{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:32:57Z","timestamp":1777663977891,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1R25CA134301-01A2"],"award-info":[{"award-number":["1R25CA134301-01A2"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54CA096297"],"award-info":[{"award-number":["U54CA096297"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000097","name":"National Center for Research Resources","doi-asserted-by":"publisher","award":["U54 RR026139-01A1"],"award-info":[{"award-number":["U54 RR026139-01A1"]}],"id":[{"id":"10.13039\/100000097","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000096","name":"National Center on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["G12MD007600"],"award-info":[{"award-number":["G12MD007600"]}],"id":[{"id":"10.13039\/100000096","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"national institute on minority health and health disparities","doi-asserted-by":"publisher","award":["8U54 MD007587-03"],"award-info":[{"award-number":["8U54 MD007587-03"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Educ Behav"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>\n                    Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged \u226540 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    = 300; aged \u226540 years old) enrolled in the intervention trial\n                    <jats:italic toggle=\"yes\">Cultivando la Salud<\/jats:italic>\n                    , implemented in Can\u00f3vanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.\n                  <\/jats:p>","DOI":"10.1177\/1090198120988248","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T06:23:46Z","timestamp":1614925426000},"page":"559-566","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Never Screened: Understanding Breast Cancer Nonadherence in Puerto Rico"],"prefix":"10.1177","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8914-0752","authenticated-orcid":false,"given":"Alel\u00ed M.","family":"Ayala-Mar\u00edn","sequence":"first","affiliation":[{"name":"U54 Partnership for Excellence in Cancer Research, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0008-1539","authenticated-orcid":false,"given":"Vivian","family":"Col\u00f3n-L\u00f3pez","sequence":"additional","affiliation":[{"name":"University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico"},{"name":"UPR Comprehensive Cancer Center, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille","family":"V\u00e9lez-\u00c1lamo","sequence":"additional","affiliation":[{"name":"U54 Partnership for Excellence in Cancer Research, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Fern\u00e1ndez-Espada","sequence":"additional","affiliation":[{"name":"The University of Texas Health Science Center, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Pattatucci","sequence":"additional","affiliation":[{"name":"University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda E.","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"The University of Texas Health Science Center, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"Administraci\u00f3n de Seguros de Salud de Puerto Rico. (2013 May 31). Total de vidas aseguradas Platino y Mi Salud [Total number of dual eligible and Medicaid beneficiaries]. https:\/\/www.asespr.org\/total-de-vidas-aseguradas-platino-y-mi-salud\/"},{"key":"e_1_3_2_3_1","volume-title":"Planning health promotion programs: An intervention mapping approach","author":"Bartholomew L. K.","year":"2006","unstructured":"Bartholomew L. K., Parcel G. S., Gerjo K., Gottlieb N. H. (2006). Planning health promotion programs: An intervention mapping approach. Jossey-Bass."},{"key":"e_1_3_2_4_1","unstructured":"Centers for Disease Control and Prevention. (2015). BRFSS prevalence and trends data (health care coverage). http:\/\/www.cdc.gov\/brfss\/brfssprevalence\/"},{"key":"e_1_3_2_5_1","unstructured":"Centers for Disease Control and Prevention. (2016). BRFSS prevalence and trends data (mammogram). https:\/\/www.cdc.gov\/brfss\/brfssprevalence\/"},{"issue":"4","key":"e_1_3_2_6_1","first-page":"191","article-title":"Community-academic partnership to implement a breast and cervical cancer screening education program in Puerto Rico","volume":"36","author":"Colon-Lopez V.","year":"2017","unstructured":"Colon-Lopez V., Gonzalez D., Velez C., Fern\u00e1-Espada N., Feldman-Soler A., Ayala-Escobar K., Ayala-Marin A. M., Soto-Salgado M., Calo W. A., Pattatucci-Aragon A., Rivera-Diaz M., Fern\u00e1ndez M. E. (2017). Community-academic partnership to implement a breast and cervical cancer screening education program in Puerto Rico. Peurto Rico Health Science Journal, 36(4), 191\u2013197.","journal-title":"Peurto Rico Health Science Journal"},{"key":"e_1_3_2_7_1","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez M. E. Gonzales A. Tortolero-Luna G. Partida S. Bartholomew L. K. (2005). 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Castaneda-Vasquez D. E. Garcia-Morales N. G. Oliva-Sosa N. E. de-la-Garza-Salinas L. H. Nunez-Rocha G. M. Ramirez-Aranda J. M. (2018). Stages of change for mammography among Mexican women and a decisional balance comparison across countries. Journal of Cancer Education 33(6) 1230\u20131238. https:\/\/doi.org\/10.1007\/s13187-017-1236-1","DOI":"10.1007\/s13187-017-1236-1"},{"issue":"4","key":"e_1_3_2_18_1","first-page":"351","article-title":"Knowledge and beliefs of breast cancer among elderly women in Puerto Rico","volume":"20","author":"Sanchez Ayendez M.","year":"2001","unstructured":"Sanchez Ayendez M., Suarez-Perez E., Vazquez M. O., Velez-Almodovar H., Nazario C. M. (2001). Knowledge and beliefs of breast cancer among elderly women in Puerto Rico. Puerto Rico Health Science Journal, 20(4), 351\u2013359.","journal-title":"Puerto Rico Health Science Journal"},{"key":"e_1_3_2_19_1","doi-asserted-by":"crossref","unstructured":"Siu A. L. (2016). 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