Living in the context of poverty and trajectories of breast cancer worry, knowledge, and perceived risk after a breast cancer risk education session.

OBJECTIVES: The purpose of this paper was to demonstrate how living in neighborhoods with high levels of poverty (while controlling for personal income) impacts personal characteristics, which in turn impacts retention of breast cancer risk knowledge and changes in worry and perceived risk.
METHODS: The data from this project come from a larger, National Cancer Institute-funded study that included a pretest, a breast cancer risk education session, a posttest, the option of an individualized risk assessment via the Gail Model and three follow-up phone calls over the next 9 months.
RESULTS: The percent of individuals living below poverty in the community in which the participant resided was predictive of the personal characteristics assessed, and these characteristics were predictive of changes in breast cancer worry and knowledge across time.
CONCLUSION: Differentiation of self and monitoring, two of the individual characteristics that seem to allow people to process and use information to make "rational" decisions about health care, seem to be impacted by the necessity for adaptation to a culture of poverty. Thus, as a health care community, we need to tailor our messages and our recommendations with an understanding of the complex intersection of poverty and health care decision making.