Immunization with an mRNA DTP vaccine protects against pertussis in rats.

Bordetella pertussis is a Gram-negative bacterium that is the causative agent of the respiratory disease known as pertussis. Since the switch to the acellular vaccines of DTaP and Tap, pertussis cases in the US have risen and cyclically fallen. We have observed that mRNA pertussis vaccines are immunogenic and protective in mice. Here, we further evaluated the pertussis toxoid mRNA antigen and refined the formulation based on optimal pertussis toxin neutralization in vivo. We next evaluated the mRNA pertussis vaccine in Sprague-Dawley rats using an aerosol B. pertussis challenge model paired with whole-body plethysmography to monitor coughing and respiratory function. Female Sprague-Dawley rats were primed and boosted with either commercially available vaccines (DTaP or wP-DTP), an mRNA-DTP vaccine, or mock-vaccinated. The mRNA-DTP vaccine was immunogenic in rats and induced antigen-specific IgG antibodies comparable to DTaP. Rats were then aerosol challenged with a streptomycin-resistant emerging clinical isolate D420Sm1. Bacterial burden was assessed at days 1 and 9 post-challenge, and the mRNA vaccine reduced burden equal to both DTaP and wP-DTP. Whole-body plethysmography revealed that mRNA-DTP vaccinated rats were well protected against coughing which was comparable to the non-challenged group. These data suggest that an mRNA-DTP vaccine is immunogenic in rats and provides protection against aerosolized B. pertussis challenge in Sprague-Dawley rats.

The association between food insecurity and colorectal cancer screening: 2018-2021 New York State Behavioral Risk Factor Surveillance System (BRFSS).

PURPOSE: To assess the association between food insecurity and colorectal cancer screening uptake in screening eligible participants in New York State. METHODS: We analyzed 28,154 adults who participated in New York State Behavioral Risk Factor Surveillance System (BRFSS) from 2018 to 2021, were age-eligible for colorectal cancer screening based on the USPSTF guidelines at the time of survey administration and answered a version of the administered survey that included the module on food insecurity. Participants were defined as food insecure if they self-reported being always, usually, or sometimes stressed about having enough money to buy nutritious meals in the past 12 months. We compared demographic, healthcare access, overall health status, food insecurity by colorectal cancer screening status. Multivariable analyses were performed to assess the association of food insecurity and colorectal cancer screening status after adjusting for relevant covariates. Weighted analyses were performed using survey procedures to obtain population estimates. RESULTS: Food insecurity was statistically significantly associated a decreased likelihood of being up to date on colorectal cancer screening (ORadj 0.83, 95% CI [0.72, 0.94]) and being ever screened for colorectal cancer (ORadj 0.74, 95% CI [0.64, 0.87]) after adjusting for overall health status, healthcare coverage, interview year, age, race/ethnicity, sex, educational attainment, and income. Health status, health coverage, age, and Non-Hispanic Black race/ethnicity showed positive, statistically significant association with ever being screened and with being up to date for colorectal cancer screening. Lower income, lower educational attainment, and non-Hispanic Asian race/ethnicity were statistically significant inverse predictors of ever being screened and being up to date on screening. CONCLUSION: This project assessed the association between food insecurity and colorectal cancer screening uptake using the BRFSS survey. Food insecurity may be an important predictor for colorectal cancer screening uptake in eligible adults in the United States. The results from the study can inform future interventions and policies designed to improve participation in routine colorectal cancer screening.

A multi-informant qualitative analysis of desired features for an mHealth tool for youth living with HIV in South Carolina.

OBJECTIVE: Youth living with HIV (YLHIV) in the southern United States experience poor outcomes across the HIV care continuum and are at high-risk for virologic failure. This study used a qualitative, community-engaged approach to inform the development of a tailored mobile Health (mHealth) tool for YLHIV in South Carolina (SC). METHODS: Semistructured qualitative interviews were conducted with YLHIV in SC (n = 16) and their HIV care providers (n = 15). Focus group discussions (FGDs) were also conducted with HIV-focused community-based organization staff (n = 23). Interviews and FGDs queried desired components for a future mHealth tool tailored for YLHIV. Data were analyzed using a team-based rapid qualitative approach. RESULTS: Across informants, key themes emerged related to medical management of HIV, including a desire for connections with medical providers, appointment and medication reminders, and accurate HIV information. In addition, informants voiced a desire for mental health resources to be integrated into the app. Connection with HIV-positive peers also emerged as a key desire from youth informants. In terms of app design, informants emphasized the need for strict privacy practices, a youth-friendly design, compensation for use, and integration with existing healthcare systems. CONCLUSIONS: mHealth interventions developed for YLHIV should meet the mental health and social needs of YLHIV in addition to their medical needs. In addition, the highly stigmatized nature of HIV requires careful consideration when designing digital tools-youth want their privacy prioritized, but also express strong desire for social support to help cope with the isolation and stigma of this chronic health condition.

A Qualitative Study of Transportation-Related Barriers to HIV Care in South Carolina.

OBJECTIVES: Addressing structural barriers to care for people living with human immunodeficiency virus (HIV) in the southern United States is critical to increase rates of viral suppression and to reduce existing HIV disparities. This qualitative study aimed to describe transportation-related barriers experienced by people living with HIV in South Carolina, understand perceived effects of transportation vulnerability on HIV care, and explore strategies used by individuals to overcome transportation-related challenges. METHODS: We conducted semistructured interviews with 20 people living with HIV from South Carolina who were either reengaging in HIV care after a prolonged absence (>9 months) or in care but with a detectable viral load (ie, >200 copies/mL). All people living with HIV reported transportation vulnerability. A deductive/inductive approach was used to identify transportation-related barriers perceived to negatively affect HIV care. We also identified strategies and resources described by people living with HIV as helpful in addressing transportation challenges. RESULTS: Participants described a range of transportation-related barriers to HIV care, including lack of access to reliable, safe, and affordable transportation, as well as stigma due to HIV and socioeconomic statuses. These barriers were reported to negatively affect engagement in care and worsen both physical and mental health. Participants indicated flexible clinic policies and instrumental support from family and friends were useful in overcoming barriers. CONCLUSIONS: This study offers insight for the development of transportation interventions to improve equitable access to HIV care for people living with HIV in South Carolina. It also calls attention to the ways in which transportation vulnerability, HIV-related stigma, and disability status intersect to create unique challenges for some people living with HIV.

One-Stop-Shop Cancer Screening Clinic: Acceptability Testing.

Cancer screenings aid in the early detection of cancer and can help reduce cancer-related mortality. The current model of care for cancer screening is often siloed, based on the targeted cancer site. We tested the acceptability of a new model of care, called the One-Stop-Shop Cancer Screening Clinic, that centralizes cancer screenings and offers patients the option to complete all their recommended cancer screenings within one to two visits. We administered surveys to 59 community members and 26 healthcare providers to gather feedback about the One-Stop-Shop model of care. Both community members and providers identified potential benefits (e.g., decreased patient burden, increased completion of cancer screenings) and also potential challenges (e.g., challenges with workflow and timing of care) of the model of care. The results of the study support the acceptability of the model of care. Of the community members surveyed, 89.5% said, if offered, they would be interested in participating in the One-Stop-Shop Cancer Screening Clinic. Future studies are needed to formally evaluate the impact and cost effectiveness of the One-Stop-Shop Cancer Screening Clinic.

Systematic Review of Colorectal Cancer Screening-Related Apps.

Background: In the United States, colorectal cancer (CRC) is the second leading cause of cancer death in men and women combined. The United States Preventive Services Task Force recommends that average risk adults have regular CRC screening to detect and prevent CRC. Despite published CRC screening guidelines, national CRC screening rates remain suboptimal. With the exponential increase in technology use and device ownership, many mobile health applications (apps) have been developed to improve health outcomes. There is great potential for smartphone or tablet apps to help improve CRC screening uptake, with the ultimate goal of reducing CRC morbidity and mortality. To date, there are no systematic reviews that have examined the publicly available, free apps that are related to CRC screening, and therefore, the quality and the content of these apps remain unknown. Objectives: The purpose of this study was to systematically review smartphone and tablet apps that could be used to improve CRC screening uptake. Methods: Apps available on the Google Play and Apple App stores that were compatible with smartphones and tablets were reviewed. Of the 2,790 apps reviewed, 20 met inclusion criteria. Results: Of the 20 apps that met inclusion criteria, most were informational in nature. Approximately half of the apps focused on colonoscopies and did not discuss other CRC screening options. Furthermore, more than half of the apps did not include video/audio content and the majority of the apps did not provide navigation support (e.g., reminders, instructions, maps). Conclusions: There are multiple free, publicly available apps that may encourage CRC screening uptake. Despite their promise, there is a paucity of empirical evidence evaluating the efficacy and usability of these apps. Future research efforts can evaluate the content, usability, accessibility, and potential impact of these apps.

Recent Telehealth Utilization at a Large Federally Qualified Health Center System: Evidence of Disparities Even Within Telehealth Modalities.

Objective: To explore overall trends as well as racial/ethnic disparities in utilization of different telehealth modalities (telephone vs. televideo) at federally qualified health centers (FQHCs) during the COVID-19 pandemic. Methods: Using electronic health record data from a large New York-based FQHC system, we aggregated (separately) Behavioral Health and Family Practice visits per month occurring in-person, by telephone, or by televideo and graphed monthly trends in visits across the pre-pandemic, peak-pandemic, and post-peak-pandemic periods. We calculated fractions of visits conducted by modality for each patient demographic (race/ethnicity, primary language, age, gender, insurance type, and geography) and conducted bivariate assessments to test relationships between patient characteristics and modality. Results: Our data contained 121,072 unique patients and 811,105 visits overall. Telehealth use peaked in April 2020 but continued to account for a significant fraction of FQHC visits-nearly 25% (N = 4,908) of monthly Family Practice visits and a massive 98% (N = 14,173) of Behavioral Health visits as late as June 2021. Of all telehealth visits, nearly half were by telephone. Moreover, demographic factors differed between FQHC patients using telephone visits versus those using televideo: Black, non-English speaking, older, and Medicaid patients had significantly higher utilization of telephone visits than televideo visits (e.g., 25.9% of all Black patients' visits were via telephone vs. 17.1% via televideo; p < 0.001). In contrast, younger, Asian, and privately insured patients had significantly higher televideo visits. Conclusions: Our results suggest that telephone visits remain critical to the provision of health care for FQHC patients. They also suggest that disparities extend beyond the telehealth versus in-person dichotomy and inequities exist even within the type of telehealth used. This has implications for patient health, FQHC quality outcomes, as well as optimal Medicaid telehealth reimbursement policy.

Knowledge of the Relationship Between Breastfeeding and Breast Cancer Risk Among Racial and Ethnic Minority Women.

Research indicates breastfeeding can reduce the risk of breast cancer in women. Black and Hispanic women are more likely to die from breast cancer than non-Hispanic white women and are least likely to breastfeed. The current study was designed to evaluate women's knowledge of the link between breastfeeding and decreased breast cancer risk among a racially diverse cohort of pregnant women. Pregnant women 18 and older (N = 89; 48.4% black; 28% Hispanic) were recruited during a prenatal visit to complete a survey. Women indicated limited understanding of the association between breastfeeding and breast cancer risk reduction; less than 40% of black and white women indicated knowledge, while 64.7% of Hispanic women were aware of the association. These findings underscore the need for interventions to educate women about the protective benefits of breastfeeding as a strategy to reduce their breast cancer incidence and mortality.

Behavioural incentive interventions for health behaviour change in young people (5-18 years old): A systematic review and meta-analysis.

Physical inactivity, an unhealthy diet, smoking, and alcohol consumption are key determinants of morbidity and mortality. These health behaviours often begin at a young age and track into adulthood, emphasising a need for interventions in children and young people. Previous research has demonstrated the potential effectiveness of behavioural incentive (BI) interventions in adults. However, little is known about their effectiveness in children and adolescents. Eight bibliographic databases were searched. Eligibility criteria included controlled trials using behavioural incentives (rewards provided contingent on successful performance of the target behaviour) as an intervention component for health behaviour change in children and adolescents. Intervention effects (standardised mean differences or odds ratios) were calculated and pooled by health behaviour, using a random effects model. Twenty-two studies were included (of n = 8392 identified), 19 of which were eligible for meta-analysis: physical activity (n = 8); healthier eating (n = 3); and smoking (n = 8). There was strong evidence that behavioural incentives may encourage healthier eating behaviours, some evidence that behavioural incentives were effective for encouraging physical activity behaviour, and limited evidence to support the use of behavioural incentives for smoking cessation and prevention in adolescents. Findings suggest that behavioural incentives may encourage uptake and initiation of healthy eating and physical activity in young people. However, this is a limited evidence base and a wide range of incentive designs have yet to be explored. Future research should further investigate the acceptability of these intervention approaches for young people.

Low-dose computed tomography lung cancer screening as a teachable moment for smoking cessation among African American smokers: A feasibility study.

Low-dose computed tomography (LDCT) screening may be a teachable moment for smoking cessation among African Americans. African Americans have been understudied within the context of LDCT and smoking cessation. The study objective was to evaluate the feasibility of recruiting African Americans to a future longitudinal trial and to obtain sample size estimates for that trial. Participants (N = 18) were African Americans eligible for LDCT screening who completed a questionnaire at three time points. Self-efficacy and intention to quit smoking were compared. The results of the current study show that it is feasible to recruit African Americans eligible for LDCT.

Colonoscopy-specific fears in African Americans and Hispanics.

Although fears of colonoscopy may deter African Americans and Hispanics from having a screening colonoscopy, little is known about these fears. This study examined the proportion of African Americans and Hispanics who experience colonoscopy-specific fears and identified factors associated with these fears. Data were collected at an academic hospital in New York City between 2008-2010. African Americans (N = 383) and Hispanics (N = 407) who received a recommendation for a screening colonoscopy completed a questionnaire that assessed: colonoscopy-specific fears, demographics, and psychological variables. Presence of colonoscopy-specific fears was endorsed by 79.5% of participants. Being female (p < 0.001), speaking English (p < 0.001), having greater perceived risk of colorectal cancer (CRC) (p < 0.01), greater worry about risk of CRC (p < 0.01), greater fear of CRC (p < 0.001) and lower levels of self-efficacy of having a colonoscopy (p < 0.01) were associated with greater colonoscopy-specific fears. Results can inform interventions designed to assuage fears in African Americans and Hispanics.

Pre-biopsy psychological factors predict patient biopsy experience.

BACKGROUND: Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort). PURPOSE: The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy) and (b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes. METHODS: Fifty image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-tension/anxiety subscale and two visual analog scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two visual analog scale items (pain and physical discomfort at their worst during the procedure). RESULTS: The following results were gathered: (1) Pre-biopsy worry about the procedure was significantly related to both pain (r = 0.38, p = 0.006) and physical discomfort (r = 0.31, p = 0.026); (2) pre-biopsy general anxiety was significantly related to pain (r = 0.36, p = 0.009), but not to physical discomfort; and (3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort. CONCLUSIONS: Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences and who might benefit from brief interventions to reduce pre-biopsy worry.

The relationship between body image, age, and distress in women facing breast cancer surgery.

OBJECTIVES: Research suggests that the strength of the relationship between body image and emotional distress decreases with age. Past research has focused on expected aging-related body changes, and has not yet examined unexpected body changes (e.g., breast cancer surgery). The present post-hoc study assessed relationships between age, body image, and emotional distress in women facing breast cancer surgery. METHODS: Older (≥ 65 years, n = 40) and younger (<65 years, n = 40) women were matched on race/ethnicity, marital status, and surgery type. Within one week prior to surgery, participants completed measures of demographics, aspects of body image, and emotional distress (general and surgery-specific). RESULTS: Results indicated that: (1) body image did not differ by age (p > 0.999); (2) older women reported less pre-surgical emotional distress than younger women (p's < 0.01); and, (3) age moderated the relationship between body image and emotional distress (p's < 0.06). SIGNIFICANCE OF RESULTS: The results suggest that younger women, particularly those with poor body image, are at an increased risk for pre-surgical emotional distress. These women may benefit from pre-surgical interventions designed to improve body image or to reduce pre-surgical emotional distress.

Isolation and Flow Cytometry Analysis of Macrophages from the Kidney.

Renal macrophages help maintain homeostasis, participate in tissue injury and repair, and play a vital role in immune surveillance [1-3]. Kidney macrophages can be broken down into two subsets, infiltrating macrophages, which can be further broken down into Ly6Chi and Ly6Clo cells, and kidney resident macrophages. While recent studies have shed light on the differing origins and niches of these cells, a more thorough understanding of kidney macrophage populations and how they may respond to various conditions is needed. This protocol describes how to efficiently isolate murine kidney macrophage populations for flow cytometry analysis.

Macrophage Ontogeny, Phenotype, and Function in Ischemia Reperfusion-Induced Injury and Repair.

AKI is characterized by a sudden, and usually reversible, decline in kidney function. In mice, ischemia-reperfusion injury (IRI) is commonly used to model the pathophysiologic features of clinical AKI. Macrophages are a unifying feature of IRI as they regulate both the initial injury response as well as the long-term outcome following resolution of injury. Initially, macrophages in the kidney take on a proinflammatory phenotype characterized by the production of inflammatory cytokines, such as CCL2 (monocyte chemoattractant protein 1), IL-6, IL-1 ß , and TNF- α . Release of these proinflammatory cytokines leads to tissue damage. After resolution of the initial injury, macrophages take on a reparative role, aiding in tissue repair and restoration of kidney function. By contrast, failure to resolve the initial injury results in prolonged inflammatory macrophage accumulation and increased kidney damage, fibrosis, and the eventual development of CKD. Despite the extensive amount of literature that has ascribed these functions to M1/M2 macrophages, a recent paradigm shift in the macrophage field now defines macrophages on the basis of their ontological origin, namely monocyte-derived and tissue-resident macrophages. In this review, we focus on macrophage phenotype and function during IRI-induced injury, repair, and transition to CKD using both the classic (M1/M2) and novel (ontological origin) definition of kidney macrophages.

Multi-cancer early detection (MCED) tests: prioritizing equity from bench to bedside.

Multi-cancer early detection (MCED) tests are blood-based tests designed to screen for signals of multiple cancers. There is growing interest and investment in examining the potential benefits and applications of MCED tests. If MCED tests are shown to have clinical utility, it is important to ensure that all people-regardless of their demographic or socioeconomic background-equitably benefit from these tests. Unfortunately, with health care innovation, such considerations are often ignored until after inequities emerge. We urge for-profit companies, scientists, clinicians, payers, and government agencies to prioritize equity now-when MCEDs are still being developed and researched. In an effort to avoid creating and exacerbating cancer inequities, we propose 9 equity considerations for MCEDs.

Acceptability and usability of the Planning Advance Care Together (PACT) website for improving patients' engagement in advance care planning.

Objectives: Most prior advance care planning (ACP) interventions lack integration of the social context of patients' ACP process, which patients indicate is critically important. The current study developed the Planning Advance Care Together (PACT) website to foster inclusion of loved ones in the ACP process. Methods: To provide feedback about the PACT website, patients with advanced cancer (N = 11), their caregivers (N = 11), and experts (N = 10) participated in semi-structured interviews. Patients and caregivers also completed standardized ratings of acceptability and usability. Results: Overall, patient (n = 11) and caregiver (n = 11) ratings of acceptability and usability of the website exceeded benchmark cut-offs (≥24 on the Acceptability E-Scale and ≥ 68 on the System Usability Scale). Patients, caregivers, and experts liked the topic of ACP but felt that it could be emotionally challenging. They recommended focusing more on planning and less on end of life. They appreciated being able to include loved ones and recommended adding resources for caregivers. Conclusions: Study findings support the preliminary usability and acceptability of the PACT website. Findings will be used to inform a modified prototype of the PACT website that is interactive and ready for field testing with patients with advanced cancer and their loved ones. Innovation: We utilized a novel application of the shared mind framework to support patients with advanced cancer in engaging their loved ones in the ACP process.

The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing.

BACKGROUND: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. OBJECTIVE: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. METHODS: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a "think aloud" exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. RESULTS: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. CONCLUSIONS: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs.

Protective role for kidney TREM2high macrophages in obesity- and diabetes-induced kidney injury.

Diabetic kidney disease (DKD), the most common cause of kidney failure, is a frequent complication of diabetes and obesity, and yet to date, treatments to halt its progression are lacking. We analyze kidney single-cell transcriptomic profiles from DKD patients and two DKD mouse models at multiple time points along disease progression-high-fat diet (HFD)-fed mice aged to 90-100 weeks and BTBR ob/ob mice (a genetic model)-and report an expanding population of macrophages with high expression of triggering receptor expressed on myeloid cells 2 (TREM2) in HFD-fed mice. TREM2high macrophages are enriched in obese and diabetic patients, in contrast to hypertensive patients or healthy controls in an independent validation cohort. Trem2 knockout mice on an HFD have worsening kidney filter damage and increased tubular epithelial cell injury, all signs of worsening DKD. Together, our studies suggest that strategies to enhance kidney TREM2high macrophages may provide therapeutic benefits for DKD.

Identifying Frequently Endorsed Benefits and Barriers to Breast Cancer Screening for African-Born Women in the NYC Metropolitan Area: a Pilot Study.

Most cancer screening data report on Black participants without distinguishing nativity, limiting our understanding of the needs of distinct groups within the African diaspora. The purpose of this pilot study was to assess demographic characteristics and perceptions of the benefits of and barriers to mammography among African immigrant women in New York City (NYC). Forty-two women who were 40 years or older, born in Africa, and English and/or French-speaking were recruited from African immigrant communities in NYC to complete a survey. Eighty percent of our sample aged 50 to 73 was adherent to the 2016 USPSTF mammography screening guideline. The most frequently endorsed benefits were that mammography will help find breast cancer early, could help find a breast lump before it is big enough to feel, and that if found early, breast cancer could be successfully treated. The most endorsed barriers were that having a mammogram is painful and that lack of insurance or being treated rudely at the mammogram center would keep participants from having a mammogram. Chi-square analyses assessed relationships between demographic characteristics and perceptions about mammography and revealed that endorsement of barriers to screening (e.g., health issues, transportation problems, pain, and time associated with mammography) varied by educational attainment. Findings suggest that future interventions should be multi-level and (1) support patients in accessing screening via resource sharing, (2) address other commonly cited barriers such as fear of pain during the procedure, and (3) support anti-racist healthcare environments especially in terms of treatment by providers.