The contribution of emotional characteristics to breast cancer screening among women from six ethnic groups $ Nathan S. Consedine, Ph.D., a, * Carol Magai, Ph.D., a and Alfred I. Neugut, M.D., Ph.D. b a Department of Psychology, Long Island University, Brooklyn, NY, USA b Columbia University, New York, NY, USA Abstract Background. This study was designed to determine which of several emotional propensities were associated with the frequency of mammograms and clinical breast exams among six groups of minority women. Three emotion-related variables that have been identified in the previous literature as influencing screening were examined: Repression, cancer worry, and embarrassment. However, these variables have never been examined within the same study, nor where relevant background variables are controlled. Methods. 1364 African American, US-born white, English-speaking Carribean, Haitian, Dominican, and Eastern European women were recruited via stratified-cluster sampling. Participants provided demographics and measures of beliefs and knowledge. Results. As expected, self-regulation and cancer worry were both positively associated with mammogram and clinical breast exam frequency, while embarrassment regarding having a mammogram was negatively associated with screening. These results held even after controlling for demographic variables and the presence or absence of physician recommendation. Screening rates for African American women equaled or exceeded the rates for European Americans. Other minority subpopulations had even lower screening rates, including women from the English-speaking Caribbean and Haitians. Conclusions. Results are discussed in terms of their implications for screening intervention, models of health behavior, and the need for more precise operationalizations of ethnicity in screening research. D 2003 American Health Foundation and Elsevier Inc. All rights reserved. Keywords: Emotional characteristics; Breast cancer screening; Ethnicity Introduction Despite some recent improvements, minority women continue to bear a disproportionate breast cancer burden in the United States. While there is a lower incidence of breast cancer among African American [1–3] and Hispanic wom- en [4], mortality is higher and 5-year survival lower among minority groups [1,3,4]. Analyses based in recent SEER data, for example, show age-adjusted survival rates of 73.5 and 87.9 for Blacks and Whites, respectively, and 35.9 deaths per 100,000 among Blacks compared to only 27.2 among Whites [3]. Recent analyses suggest that this dis- crepancy may be increasing [5–7]. Although there may be additional racial differences in tumor characteristics [8], ethnic differences in survival and mortality are often attributed to poorer screening practices and, consequently, later detection and poorer prognosis [9,10]. Notwithstanding recent controversy [11], breast cancer screening has been shown to decrease breast can- cer-related mortality rates among women 50 to 74 years of age [12] and several authors argue that screening represents our best means of decreasing mortality [13–16]. The American Cancer Society recommends yearly mammo- grams for women over the age of 40 [17]. Some research has suggested that African American women, including those with a family history of breast cancer [18,19], are less likely to be screened than Whites [12,20], particularly if they are older [21], while other data have suggested a possible ‘‘convergence’’ of screening rates [14,22 – 25]. Most data show women from the other major minority group, Hispanics, being less likely to screen than either Whites or Blacks [26–29] although there are some exceptions [30]. Survey data suggest that Hispanics have 0091-7435/$ - see front matter D 2003 American Health Foundation and Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2003.09.030 $ This research was supported by grants from the National Institute on Aging (KO7 AG00921), the National Institutes of Health MBRS Program (2SO6 GM54650), and the National Cancer Institute (1P20 CA 91372). * Corresponding author. Center for Studies of Ethnicity and Human Development, 191 Willoughby Street, Suite 1A, Brooklyn, NY 11201. E-mail address: nconsedi@liu.ed (N.S. Consedine). www.elsevier.com/locate/ypmed Preventive Medicine 38 (2004) 64 – 77