Older Hispanic and Non-Hispanic White Women and Breast Cancer Screening: Do Psychosocial and Cultural Factors Matter?

Background: In 2012, estimates indicate that 41% of breast cancer diagnoses occurred in women over the age of 65 (Howlader et al., 2010), with Hispanic women 20% more likely to die of breast cancer than Non-Hispanic White (NHW) women. Cancer etiology includes behaviors influenced by psychosocial and cultural factors, specifically related to lower participation in cancer screenings that would lead to early diagnosis and treatment. Investigations examining the role of psychosocial and cultural factors and cancer screening disparities remain at the forefront of national research initiatives due to the increasing cancer mortality rates of older minority adults. Thus, this study explored the psychosocial and cultural factors expected to influence older Hispanic and NHW women’s participation in breast cancer screening services. Specifically, this study investigated the psychosocial and cultural factors that may result in low rates of participation in cancer screenings by older Hispanic women.

Method: Guided by the constructs of attitudes, perceived control, emotions, and culture of the Theory of Planned Behavior, the Self-Regulation Theory of Health Behavior, and the Cultural Dimensions Theory, this paper presents findings from a secondary analysis of the 2008 wave of the ongoing Health and Retirement Study (HRS) to investigate the relationship between psychosocial and cultural factors of Hispanic (n = 1,547,053) and NHW (n = 22,297,461) women and their participation in breast cancer screening services. The HRS, a nationally representative longitudinal study of Americans over the age of 50, contains questions at the individual and household levels, including information about demographics, income and assets, physical and mental health, cognition, family structure, social supports, health care utilization and costs, health insurance coverage, labor force status and job history, and retirement planning and expectations.

Findings: Multivariate logistic regression models were used to identify factors associated with cancer screening participation. Results indicate that the socio-demographic factors, immigration status, activities of daily living, and health insurance, and the psychosocial factors, satisfaction with aging and constraints decreased the likelihood of older Hispanic women’s participation in breast cancer screening. In addition, the psychosocial factor, religiosity increased the likelihood of older Hispanic women’s participation in breast cancer screening. The socio-demographic factor, age increased the likelihood of older NHW women’s participation in breast cancer screenings. In addition, the socio-demographic factor, education and the cultural factor, uncertainty avoidance-hopelessness decreased the likelihood of older NHW women’s participation in breast cancer screenings.

Conclusions and Implications: Findings indicate that socio-demographic factors remain critical to cancer screening participation for Hispanic and NHW women. In addition, findings suggest that older Hispanic women’s satisfaction with aging, perceptions of control over their lives, and religiosity may be important considerations for social workers and other health providers to assess when engaging with this population. This investigation provides formative data for the development of interventions to increase older Hispanic women’s participation in cancer screening initiatives to assist in reducing cancer screening disparities.