FACTORS ASSOCIATED WITH WOMENS ADHERENCE TO MAMMOGRAPHY SCREENING GUIDELINES

Objective. To examine individual and environmental factors associated with adherence to mammography screening guidelines. Data Sources. A un ique data set that combines a national probability sample (1992 Nation al Health Interview Survey); a national probability sample of mammogra phy facility characteristics (1992 National Survey of Mammography Faci lities); county-level data on 1990 HMO market share; and county-level data on the supply of primary care providers (1991 Area Resource File) . Study Design. The design was cross-sectional, Data Extraction/Analys is. Data sets were linked to create an individual-level sample of wome n ages 50-74 (weighted n = 2,026). We used multipart, sequential logis tic regression models to examine the predictors of having ever had mam mography, having had recent mammography, and adherence to guidelines. We categorized women as adherent if they reported a lifetime number of exams appropriate for their age (based on screening every two years) and they reported having had an exam in the past two years. Principal Findings. Only 27 percent of women had the age-appropriate number of s creening exams (range 16 percent-37 percent), while 59 percent of wome n had been screened within two years. Women were significantly more li kely to adhere to screening guidelines if they reported participating with their doctor in the decision to be screened; were younger; had sm aller families, higher education and income, and a recent Pap smear; r eported breast problems; and lived in an area with a higher percentage of mammography facilities with reminder systems, no shortage of prima ry care providers, higher HMO market share, and higher screening charg es. Conclusions. A small percentage of women adhere to screening guide lines, suggesting that adherence needs to become a focus of clinical, programmatic, and policy efforts.