ORIGINAL PAPER The Demographic, System, and Psychosocial Origins of Mammographic Screening Disparities: Prediction of Initiation Versus Maintenance Screening Among Immigrant and Non-Immigrant Women Nathan S. Consedine Published online: 9 September 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Disparities in breast screening are well docu- mented. Less clear are differences within groups of immigrant and non-immigrant minority women or differ- ences in adherence to mammography guidelines over time. A sample of 1,364 immigrant and non-immigrant women (African American, English Caribbean, Haitian, Domini- can, Eastern European, and European American) were recruited using a stratified cluster-sampling plan. In addi- tion to measuring established predictors of screening, women reported mammography frequency in the last 10 years and were (per ACS guidelines at the time) cate- gorized as never, sub-optimal ( \ 1 screen/year), or adherent (1? screens/year) screeners. Multinomial logistic regres- sion showed that while ethnicity infrequently predicted the never versus sub-optimal comparison, English Caribbean, Haitian, and Eastern European women were less likely to screen systematically over time. Demographics did not predict the never versus sub-optimal distinction; only reg- ular physician, annual exam, physician recommendation, and cancer worry showed effects. However, the adherent categorization was predicted by demographics, was less likely among women without insurance, a regular physi- cian, or an annual exam, and more likely among women reporting certain patterns of emotion (low embarrassment and greater worry). Because regular screening is crucial to breast health, there is a clear need to consider patterns of screening among immigrant and non-immigrant women as well as whether the variables predicting the initiation of screening are distinct from those predicting systematic screening over time. Keywords Mammography Á Ethnic disparities Á Immigrant health Á Minority health Á Psychosocial factors Introduction Breast cancer is a major threat to women’s health, with more than 200,000 cases and 40,000? deaths expected in the United States in 2010 [1]. Randomized control and observational studies suggest that mammographic screening reduces mortality [2]. While the optimal schedule is debated and recommended timeframes vary between one and 2 years, evidence suggests that regular screening may be the key to reducing mortality [3]. Typically, empirical works document ‘‘repeat mammography’’ (two sequential screens occurring within a stipulated timeframe) [4], although others have studied three-screen timeframes [5]; adherence is lower with longer timeframes and more stringent definitions. Timeframe notwithstanding, rates of repeat mammography are low. Less than 50% of women obtain two consecutive mammograms on schedule [6, 7] with estimates ranging between 20 and 92% [7–9]. Another study [8] found that only 42% of women reported 3? screenings within 6 years or two screens within four. Most closely linked to the current study’s focus on longer time- frames, an 8-year study found that only 16% of women had all expected screenings [10]. The current report examines mammographic screening behavior across 10 years among a large, diverse sample of women aged 50–70 years. Disparities in Screening and Repeat Screening: The Rationale for Subpopulation Research Although disparities in breast screening are well docu- mented, there are several reasons to continue examinations N. S. Consedine (&) Department of Psychological Medicine, University of Auckland, Auckland, New Zealand e-mail: n.consedine@auckland.ac.nz 123 J Immigrant Minority Health (2012) 14:570–582 DOI 10.1007/s10903-011-9524-z