupational Medicine. 1992,34:1071–1078.PubMedCrossRefGoogle Scholar
  30. (30).
    Champion V: Relationship of age to mammography compliance.Cancer. 1994,74:329–335.PubMedGoogle Scholar
  31. (31).
    Rimer BK, Trock B, Engstrom PF: Why do some women get regular mammograms?American Journal of Preventive Medicine. 1991,7:69–74.PubMedGoogle Scholar
  32. (32).
    King E, Rimer BK, Balshem A, Ross E, Seay J: Mammography-related beliefs among older women.Journal of Aging and Health. 1993,5:82–100.PubMedCrossRefGoogle Scholar
  33. (33).
    Lerman C, Rimer B, Trock B, Balshem A, Engstron PF: Factors associated with repeat adherence to breast cancer screening.Preventive Medicine. 1990,19:279–290.PubMedCrossRefGoogle Scholar
  34. (34).
    Champion VL: Compliance with guidelines for mammography screening.Cancer Detection and Prevention. 1992,16:253–258.PubMedGoogle Scholar
  35. (35).
    Bureau of the Census: We the American women. U.S. Department of Commerce, Economics and Statistics Administration. Washington, DC: U.S. Government Printing Office, September 1993.Google Scholar
  36. (36).
    Berkman LF, Syme SL: Social networks host resistance and mortality: A nine-year follow-up of Alameda County residents.American Journal of Epidemiology. 1979,109:186–204.PubMedGoogle Scholar
  37. (37).
    Broadhead WE, Gehlbach SH, DeGruy FV, Kaplan BH: Functional versus structural social support and health care utilization in a family medicine outpatient practice.Medical Care. 1989,27:221–233.PubMedCrossRefGoogle Scholar
  38. (38).
    House JS, Landis KR, Umberson D: Social relationships and health.Science. 1988,241:540–544.PubMedCrossRefGoogle Scholar
  39. (39).
    Seeman TE, Syme SL: Social networks and coronary artery disease: A comparison of the structure and function of social relations as predictors of disease.Psychosomatic Medicine. 1987,49:341–354.PubMedGoogle Scholar
  40. (40).
    Berkman LF: The role of social relations in health promotion.Psychosomatic Medicine. 1995,57:245–254.PubMedGoogle Scholar
  41. (41).
    Thoits PA: Stress, coping, and social support processes: Where are we? What next?Journal of Health and Social Behavior. 1995,Extra Issue:53–79.Google Scholar
  42. (42).
    Cohen S, Wills TA: Stress, social support, and the buffering hypothesis.Psychological Bulletin. 1985,98:310–357.PubMedCrossRefGoogle Scholar
  43. (43).
    Cohen S, Syme LS (eds):Social Support and Health. New York: Academic Press, Inc., 1985.Google Scholar
  44. (44).
    Bandura A:Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1986.Google Scholar
  45. (45).
    Perry CL, Baranowski T, Parcel GS: How individuals, environments, and health behavior interact: Social Learning Theory. In Glanz K, Lewis FM, Rimer BK (eds),Health Behavior and Health Education: Theory, Research and Practice. San Francisco, CA: Jossey-Bass Publishers, 1990, 161–186.Google Scholar
  46. (46).
    Azjen I, Fishbein M:Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall, 1980.Google Scholar
  47. (47).
    Carter WB: Health behavior as a rational process: Theory of Reasoned Action and Multiattribute Utility Theory. In Glanz K, Lewis FM, Rimer BK (eds),Health Behavior and Health Education: Theory, Research and Practice. San Francisco, CA: Jossey-Bass Publishers, 1990, 63–91.Google Scholar
  48. (48).
    Janz NK, Becker MH: The Health Belief Model: A decade later.Health Education Quarterly. 1984,11:1–47.PubMedGoogle Scholar
  49. (49).
    Rosenstock I: The Health Belief Model: Explaining health behavior through expectancies. In Glanz K, Lewis FM, Rimer BK (eds),Health Behavior and Health Education: Theory, Research and Practice. San Francisco, CA: Jossey-Bass Publishers, 1990, 39–62.Google Scholar
  50. (50).
    Bastani R, Marcus AC, Hollatz-Brown A: Screening mammography rates and barriers to use: A Los Angeles county survey.Preventive Medicine. 1991,20:350–363.PubMedCrossRefGoogle Scholar
  51. (51).
    Breen N, Kessler L: Changes in the use of screening mammography: Evidence from the 1987 and 1990 National Health Interview Survey.American Journal of Public Health. 1994,84:62–67.PubMedGoogle Scholar
  52. (52).
    Centers for Disease Control: Use of mammography—United States.Morbitity and Mortality Weekly Report. 1990,39:621–630.Google Scholar
  53. (53).
    Champion VL: The relationship of selected variables to breast cancer detection behaviors in women 35 and older.Oncology Nursing Forum. 1991,18:733–739.PubMedGoogle Scholar
  54. (54).
    Israel BA: Social networks and health status: Linking theory, research, and practice.Patient counseling and Health Education. 1982,4:65–79.CrossRefGoogle Scholar
  55. (55).
    Israel BA, Schurman SJ: Social support, control, and the stress process. In Glanz K, Marcus-Lewis F, Rimer BK (eds),Health Behavior and Health Education. San Francisco, CA: Jossey-Bass Publishers, 1990, 187–215.Google Scholar
  56. (56).
    Rimer BK, Kasper Keintz M, Kessler HR, Engstrom PF, Rosan JR: Why women resist mammography: Patient-related barriers.Radiology. 1989,172:243–246.PubMedGoogle Scholar
  57. (57).
    Fletcher SW: Whither scientific deliberation in health policy recommendations?New England Journal of Medicine. 1997,336:1180–1183.PubMedCrossRefGoogle Scholar
  58. (58).
    Kaluzny AD, Rimer B, Harris R: The National Cancer Institute and guideline development: Lessons from the breast cancer screening controversy.Journal of the National Cancer Institute. 1994,86:901–902.PubMedCrossRefGoogle Scholar
  59. (59).
    Baines CJ: Breast self-examination.Cancer. 1989,64:2661–2663.PubMedCrossRefGoogle Scholar
  60. (60).
    O’Malley MS, Fletcher SW: Screening for breast cancer with breast self-examination.Journal of the American Medical Association. 1987,16:2196–2203.CrossRefGoogle Scholar
  61. (61).
    National Cancer Institute: Screening mammography: A missed clinical opportunity.Journal of the American Medical Association. 1990,264:54–58.CrossRefGoogle Scholar
  62. (62).
    Seeman TE, Berkman LF, Blazer D, Rowe JW: Social ties and support and neuroendocrine function: The MacArthur Studies of Successful Aging.Annals of Behavioral Medicine. 1994,16:95–106.Google Scholar
  63. (63).
    Murray DM:Design and Analysis of Group-Randomized Trials. New York: Oxford University Press, 1998, 241.Google Scholar
  64. (64).
    Allen JD, Sorensen G, Stoddard AM, Colditz G, Peterson K: Intention to have a mammogram in the future among women who have underused mammography in the past.Health Education and Behavior. 1998,25:474–488.PubMedCrossRefGoogle Scholar
  65. (65).
    Fox SA, Stein JA: The effect of physician-patient communication on mammography utilization by different ethnic groups.Medical Care. 1991,29:1065–1082.PubMedCrossRefGoogle Scholar
  66. (66).
    Horton JA, Romans MC, Cruess DF: Mammography Attitudes and Usage Study.Women’s Health Issues. 1992,2:180–186.PubMedCrossRefGoogle Scholar
  67. (67).
    U.S. Department of Commerce, Economics and Statistics Administration, Bureau of the Census:1990 Census of Population and Housing: Summary of Social, Economic and Housing Characteristics. 1990.Google Scholar
  68. (68).
    Etzi S, Lane DS, Grimson R: The use of mammography vans by low-income women: The accuracy of self-reports.American Journal of Public Health. 1994,84:107–109.PubMedGoogle Scholar
  69. (69).
    Degnan D, Harris R, Ranmey J, et al: Measuring the use of mammography: Two methods compared.American Journal of Public Health. 1992,82:1386–1388.PubMedGoogle Scholar
  70. (70).
    King ES, Rimer BK, Trock B, Balshem A, Engstrom P: How valid are mammography self-reports?American Journal of Public Health. 1990,80:1386–1388.PubMedGoogle Scholar
  71. (71).
    Zapka JG, Bigelow C, Hurley T, et al: Mammography use among sociodemographically diverse women: The accuracy of self-report.American Journal of Public Health. 1996,86:1016–1021.PubMedGoogle Scholar
  72. (72).
    Fowler FJ:Survey Research Methods. London: Sage Publications, 1988.Google Scholar
  73. (73).
    Suarez L, Nichols DC, Brady CA: Use of peer role models to increase Pap smear and mammography screening in Mexican-American and Black women.American Journal of Preventive Medicine. 1993,9:290–296.PubMedGoogle Scholar
  74. (74).
    Sung JC, Blumenthal DS, Coates RJ, et al: Effect of a cancer screening intervention conducted by lay health workers among inner-city women.American Journal of Preventive Medicine. 1997,13:51–57.PubMedGoogle Scholar
  75. (75).
    Eng E, Young R: Lay health advisors as community change agents.Journal of Family and Community Health. 1992,15:24–40.Google Scholar
  76. (76).
    Ramirez AG, McAlister AL: Mass media campaign—A Su Salud.Preventive Medicine. 1988,17:608–621.PubMedCrossRefGoogle Scholar
  77. (77).
    Bird JA, McPhee SJ, Jenkins C, Fordham D: Three strategies to promote cancer screening.Medical Care. 1990,28:1005–1012.PubMedCrossRefGoogle Scholar
  78. (78).
    Garr DR, Ornstein SM, Jenkins RG, Zemp LD: The effect of routine use of computer-generated preventive reminders in a clinical practice.American Journal of Preventive Medicine. 1993,9:55–61.PubMedGoogle Scholar
  79. (79).
    Harris RP, O’Malley MS, Fletcher SW, Knight BP: Prompting physicians for preventive procedures: A five-year study of manual and computer reminders.American Journal of Preventive Medicine. 1990,6:145–152.PubMedGoogle Scholar
  80. (80).
    Rimer BK, Ross E, Balshem A, Engstrom PF: The effect of a comprehensive breast screening program on self-reported mammography use by primary care physicians and women in a Health Maintenance Organization.Journal of the American Board of Family Practitioners. 1993,6:443–451.Google Scholar
  81. (81).
    Snell JL, Buck EL: Increasing cancer screening: A meta-analysis.Preventive Medicine. 1996,25:702–707.PubMedCrossRefGoogle Scholar
  82. (82).
    Trock B, Rimer BK, King E, et al: Impact of an HMO-based intervention to increase mammography utilization.Cancer Epidemiology, Biomarkers and Prevention. 1993,2:151–156.PubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 1999

Authors and Affiliations

  • Jennifer Dacey Allen
    • 1
  • Glorian Sorensen
    • 1
    • 2
  • Anne M. Stoddard
    • 3
  • Karen E. Peterson
    • 2
  • Graham Colditz
    • 2
    • 4
    • 5
  1. 1.Center for Community-Based ResearchDana-Farber Cancer InstituteBoston
  2. 2.Harvard School of Public HealthBostonUSA
  3. 3.University of Massachusetts School of Public HealthUSA
  4. 4.Channing LaboratoryBrigham and Women’s HospitalBostonUSA
  5. 5.Harvard Medical SchoolBostonUSA

Personalised recommendations