Purpose: To determine college students' intentions to be Human Papillomavirus (HPV) vaccinated. Methods: The study was comprised of college students aged 18-45 years. A survey was developed based on the Theory of Planned Behavior (TPB). The significance of the TPB constructs-attitude, subjective norms, and perceived behavioral control-and an additional construct-knowledge-in predicting intention were assessed. Results: The regression model containing attitude, subjective norms and perceived behavioral control accounted for 40% of the variance in intention. Attitude and subjective norms were significant predictors, while perceived behavioral control was not. Provider recommendation was the only significant covariate. Knowledge did not significantly contribute to the model. Discussion: The TPB was useful in predicting HPV vaccination intentions. A focus on attitude, subjective norms and provider recommendation may be useful in creating new or enhancing existing interventions.

Purpose: To assess pharmacists' mental well-being, perceptions of safety, and willingness to administer vaccines before and during the COVID-19 pandemic. Methods: An electronic survey was administered to a convenient sample of practicing pharmacists working in Alabama, Tennessee and Texas. The 33-item survey examined pharmacists' beliefs about the pandemic's impact on their mental well-being, their perceptions of safety in vaccine administration, and their willingness to vaccinate. Responses were assessed on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). A recruitment email with the survey link was sent to pharmacists, with periodic reminders over a 4-week period. Descriptive statistics and bivariate analyses were utilized to evaluate survey responses. Results: A total of 387 responses were analyzed, with an estimated response rate of 3.93%. Most respondents were women (65%) and had at least 6 to 10 years of practice experience (28%). Overall, participants felt that the pandemic worsened their mental well-being, with women reporting a more negative mental well-being compared with men (P < .001). They reported having less time during workflow to apply personal protective equipment (PPE) (P = .0074) compared to before the pandemic. They also reported a decrease in willingness to vaccinate adult patients during the pandemic (P < .0001), and that concern about contracting COVID-19 prevented them from giving vaccinations (P < .0001). Conclusions: Pharmacists felt their mental well-being and willingness to vaccinate patients suffered as a result of the COVID-19 pandemic. Future research and initiatives that focus on improving vaccination rates should also consider pharmacists' concerns and well-being.

To investigate real-world homologous recombination repair mutation (HRRm) testing patterns in patients with metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC), and barriers to testing

To describe the metastatic castration-resistant prostate cancer (mCRPC) treatment landscape and sequencing – including metastatic hormone-sensitive prostate cancer (mHSPC) to first-line (1L) mCRPC.

Although a safe and effective human papillomavirus (HPV) vaccine exists, HPV remains prevalent and vaccine uptake remains suboptimal especially among young adults. This study aimed to determine the salient beliefs of college students regarding HPV vaccination.

IntroductionThis study aims to (1) describe the prevalence and clustering of 3 health behaviors, (2) examine the association between individual health behaviors and health-related quality of life, and (3) explore the association between the clustering of the health behaviors and health-related quality of life.MethodsInvestigators analyzed a sample of U.S. adults aged 18–64 years using data from the 2016–2018 Behavioral Risk Factor Surveillance System survey in March 2020. Logistic regression models examined the associations among 3 healthy behaviors (currently not smoking, physical activity, and nonheavy alcohol consumption) and 4 indicators of health-related quality of life (general health, physical health, mental health, and activity limitation). Alpha was set at 0.01.ResultsA total of 450,870 individuals were included in the analysis (weighted n=100,102,329). Of these, 82.0% were current nonsmokers, 92.8% were nonheavy drinkers, and 77.6% reported physical activity. The prevalence of having none, 1, 2, and 3 of the health behaviors was 0.7%, 7.7%, 30.1%, and 61.5%, respectively. Smoking status and physical activity status were significantly associated with all the 4 health-related quality of life indicators. Alcohol status was significantly associated with mental health and activity limitation. The associations demonstrated a higher health-related quality of life among individuals who reported healthy behaviors than among those who did not engage in healthy behaviors. Compared with respondents who reported none of the health behaviors, people with all 3 health behaviors were more likely to report higher health-related quality of life.ConclusionsHealth behaviors were significantly associated with health-related quality of life among U.S. adults. Healthy behaviors should be encouraged because adopting these behaviors may contribute to a higher health-related quality of life.

PURPOSE: Practice guidelines recommend the prophylactic use of granulocyte colony–stimulating factors (G-CSFs) in patients with high risk of febrile neutropenia, but evidence suggests that G-CSFs are frequently overused. The objectives of this study were (1) to determine the prevalence and prescribing patterns of G-CSF and (2) to evaluate the impact of a program initiative on G-CSF prescribing patterns, adherence to guidelines, and mortality. METHODS: In this retrospective cohort study, data were used from the electronic health records of patients with metastatic colorectal cancer who received care at a multicenter oncology practice network during two time periods: July 01, 2013, to December 31, 2014, and July 01, 2017, to December 31, 2017. Beginning 2016, a site-wide program initiative that involved educational materials, appropriate nonuse recommendations, and prior authorization was introduced in the oncology practice network with an aim of reducing G-CSF overutilization. Descriptive statistics, t tests, and chi-squared tests were employed to analyze program impact. RESULTS: There were 3,426 chemotherapy regimens corresponding to 2,968 patients. There were a total of 387 (11.3%) G-CSF–treated patients and 3,095 G-CSF administrations during the study period. G-CSF use was significantly lower in the postperiod, compared with the preperiod ( P < .0001). Adherence to guidelines was significantly higher in the postperiod, compared with the preperiod ( P < .0001). Mortality rates did not significantly differ between the two time periods. CONCLUSION: This study demonstrates that policy initiatives have the potential to positively affect G-CSF prescription patterns and promote guideline adherence. These findings could help prescribers adopt a cost-effective approach in patients with metastatic colorectal cancer, leading to enhanced clinical practice and value-based care.

Granulocyte Colony Stimulating Factors (G-CSF) are recommended by cancer consortia for the management of febrile neutropenia. Also recommended are viable alternatives, of which chemotherapy dose reduction (CDR) is well suited, as it may lead to cost savings for patients and payers. Evidence is lacking on the value of G-CSF in metastatic tumors. This study aimed to compare survival outcomes among 1) G-CSF treated vs G-CSF untreated patients and 2) G-CSF treated vs CDR treated patients. We utilized data from the electronic health records of metastatic colorectal cancer patients who received chemotherapy between 7/1/13 and 12/1/14 at US Oncology practices. The outcome assessed was overall survival, defined as time from first day of chemotherapy to death of any cause or last clinic visit. Propensity scoring was used to match (1:1) the cohorts using the variables age, gender, disease, febrile neutropenia risk, year of diagnosis and line of therapy. Kaplan-Meier and log-rank methods were used to assess survival. Conditional cox proportional hazards regression was used to estimate the hazards. The first model included matched G-CSF treated (n=235) and G-CSF untreated (n=235) patients, and median survival was 26.1 and 27.6 months, respectively (p=0.2778). The cox model showed no difference in overall survival between the groups (Hazard Ratio [HR]: 1.14; 95% CI: 0.90,1.44). In the second model, matched G-CSF treated (n=123) and CDR treated (n=123) patients had a median survival of 22.2 and19.5 months, respectively (p=0.6886). The cox model showed no difference in overall survival between the groups (HR: 0.75; 95% CI: 0.51,1.12). Results demonstrate no benefit of G-CSF use alone or G-CSF use over CDR in terms of overall survival for this population. These conclusions could help decrease G-CSF overutilization and result in enhanced clinical practice and cost savings, without compromising health outcomes.

Objectives: The purpose of this study was to assess factors that influence use of mammography screening among African American women, with a focus on social and cultural influences using Andersen's behavioral model (ABM), and to assess the methodological quality of the included studies. Methods: A literature review was conducted using PubMed, CINAHL, PSYCINFO, and Web of Science. Search terms included a combination of the following words using Boolean operators: breast cancer screening, mammography, repeat mammography, and African American. Studies that met the following criteria were included in the review: 1) examined factors associated with mammography screening, 2) included African American women as a majority, 3) published in a peer-reviewed English language journal between 2005 and 2017, and 4) conducted in the United States. Literature reviews, commentaries and nonresearch studies were excluded. Cited references from identified studies were examined for additional, relevant articles. Associated factors were grouped into predisposing, enabling, and need factor domains of ABM. The reviewed studies were rated using a methodological quality score (MQS) ranging from 0 to 20, with higher scores indicating higher methodological quality. Results: Twenty-four studies met the inclusion criteria. Fifteen factors that affect breast cancer screening in African American women were identified: predisposing (age, education, knowledge, beliefs, mistrust, religiosity, fears and fatalism), enabling (health insurance, access to care, income, health utilization), and need (physician recommendation, family/personal history, pain/ discomfort, family responsibilities) factors. The most common factor was insurance status, although cultural issues (e.g., mistrust) were evident. Most of the identified factors are modifiable. The mean MQS was 12.2, indicating that the studies were slightly above average in quality. Conclusions: Financial and cultural issues were important hindrances to breast cancer screening in African American women. These findings highlight the importance of affordable health care for preventive health services as well as the relevance of culturally embedded issues to health, while the MQS accentuates the need for more rigorous research articles. Breast cancer screening interventions in this population should attend to barriers identified in this review.

To evaluate incidence of complications associated with central venous access devices (CVADs) in PwHA. This retrospective cohort study was conducted using claims data from MarketScan Commercial Research Database from 07.01.2005–03.31.2019. The study cohort comprised PwHA and included CVAD cases (≥1 CVAD insertion claim), and controls with no CVAD insertion claim through the study period. Patients were required to have continuous enrollment for 6 months pre- and at least 3 months post-index date. Index date was defined as the first date of port insertion for CVAD cases and first hemophilia A (HA) diagnosis for controls during the study period. HA was identified using a previously validated claims-based algorithm. CVAD use and complications (all-cause infections, thrombosis and hematoma) were identified using ICD-9-CM/ICD-10-CM diagnosis/procedure and CPT codes. Patients were followed until first outcome, plan switch or over a 2-year post-index period. Incidence and rates of complications among CVAD cases and controls were evaluated using Cox proportional-hazards models (adjusted for age, region, comorbidity score, and insurance type). The study cohort comprised 862 PwHA; 61 (7%) had evidence of CVAD use. CVAD cases were significantly younger than controls (mean age ± SD: 4.7±5.3 years vs. 25.9±17.5 years, p<0.001) and had a significantly higher Elixhauser comorbidity score (mean ± SD: 0.9±0.6 vs. 0.5±0.8, p<0.001). In the post-index period, a significantly higher proportion of CVAD cases (vs. controls) had all-cause infections (44.3% vs. 26.7%, p<0.001) and thrombosis (13.1% vs. 1.1%, p<0.001). No CVAD cases had evidence of hematoma; it occurred in 1.5% of controls. Cox models revealed that CVAD cases had 2.3 times (95%CI: 1.5–3.6) and 9.2 times (95%CI: 2.4–35.6) higher rate of all-cause infections and thrombosis, respectively. CVAD use in HA is associated with higher rates of complications, underscoring the need for novel non-intravenous treatments which remove the need for CVADs.

The American Society of Clinical Oncology (ASCO) recommends prophylactic use of Granulocyte Colony Stimulating Factors (G-CSF) for febrile neutropenia. Chemotherapy dose reduction is a viable alternative that is not routinely recommended but may result in cost savings. The purpose of this study was to determine the prevalence and predictors of chemotherapy dose reduction in patients with metastatic colorectal cancer. Data were obtained from the electronic health records of patients who received chemotherapy at a multi-center oncology practice network between 07/012013 and 12/31/2014. Chemotherapy dose reduction was defined as ≥ 10% reduction in dose of at least one cytotoxic drug, compared to the standard or initial dose. The prevalence of chemotherapy dose reduction was evaluated. A multivariate logistic regression model was used to explore the relationships between chemotherapy dose reduction and predictors including age, gender, disease, year of diagnosis, febrile neutropenia [FN] risk, line of therapy and duration of chemotherapy treatment. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated. Of the 508 chemotherapy regimens included in the study, 209 (41.1%) were female and the mean (SD) age was 61.2 (12.0) years. Prevalence of chemotherapy dose reduction in the cohort was 67.3% (n=342). In the multivariate analysis, FN risk, line of therapy and duration of treatment were significantly associated with chemotherapy dose reduction. Patients who received chemotherapy dose reduction were more likely to have a higher FN risk (OR=2.45; 95% CI=1.53-3.94), be on a lower line of therapy (ORs range: 7.23-10.02) and have a longer duration of treatment (ORs range: 4.75-6.99). A substantial proportion of the patients received chemotherapy dose reduction. Factors identified in this study may be used to target patient sub-groups for chemotherapy dose reduction and better design evidence-based interventions. Prescribers may want to consider chemotherapy dose reduction in lieu of G-CSF for this population.

OBJECTIVES/SPECIFIC AIMS: Cancer related pain presents a significant risk for opioid abuse among cancer survivors and contributes to the current opioid crisis. Nearly 90% of breast cancer patients have been reported to have cancer-related pain requiring treatment. Opioids, in combination with NSAIDs, have been widely used for pain management in this population despite the risk of abuse. Long-term NSAID use due to their antineoplastic and neuroprotective effects may offer additional protective effects against opioid abuse. Here, we assess the relationship between NSAID use and opioid abuse among breast cancer patients. METHODS/STUDY POPULATION: Using ICD-9-CM codes, we identified and selected women aged >18 years with breast cancer from the National Inpatient Sample (NIS). Our primary predictor was a history of long-term NSAID use. Opioid abuse was the primary outcome of interest. Secondary outcomes were inpatient mortality and length of stay. Multivariable regression models were employed in assessing the association between predictors and outcomes while adjusting for relevant covariates. RESULTS/ANTICIPATED RESULTS: Among 170,644 women with breast cancer, 7,838 (4.6%) reported a history of long-term NSAID use. Patients with a history of long-term NSAID use had lower odds of opioid abuse (aOR 0.53; 95% CI [0.32-0.88]) and in-hospital mortality (aOR 0.52; 95% CI [0.45-0.60]) and were likely to have shorter hospital stay (7.12 vs. 8.11 days) compared to women with no history of long-term NSAID use. DISCUSSION/SIGNIFICANCE OF IMPACT: Long-term NSAID use may offer a protective effect against opioid abuse and improve in-hospital outcomes translating to better quality of life and healthcare utilization indices among breast cancer patients.

BACKGROUND:Improving survival rates among patients with breast cancer has been associated with an increase in the prevalence of co-morbidities like cancer-related pain. Opioids are an important component in the management of pain among these patients. However, the progression from judicious use to abuse defeats the aim of pain control. Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as the first step in cancer-related pain management. Due to their anti-inflammatory, anti-neoplastic and neuroprotective properties, NSAIDs have been shown to reduce the risk of progression of certain cancers including breast cancers. In this study, we assessed whether an association exists between long-term NSAID use and opioid abuse among breast cancer survivors. We also explored the relationship between long-term NSAID use and inpatient mortality and length of stay (LOS).METHODS:Using ICD-9-CM codes, we identified and selected women aged 18 years and older with breast cancer from the National Inpatient Sample. Our primary predictor was a history of long-term NSAID use. Multivariable regression models were employed in assessing the association between long-term NSAID use and opioid abuse, inpatient mortality and LOS.RESULTS:Among 170,644 women with breast cancer, 7,838 (4.6%) reported a history of long-term NSAID use. Patients with a history of long-term NSAID use had lower odds of opioid abuse (adjusted odds ratio (aOR) 0.53; 95% CI [0.32-0.88]), lower in-hospital mortality (aOR 0.52; 95% CI [0.45-0.60]) and shorter LOS (7.12 vs. 8.11 days).DISCUSSION:Further studies are needed to understand the underlying mechanism of the association between long-term NSAID use and opioid abuse.

This study aimed to determine the relationships between sexual orientation/gender identity and Health-Related Quality of Life (HRQoL) indicators in a sample of US adults and evaluate if a self-reported history of depression explains the relationship. Data were obtained from the 2015-2017 Behavioral Risk Factor Surveillance System (BRFSS) survey. The HRQoL outcome variables were general health status, mental health, physical health and impaired activity, which were dichotomized. The primary predictor was LGBTH status which had three groups: lesbian, gay, bisexual (LGB), transgender (T) and heterosexual-cisgenders (H). Logistic regression models were used to assess the relationships between the predictor and each HRQoL outcome, and to evaluate the explanatory effect of depression. We adjusted for sociodemographic factors, health-risk behaviors, co-morbid conditions and disabilities. The statistical analysis accounted for the complex sampling design of BRFSS and alpha was set at 0.01. The unweighted sample consisted of 1670 (0.48%) individuals who identified as transgender, 13,423 (3.19%) individuals who identified as LGB and 405,956 (95.7%) heterosexual-cisgenders. The adjusted analysis showed that compared to heterosexuals, both LGB and transgenders reported significantly lower odds of good mental health [odds ratio (OR) 0.64, 95% CI: 0.58-0.71, P = <0.0001; OR 0.68, 95% CI: 0.53-0.88, P =0.003] respectively. However, the significance for transgenders was lost when results were adjusted for depression. [OR 0.80, 95% CI: 0.72-0.89, P = <0.0001; OR 0.86, 95% CI: 0.66-1.12, P =0.260]. The three groups did not significantly differ in respect to general health, physical health, and impaired activity. The was an association between reporting low mental health and identifying as being LGB or transgender. Our results suggest that depression explains some of the differences in mental health between LGBT and heterosexual respondents. Mental health support, that includes depression screening and treatment may be essential in improving transgender health.

Introduction Intracranial hemorrhage (ICH) is a serious, life-threatening complication of hemophilia A (HA). Previous studies have reported an incidence rate of ICH between 2-4% in persons with hemophilia A (PwHA); however, a single episode of ICH can result in significant morbidity and mortality. Few studies have assessed the long-term consequences of ICH among PwHA. We aimed to examine the downstream clinical, healthcare resource utilization (HRU), and cost burden of ICH in PwHA. Methods We utilized commercial administrative claims data from US MarketScan Commercial Research Database and PharMetrics Plus Database from 01/01/06 to 12/30/18 (MarketScan data available until 9/30/18 at the time of analysis). PwHA aged ≤65y were identified using a validated claims-based HA algorithm (Lyons et al. 2018). Further, PwHA with ICH were identified as those with ≥1 claim involving ICD-9-CM/ICD-10-CM diagnosis codes for ICH. The first ICH event was identified as the index event. PwHA with ICH were required to have ≥6 months of continuous enrollment from the index event (follow-up period). Clinical conditions were identified using ICD-9-CM/ICD-10-CM diagnosis codes, and major bleeds were identified using a previously developed algorithm (Shrestha et al. 2017). Physical therapy (PT), durable medical equipment (DME) use, factor VIII (FVIII), and bypassing agents (BPAs) were identified using NDC, CPT, or other HCPCS codes. Patient demographics, clinical characteristics, HRU, and costs were descriptively examined during the follow-up period. Results Of the total 4539 PwHA, 94 (2.1%) had ≥1 ICH diagnosis. Of these, 69 individuals with ≥6 months of continuous enrollment constituted the current study cohort. The majority (59.4%, n=41) had their index ICH event recorded in an ICU or inpatient setting. The mean age was 21.1y (SD±18.9) with 33 adults (range: 19-65y) and 36 children (range: 0-16y); 16 (23.2%) were aged <5y; all were male; 27 (39.1%) were in the northeast/east US; 37 (53.6%) had a Preferred Provider Organization health plan. In the ICH cohort, 26 (37.7%) individuals had evidence of ≥1 major bleed in the 6 months following the index ICH event, while 11 (15.9%) had evidence of inhibitors (i.e. claim for a BPA). The mean Charlson Comorbidity Index score of those in the ICH cohort was 0.9 (SD±1.8); 23 (33.3%) had a diagnosis of joint/musculoskeletal conditions including arthropathy, 22 (31.9%) had chronic pain diagnosis, 12 (17.4%) had evidence of fracture, 11 (15.9%) had a mental health-related diagnosis including depression/anxiety, and 10 (14.5%) had evidence of paraplegia/hemiplegia. In the 6 months following the index ICH event, 26 (37.7%) of the individuals had ≥1 ICU visit (mean no. of visits=0.6, SD±1.0), 23 (33.3%) had ≥1 non-ICU in-patient stay (mean=0.6, SD±1.5) and a mean length of stay of 5.5 (SD±14.9) days, 44 (63.8%) had ≥1 ER visit (mean=1.6, SD±2.3), 55 (79.7%) had ≥1 outpatient hospital visit (mean=6.2, SD±11.8), 64 (92.8%) had ≥1 office visit (mean=7.9, SD±7.4), 19 (27.5%) had evidence of DME or PT, and 47 (68.1%) had ≥1 claim for FVIII prescription/administration with an average of 5.2 (SD±11.4) claims in the post 6-month period. The average all-cause healthcare costs among PwHA with ICH was $201,595 (SD±205,388, median=$135,374) over 6 months following the ICH event, and medical costs accounted for 25.3% ($50,937) of these costs. The average healthcare costs associated with the index ICH episode were estimated to be $63,369 (SD±97,925, median=$16,813). To contextualize these findings, we estimated the average 6-month healthcare costs of PwHA without any ICH diagnosis to be $102,548 (SD±214,065, median=$40,401). Among the 69 PwHA in the ICH cohort, 51 had continuous enrollment for 6 months prior to the index event. Of these, 31 (60.8%) had evidence of any FVIII or BPA use while 15 (29.4%) had a diagnosis of ≥1 non-ICH related major bleed in the 6 months preceding the index event. Conclusions Although rare, ICH still occurs in PwHA including younger children. ICH was associated with high comorbidity burden, health care service utilization, and costs. Due to unavailability of mortality data, the current analysis may still be an underestimate of the true burden of ICH in PwHA. Based on our findings, two out of five PwHA with ICH had no evidence of HA treatments prior to the incidence of ICH. Early management and treatment of HA may reduce the burden of ICH in this population. Disclosures Mahajerin: Genentech: Consultancy, Speakers Bureau; Alexion: Speakers Bureau; Spark: Speakers Bureau; Kedrion: Membership on an entity's Board of Directors or advisory committees. Patel:Roche/Genentech: Equity Ownership; Genentech: Employment. Yang:Genentech, Inc.: Employment, Equity Ownership. Orji:Genentech: Employment. Ko:Genentech, Inc.: Employment.

24 Background: Current American Society of Clinical Oncology (ASCO) guidelines recommend prophylactic use of colony stimulating factors (CSF) for prevention of febrile neutropenia among cancer patients. ASCO also recommends chemotherapy dose reduction as a viable alternative to CSF administration, which may result in cost savings to patients and payers, but adherence to these guidelines has been less than ideal. The objectives of this study were i.) to determine the prevalence and prescribing patterns of CSF and dose reduction in metastatic colorectal cancer patients and ii.) to evaluate the impact of a program initiative on CSF prescribing patterns and on compliance to ASCO guidelines. Methods: In this retrospective study, we utilized data from the electronic health records of metastatic colorectal cancer patients who received care at a multi-center oncology practice network during two time periods: July 2013 to December 2014 and July to December 2017. In 2016, a site-wide program initiative that involved educational materials, appropriate non-use recommendations and prior authorization was introduced in the oncology practice network with an aim of reducing CSF overutilization. Descriptive statistics and chi squared tests were employed to explore CSF utilization across patient age, gender, disease, year of diagnosis, febrile neutropenia risk, line of therapy and duration of treatment. Results: There were 3426 chemotherapy regimens corresponding to 2968 patients. There was a total of 3095 CSF administrations and the CSF administered was pegfilgrastim. There were 343 (10%) CSF users. Among subjects who had data on dose reduction (N = 508), 58.7% received dose reduction. CSF use was significantly lower in the post-period, compared to the pre-period (p < 0.0001). Compliance to guidelines was significantly higher in the post-period, compared to the pre-period (p < 0.0001). Conclusions: Our results demonstrate that program initiatives have the potential to positively impact CSF prescription patterns. These findings could help prescribers adopt a cost-effective approach for this population, leading to enhanced clinical practice and value-based care.

The purpose of this study was to assess factors that influence mammography screening among African American women with a focus on behavioral and cultural influences using Anderson’s behavioral model (ABM). A literature review was conducted using PubMed, CINAHL, PSYCINFO, and Web of Science. English language articles published from 2005 to 2017 were reviewed. Search terms included a combination of the following words using Boolean operators: breast cancer screening, repeat mammography, and African American. The study’s inclusion criteria were: 1) examined factors associated with mammography screening, 2) included African American women as majority, 3) published in a peer-reviewed English language journal, and 4) conducted in the United States. Literature reviews, commentaries and non-research studies were excluded. Cited references from identified studies were examined for additional, relevant articles. Associated factors were grouped into predisposing, enabling and need factor domains of ABM. Twenty-four studies met the inclusion/exclusion criteria. Fifteen factors that affect breast cancer screening in African American women were identified: predisposing (age, education, knowledge, beliefs, mistrust, religiosity, fears and fatalism), enabling (income, health insurance, access to care, health utilization), and need (physician recommendation, family/personal history, pain/discomfort, family responsibilities) factors. The most common factor was insurance status, although cultural issues (e.g., mistrust) were evident. Most of the identified factors are modifiable. Financial and cultural issues were important hindrances to breast cancer screening in African American women. These findings highlight the importance of affordable health care for preventive health services as well as the relevance of culturally embedded issues to health. Breast cancer screening interventions in this population should attend to barriers identified in this review.