Abstract
Poor adherence to screening recommendations is an important contributing factor to disparities in breast and cervical cancer outcomes among women in the USA. Screening behaviors are multifactorial, but there has been limited focus on how family network beliefs and behaviors influence individual’s likelihood to complete screening. This research aims to fill this gap by evaluating the role of family network composition and screening behaviors on women’s likelihood to adhere to mammogram and pap screening recommendations. We used an ego network approach to analyze data from 137 families and their networks. Primary outcomes were whether an individual had received a mammogram in the past year and whether she had received a pap screening in the past 3 years. Network-level predictors included network composition (size of network, average age of network members, satisfaction with family communication) and network screening behaviors. We conducted multivariable logistic regressions to assess the influence of network-level variables on both mammogram and pap smears, adjusting for potential individual-level confounders. Each network had an average age of 47.9 years, and an average size of 3.05 women, with the majority of members being sisters (57.7%). We found differences in network screening behaviors by race, with Arab networks being less likely to have completed self-breast exams (OR = 0.21, 95%CI = 0.05-0.76, p = 0.02), ever a gotten pap screen (OR = 0.11, 95%CI = 0.01-0.85, p = 0.04), and gotten pap screening in the last 3 years (OR = 0.31, 95%CI = 0.10-0.99, p = 0.04) compared with African American networks. Network screening behaviors also strongly influenced the likelihood of an individual completing a similar screening behavior. This analysis sheds light on family network characteristics that influence screening behaviors among medically underserved women. These findings support the development and dissemination of screening interventions among female’s family networks.
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Funding
Data for this paper were supported by the National Institutes of Nursing Research R01NR011323-05. Caitlin Allen was supported by the Cancer Epidemiology Education in Special Populations (CEESP) Program through funding from the National Cancer Institute's grant (R25CA112383) and through the National Cancer Institute of the National Institute of Health under Award Number F99CA253576. David Todem was supported by the National Institute on Minority Health and Health Disparities HYPERLINK 1U54MD011227. The content is solely the responsibility of authors.
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Dr. Williams is the PI and oversaw the initial intervention delivery. She reviewed the current analysis and write-up. Ms. Allen conceptualized this paper and conducted analysis and write-up. Dr. Todem oversaw statistical analyses. All authors contributed to writing and final review of the manuscript.
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This analysis sheds light on family network characteristics that influence cancer screening behaviors among underrepresented women. These findings support the development and dissemination of cancer screening interventions among female’s family networks.
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Allen, C.G., Todem, D. & Williams, K.P. Adherence to Mammography and Pap Screening Guidelines Among Medically Underserved Women: the Role of Family Structures and Network-Level Behaviors. J Canc Educ 36, 1155–1162 (2021). https://doi.org/10.1007/s13187-020-01879-y
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DOI: https://doi.org/10.1007/s13187-020-01879-y