Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy


Human Ecology

Major Professor

James J. Neutens

Committee Members

Eugene C. Fitzhugh, Diane A. Klein, Priscilla Blanton, Paul Erwin


Between 1990 and 2002, breast cancer mortality rates decreased by over 2% each year. Regular screening mammography is largely credited with the decline as it permits detection of breast cancer at its most treatable stage. In the United States approximately 75% of women over forty years of age report mammography screening within the past two years. However, rates vary by age, income, education, and residence.

The purpose of this study was to determine the prevalence of screening mammography compliance in women living in rural and urban areas of Tennessee; as well as the associated risk factors with special emphasis on risk associated with rural residence.

Using combined data from the Tennessee Behavioral Risk Factor Surveillance System (2001 and 2003), compliance with having accessed a screening mammogram within a two-year period was examined for a sample of 1922 women 40 years and older. Demographic, behavioral, and health-related variables were used to explore associations with compliance. Multivariate logistic regression was performed to identify the association between residence and compliance.

The prevalence of screening mammography compliance (71.3% 95% CI 67.4-75.2) in women living in rural areas of Tennessee was significantly different from the prevalence of compliance in women living in urban areas (78.3% 95% CI 75.9-80.7). Significantly higher rates of compliance were associated with income ≥ $50,000, having at least a high school education, having health insurance, having a personal healthcare giver, non-smoking, recent use of alcohol, recent clinical breast exam or Pap test, and meeting the Healthy People 2010 (HP2010) recommendation for physical activity.

After controlling for all other factors, residence was not significantly associated with likelihood of compliance. Specific to rural women, identifying a personal healthcare giver and smoking status were significantly associated with increased likelihood of compliance. These associations can be used by health educators and service providers for identifying at-risk population and making programmatic decisions.

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