Department of Quantitative Health Sciences; Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center
Behavioral Medicine | Behavior and Behavior Mechanisms | Community Health and Preventive Medicine | Diagnosis | Health Psychology | Neoplasms | Preventive Medicine
Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for > /=2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.
breast cancer, cynical hostility, optimism, psychological attitudes, screening mammograms
Rights and Permissions
Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
DOI of Published Version
Medicine (Baltimore). 2019 Jun;98(24):e15869. doi: 10.1097/MD.0000000000015869. Link to article on publisher's site
Progovac AM, Pettinger M, Donohue JM, Chang CH, Matthews KA, Habermann EB, Kuller LH, Rosal MC, Li W, Garcia L, Tindle HA. (2019). Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study. Open Access Articles. https://doi.org/10.1097/MD.0000000000015869. Retrieved from https://escholarship.umassmed.edu/oapubs/3891
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Behavioral Medicine Commons, Behavior and Behavior Mechanisms Commons, Community Health and Preventive Medicine Commons, Diagnosis Commons, Health Psychology Commons, Neoplasms Commons, Preventive Medicine Commons