Is Perceived Susceptibility for Breast Cancer Less Predictive of Mammogram Use among Blacks and Hispanics than Whites?

Background: Intervention efforts should be tailored to be meaningful within the context of people's beliefs, values and social contexts. Significance: Increasingly, researchers are inquiring into the cross-cultural relevance of constructs long considered central to health behavior theory. Some suggest that perceived susceptibility may lack cultural resonance for some groups, including Blacks and Hispanics; however, there have been few empirical tests of this hypothesis. Purpose: We examined the relative importance of perceived susceptibility to breast cancer (BCa) for predicting ever mammogram use among Blacks, Hispanics, and Whites. Methods: We employed data from female respondents, aged 40 and over (ns >=2046), to HINTS 2003, a nationally representative survey of adults in the U.S. Analyses were conducted using weighted data and controlling for demographic characteristics and access to care. Results: For the sample as a whole, perceived susceptibility to BCa (absolute risk, comparative risk, worry) predicted having had a mammogram (ORs =1.27, 1.44, 1.45); however, there was an interaction between race/ethnicity (Hispanic vs. White) and susceptibility such that the associations between susceptibility and screening only held for Whites. Interaction terms were significant for absolute risk and worry (interaction ORs = 0.64, 0.47). Interaction effects for Blacks vs. Whites followed the same pattern but were not statistically significant. Conclusion: System-level barriers and lack of cultural resonance may explain the lack of association between perceived susceptibility and mammogram use for Hispanics. Stratifying by race/ethnicity when identifying determinants of health behavior provides useful information for focusing culturally tailored health promotion programs on constructs of maximum relevance.