{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:04:51Z","timestamp":1784199891548,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Mammography screening rates in rural counties are lower compared to urban counties. We hypothesized that social associations may help ameliorate this rural\u2013urban disparity. Thus, the purpose of this ecological study was to explore the relationships among rurality, social associations, and mammography screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary, county\u2010level analysis of the 2022 County Health Rankings and Roadmaps data. We classified counties as rural or urban (rural\u2013urban continuum code of 4+ vs. others), and we gathered the number of social organizations per 10,000 residents (i.e., \u201csocial associations\u201d). We used a structural equation model to examine the direct and indirect effects of rurality and social associations on the mammography screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 3143\u2009U.S. counties, 1976 (62.9%) were rural. Rural counties have greater social associations compared to urban counties (\n                      <jats:italic>\u03b2\u2009=<\/jats:italic>\n                      \u20090.20, SE\u2009=\u20090.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Counties with greater social associations had higher mammography screening rates (\n                      <jats:italic>\u03b2\u2009=<\/jats:italic>\n                      \u20090.34, SE\u2009=\u20090.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) while rural counties had lower screening rates (\n                      <jats:italic>\u03b2\u2009=<\/jats:italic>\n                      \u2009\u22120.24, SE\u2009=\u20090.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). There was a significant indirect effect of rurality through social associations on mammography screening (\n                      <jats:italic>\u03b2\u2009=<\/jats:italic>\n                      \u20090.07, SE\u2009=\u20090.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Living in a rural area in the presence of increased social associations led to increased mammography screening.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural counties have more social associations but a lower rate of mammography screening. These analyzes revealed, however, that social associations buffer the negative relationship between rurality and mammography, leading to increased mammography screening rates. Clinical\u2010community partnerships leveraging social associations could minimize rural mammography screening disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71990","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:53:03Z","timestamp":1779943983000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Social Associations on Mammography Screening Disparities in Rural Communities: A County\u2010Level Secondary Analysis"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7694-1224","authenticated-orcid":false,"given":"V.","family":"Bernacchi","sequence":"first","affiliation":[{"name":"Michigan State University College of Nursing  East Lansing Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0050-655X","authenticated-orcid":false,"given":"K.","family":"Hirko","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine  East Lansing Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9163-8103","authenticated-orcid":false,"given":"E.","family":"Adjei Boakye","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine  East Lansing Michigan USA"},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Henry Ford Health  Detroit Michigan USA"},{"name":"Department of Public Health Sciences Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1145-5185","authenticated-orcid":false,"given":"S.","family":"Tam","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Arcoleo","sequence":"additional","affiliation":[{"name":"Michigan State University College of Nursing  East Lansing Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Public Health Michigan State University College of Human Medicine  East Lansing Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Moss","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Penn State College of Medicine  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-17-0092"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2013.12.002"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1206809"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-0969"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2011.00365.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2017.09.008"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2023.110693"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.4837"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-024-07499-0"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac217"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2023.10.019"},{"key":"e_1_2_11_13_1","unstructured":"K. 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