Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Robin Vanderpool, DrPH, CHES

Committee Member

Kathryn Cardarelli, PhD

Committee Member

Christina Studts, Ph.D.


Introduction. Breast cancer is the cancer of highest incidence among women in the U.S., making it a significant public health problem. Currently, the U.S. Preventive Services recommends biennial screening mammography for women ages 50-74. This study examined the associations between socioeconomic status and rurality on breast cancer screening behavior. Methods. Data for this study come from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System Survey (BRFSS). Breast cancer screening behavior was dichotomized into those who did not meet screening mammogram recommendations (2 years or more) and those who met screening mammogram recommendations (within the past 2 years). Chi-square tests of independence and a Gamma statistic and Phi statistic were used to analyze the relationship between income and rurality on breast cancer screening behavior, respectively. Logistic regression with adjusted odds ratios was used to examine the impact of combined rurality and income on breast cancer screening behavior. Results. Of the 113,395 women ages 50-74 with no history of cancer, the mean age was 61.9 years (SD = 6.9) and most participants were non-Hispanic White (78.3%). Bivariate analysis revealed a significant association between income level and breast cancer screening behavior (X2 = 2782.3, p2 = 437.6, p<0.001, Gamma = 0.267) and a significant association between rural/urban status and breast cancer screening behavior (X2 = 437.6, p<0.001, Phi = 0.067). Logistic regression results controlled for race demonstrated that in comparison to rural, low-income women, rural middle- and high-income women and urban woman of all incomes had higher odds of meeting breast cancer screening recommendations. High-income urban women had 1.824 times the odds of receiving a mammogram within the past two years (95% CI 1.774-1.877) than low-income rural women. Discussion. The findings of this study support for further research and prevention efforts of aimed at breast cancer in low-income, rural women. Continued efforts that focus on the confluence of these factors could help the nation reduce its overall breast cancer burden.

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