Community attitudes and mammography use: Does it really matter what other people think?

This study examined whether community characteristics, particularly communi ty attitudes regarding mammography use, are associated with women's use of mammography in rural communities. Forty communities in predominantly rural areas of Washington State were selected for inclusion in this study based o n their size and distance from an urban center. Characteristics of the comm unities were assessed as were characteristics of women living in the commun ities. From each community, random samples of 352 women between 50 and 80 y ears old participated by completing a telephone survey that included questi ons on a variety of topics, including their use of mammography. Logistic re gression analyses revealed community of residence to be a significant predi ctor of individual women's mammography use after adjusting for individual l evel predictors of mammography use including age, education, employment, ma rital status, financial situation, and ease of access to medical services. An examination of the influence of community characteristics revealed women living in communities with supportive community attitudes towards mammogra phy use report higher levels of mammography use than do women living in com munities with less supportive attitudes. The presence or absence of male or female physicians or of mammography facilities in a local community was no t associated with statistically significant,effects on women's mammography use. Community attitudes are associated with mammography use in rural commu nities. Public health interventions that change community attitudes may hav e effects that extend beyond the people directly contacted by these interve ntions.