Factors Associated with Mammogram Use in Korean American Immigrant Women in North Carolina

Background and Purpose: Breast cancer is a common cancer in Korean American women, and the incidence rate is rising fast in this population (Tuan et al., 2020). Despite the continued increase incidence rate, the screening rates among Korean American women remain relatively low compared to other racial/ethnic groups (Lee et al., 2018). Uptake of preventative screening measures, such as a mammogram, is proven to detect breast cancer early and improve treatment outcomes. Previous literature conducted among Korean American immigrant women found that sociodemographic characteristics, access to health care, cancer and screening knowledge, and cultural beliefs were associated with mammogram use (Oh et al., 2017). Although previous studies highlighted the impact of urban/rural residence on breast cancer screening (Chandak, 2019; Leung et al., 2014), there is no such study targeting Korean American women. The purpose of this study is to describe mammogram rate based on urban/rural residence and examine the influence of the residing area on Korean American immigrant women’s recent mammogram use.

Methods: Data was collected using a cross-sectional survey with a convenience sample of 538 Korean Aimmigrant women ages 40-79 years in North Carolina (NC). The survey was conducted via a face-to-face interview or was self-administered. The average age of participants was 55.67 years old (SD=9.21), and mean length of time in the United States was 23.82 years (SD=12.10). About 63.41% attained a college degree, and 38.02% reported their annual household income as less than $50,000. The Behavioral Model of Health Services Use (Andersen, 1995) and Health Belief Model (Champion & Skinner, 2008) guided this study’s design and analysis. Logistic regression was conducted to influence of urban/rural residence on mammogram use and identify other associated factors.

Results: Around 91.2% of the participants living in Eastern NC had a mammogram at least once in their lifetime, and 65.45% had a mammogram in the past two years, which were slightly higher than those living in other areas of NC (87.8%, 60.81%, respectively). Study results show that mammogram use within two years was positively associated with age (OR=1.04, 95% CI 1.01,1.08), perceived barriers to mammogram uptake (OR=0.87, 95% CI 0.83,0.92), perceived susceptibility to breast cancer (OR=1.24, 95% CI 1.04,1.49), having health insurance (OR=2.43, 95% CI 1.23,4.79), having primary care provider (OR=2.10, 95% CI 1.20,3.67), and having clinical breast exam (OR=3.21, 95% CI 1.82,5.67). The area of residence did not affect mammogram use in the past two years.

Conclusion and Implications: Study results indicated an overall low mammogram screening rate, especially when considering recent screening experiences. Korean American immigrant women living in Eastern NC reported higher rates of mammogram use than women in other areas of NC; this is particularly interesting given that Eastern NC is considered a rural and impoverished area. Future studies should consider breast cancer risk factors (e.g., women’s perception and age) and the role of clinical breast exam when designing breast cancer screening interventions for this population, combined with strategies to increase health care accessibility.