SCREENING MAMMOGRAPHY A Cross-Sectional Study to Compare Characteristics of Women Aged 40 and Older From the Deep South Who Are Current, Overdue, and Never Screeners Ellen D. S. Lopez, MPH, PhD a, *, Amal J. Khoury, PhD, MPH b , Amy B. Dailey, PhD c , Allyson G. Hall, PhD d , and Latarsha R. Chisholm, MSW d a Department of Psychology, and The Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska b Department of Health Services Administration, East Tennessee State University, Johnson City, Tennessee c Department of Epidemiology and Biostatistics, University of Florida, Gainesville, Florida d Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida Received 30 November 2008; revised 25 July 2009; accepted 27 July 2009 Purpose. We sought to identify unique barriers and facilitators to breast cancer screening par- ticipation among women aged 40 and older from Mississippi who were categorized as current, overdue, and never screeners. Methods. Cross-sectional data from a 2003 population-based survey with 987 women aged 40 and older were analyzed. Chi-square analysis and multinomial logistic regression examined how factors organized under the guidance of the Model of Health Services Utilization were as- sociated with mammography screening status. Results. Nearly one in four women was overdue or had never had a mammogram. Enabling factors, including poor access to care (no annual checkups, no health insurance) and to health information, lack of social support for screening, and competing needs, were significantly as- sociated with being both overdue and never screeners. Pertaining to factors unique to each screening group, women were more likely to be overdue when they had no usual source of health care and believed that treatment was worse than the disease. In turn, women were more likely to be never screeners when they were African American, lacked a provider recom- mendation for screening, and held the fatalistic view that not much could be done to prevent breast cancer. Conclusion. Similar and unique factors impact utilization of mammography screening services among women. Those factors could inform efforts to increase screening rates. Introduction B reast cancer is the most frequently diagnosed can- cer and the second leading cause of cancer death for women. Following decades of rising mortality rates, 1990 marked the turning point during which breast cancer deaths began to decline (American Can- cer Society, 2007–2008). This is attributed to improved treatment options and the increased use of early detec- tion measures (Berry et al., 2005; Otto et al., 2003; Tabar et al., 2003). Professional organizations recommend that asymp- tomatic women aged 40 and older receive annual or biannual screening mammograms (Fletcher & Elmore, 2003). Healthy People 2010 seeks to increase to 70% ‘‘the proportion of women aged 40 years and older who have received a mammogram within the preceding two years’’ (Centers for Disease Control and Preven- tion [CDC], 2008). Funded by a grant from the Susan G. Komen Breast Cancer Foun- dation. * Correspondence to: Ellen D. S. Lopez, MPH, PhD, Department of Psychology, University of Alaska Fairbanks, PO 756480, Fairbanks, AK 99775-6480; Phone: (907) 474-7318; Fax: (907) 474-5781. E-mail: edlopez@alaska.edu. Copyright Ó 2009 by the Jacobs Institute of Women’s Health. 1049-3867/09 $-See front matter. Published by Elsevier Inc. doi:10.1016/j.whi.2009.07.008 www.whijournal.com Women’s Health Issues 19 (2009) 434–445