Petersen, Wesley O.

Abstract Purpose:: “No Squeeze Can Defeat Me: Mammograms for Life!” (locally, “My Life Matters: Mammograms for Life!”) was funded 2016-2019 by the Minnesota State Department of Health. It implemented a low-cost, low-tech intervention that used theory-based messaging to increase tribal women’s participation in annual mammograms and their adherence to local screening guidelines. Messaging was grounded in elements of theoretical models of health behavior that our previous research showed significantly differentiated adherent women from non-adherent women. Procedures: An 8-member tribal Community Advisory Project Board, including a 3-person Project Implementation Team, guided and carried out the intervention. The team developed and distributed 48 unique posters and placed 4-5 new posters every 6-8 weeks in 82 locations across four reservation communities. A convenience sample of women evaluated the posters. Posters had varied messages that were shaped by at least one influential element and theoretical model (e.g., Perceived Benefit from the Health Beliefs Model). 84% of displayed posters contained images of adherent tribal women. Pairwise associations of survey variables were examined using Fisher’s exact tests. Results: 229 women evaluated posters (32% under the age of 40, 64% between 40-70 years, 4% older than 70). Approximately 80% of women age 40 and older reported having at least one mammogram in their lifetime. 71% of all women said they learned something new. 96% of women said messages were personally important and 99% thought them important for other women. Of women finding the messages personally important, 99% were greater than age 40 compared to 90% who were less than age 40 (p=0.002). In those reporting they learned something new, 98% were greater than age 40 compared to 91% who were less than 40 (p=0.05). 97% of women said they would continue reading the messages when new ones were posted, underscoring the interest raised by the intervention. 164 women reported recognizing women featured on a poster. Of these, 77% said that recognition made the poster more interesting; only 2 said it made the poster less interesting. When asked if they would be more or less willing to get a mammogram if they knew others got one every year, 63% of women said they would get one regardless, 34% would be more willing, less than 1% would be less willing, and 3% said they would not get a mammogram regardless. Conclusions: Overall, women very positively regarded the posters. The sample was diverse by age, with almost one-third not yet age-eligible for screening. Across all ages and screening histories, a great majority of women agreed: 1) the posters were personally important and important for others; 2) were interested in seeing additional posters; and 3) appreciated seeing photos of adherent women on them. With 34% of viewers being more inclined to get mammograms upon knowing of others who had them, increases in monthly mammograms may be expected. Citation Format: Ann Nicometo, Robert A. Vierkant, Wesley O. Petersen. A tribal-academic multi-theory-driven messaging intervention to increase mammography participation is well-received by community women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B018.

Abstract Purpose: The “No Squeeze Can Defeat Me: Mammograms for Life!” study is locally known as “My Life Matters: Mammograms for Life!” and is funded by the Minnesota Department of Health. The intervention's purpose with one Midwest tribe is to increase American Indian women's regular participation in yearly mammographic screening beginning at age 40. At study initiation, mid-year 2016, adherence with annual screening guidelines stood at 36% for women 40 and older. Using previous work that significantly differentiated nonadherent women from adherent women, we are working with tribal health and the Indian Health Service partners to utilize differentiating theoretical models and elements of those models in an attempt to increase screening and adherence through poster messaging. Posters incorporated six elements of the Health Beliefs Model, two components of the Social Norms and Social Support Models, and three features of the Theory of Planned Behavior model. Multiple elements or features of each model are employed in the poster messaging. Procedures: No Squeeze works through a Community Advisory Project Board (CAPB) and a Project Implementation Team (PIT) consisting of tribal health, Indian Health Service, and community members of varied ages, screening status, and cancer history status. CAPB members take the lead on all decisions regarding messaging, message placement, frequency of new message placements, messaging evaluation and radiology performance figures. The PIT is responsible for executing CAPB decisions. Mayo Clinic is responsible for development of poster messages and data analysis. Evaluation of the intervention considers changes in screening participation and no-show (unfilled scheduled appointments) rates and collection and analysis of community women's evaluations of posted messages. The intermediate analysis takes into account comparable months from July-June of 2016/17 and 2017/18. Analysis is primarily descriptive. Where appropriate, chi-square statistics are calculated. Results: In the first half of each of the two years of the intervention (2017 and 2018), the average number of mammograms increased by 8 and 10, respectively, over an average of 36 at baseline (2016). In the same period, monthly no-show mammogram appointment rates decreased from an average of 47% to 39%. Community women's poster evaluations indicate that messages are likely to contribute to increased mammogram screening (p = <0.004). Among notable evaluation findings: Women of all ages like the posters and will continue to read them. They find the messages personally important and important to other women of the tribe. Use of community women's images in the posters adds interest in the posters and has a positive effect on women's future screening (p = 0.0002). Conclusions: To date, poster messaging appears to be associated with increased screening, decreased no-show rates and community receptiveness. Further study will be necessary to determine whether it can be employed with other tribes. Citation Format: Wesley Petersen, Ann Nicometo, Robert A. Vierkant. Impact of a multi-theory-driven community-based intervention to increase mammographic screening in a Midwest American Indian tribe [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B094.

Purpose: Develop and evaluate a mammography intervention that provides hope about cancer prevention and treatment. Design: Pilot randomized controlled trial. Setting: Two communities on the Navajo Nation. Participants: Navajo women and support persons. Intervention: Both groups received standard care: one home visit discussing mammography pros/cons and barriers. The treatment group received an intervention based on Navajo language via an additional home visit with health education materials (written and oral) in English and Navajo, including a Navajo Cancer Glossary with a new descriptive phrase for cancer. Analysis: Between control and intervention conditions, we compared baseline sociodemographics; changes from baseline to 3 months on mammography completion and breast cancer literacy scores. Measures: (1) intervention feasibility; (2) self- and clinic-reported mammography screening completion; (3) breast cancer literacy. Results: A total of 25 participants were randomly assigned (13 treatment, 12 control), with 7 support persons in each arm. Mean age was 53 years, 90% had a high school degree or higher, 86% spoke Navajo and English. At 3 months, 44% had a clinically verified mammogram. Mammography completion was 57% among those with a support person and 27% among those without ( P = .14). Intervention women reported more breast cancer beliefs consistent with mammography ( P = .015). Conclusions: Increases in breast cancer beliefs consistent with mammography show promise. Findings highlight a need to tailor education materials to Navajo culture/language and focus on enhancing support.

Abstract Purpose: To increase women's adherence with one tribe's mammographic screening guidelines. This tribe recommends annual mammograms beginning at age 40. Currently, adherence stands at 36%. Our previous work identified a demographic feature and variables within four theoretical models of health behavior that significantly differentiated nonadherent women from adherent women. In “No Squeeze Can Defeat Me: Mammograms for Life!” (No Squeeze) we are developing a messaging menu (e.g., posters, pamphlets, videos, digital stories, articles, and letters) that is guided by the differentiating variables and features. The program also is developing a supplement to an existing intake form for women to complete before they see their providers for annual Well Woman exams. The supplement intake form will help providers tailor face-to-face messages to encourage screening of known nonscreeners, known nonadherent screeners, and women approaching screening age. Procedures: This program works through a Community Advisory Project Board (CAPB) consisting of tribal health, Indian Health Service, and community members of varied ages, screening status, and cancer history status. The CAPB members take the lead on all aspects of messaging and intake form design. In their role, they have designed a logo, determined wording and design of posters; identified locations for messaging; recruited community women for video interviews and use of their images on materials; determined incentive amounts; and delegated tasks to a project implementation team (PIT) made of tribal and IHS staff. PIT members' responsibilities include posting new messages every six to eight weeks, obtaining feedback on messaging and intake forms, implementing the intake form, and organizing video interviews and photographic sessions. At this time, effort is being devoted to poster development, placement, and a refreshment schedule and to final design of intake forms. Evaluation of progress on this project involves collection and analysis of community women's surveys related to messaging and intake forms, CAPB feedback on messaging, documentation of poster placements and refresh dates, and tracking changes in screening participation. First-year analysis covers a seven-month period ending on June 30, 2017. Data Summary: Early analysis shows that: 1) community women find poster messaging generally interesting, appealing, important, and mostly persuasive. They prefer images of community women and favor fewer words in most messages. 2) The intake form supplement is easy to answer (little time to complete), appropriate as an addition to the existing Well Woman intake questions, and noninvasive. The questions were considered reasonable and women held mixed opinions regarding whether the form should be self-administered or filled in during an interview by a nurse. The CAPB assessments of messaging showed 19 of 78 posters were recommended for some revision and 10 posters were not liked at all. In general, wording was not offensive and more than half of the posters conveyed the central message in the fewest words possible. Half of the posters were rated visually attractive. As of the first poster placement period, 5 posters have been placed in two of three targeted communities and in 38 individual locations, including clinic/hospitals, post office and grocery store bulletin boards, an exercise facility, and in one casino. Between January 2017 and April 2017, radiology reported a 19% increase in screening. Conclusions: While these data are from the early period of implementation, results show that developing messages and intake forms focused on influential variables derived from demographic and theoretical models of health behavior are generally well received by the community and with continued refinement could result in sustained increases in screening. At this point we cannot discern whether documented increases are from the existing population of nonadherent screeners. Citation Format: Wesley O. Petersen, Ann M. Nicometo, Robert A. Vierkant. Launch of an intervention to improve mammographic screening adherence in women of one Bemidji Area tribe: The “No squeeze can defeat me: Mammograms for life!” project [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C86.

Abstract Purpose: To identify within demographic features and theoretical models of health behavior, the variables demonstrating differences in the behaviors, beliefs, attitudes, associations, and capacities of sporadic (non-adherent) and persistent (adherent) mammographic screeners for the purpose of guiding future interventions to improve mammographic screening adherence. Procedures: A survey was designed and mailed to all screening-age women of one Bemidji Area tribe. The survey incorporated demographic questions, and questions designed to inform about salient features of respondents' health literacy, social networks, social support, social norms, planned behavior, and health beliefs. Prior to mailing, each survey was assigned a unique identifier and sealed in an envelope. Surveys were mailed to 1,554 women in manner that ensured anonymity of the women's responses and no potential for investigators to discern women's identity via their mailing addresses or other information. Self-report data from returned surveys was used to determine women's mammographic screening status as adherent with local screening guidelines (annual mammogram beginning at age 40 for women at average risk) or non-adherent. Responses for all demographic and theoretical models of health behavior were appropriately categorized and analyzed utilizing global tests of hypotheses. Inherent multicollinearity issues required a two-step process of factor analysis followed by a multivariate analysis of variance. Where themes (e.g., demographics, health literacy, etc.) and factors within themes were significant, a univariate analysis was conducted to ascertain specific questions and responses that significantly differentiated the non-adherent from adherent screeners. Summary of data: We found no significant differences in non-adherent and adherent screeners' responses to questions related to social networks or social norms. We did find that responses from these two groups did differ on demographic features as well as on aspects of health literacy, social support, planned behavior and health beliefs. o Demographic differences involved biopsy histories and employment status. o Differentiating health literacy variables involved recognition of certain terms (e.g., annual) and understanding concepts such as ultrasound and biopsy. o Social support variables that distinguished non-adherent from adherent screeners involved sources of information support, characteristics of providers of emotional support, and sources of emotional support (e.g., solitary or communal). o Planned behavior variables illuminating differences between the screening groups involved (in additions to self-reported screening behaviors): attitudes toward the behavior of obtaining mammograms, intentions to engage in screening, and control beliefs. o Health Beliefs variables distinguishing the two sets of screeners comprised responses to questions about perceived barriers, self-efficacy, and cues to action. Conclusions: Study findings point to opportunities for tribal health and Indian Health Service (IHS) providers and staff to intervene in two broad areas. 1. Some findings associated with social support, planned behavior, and health beliefs can be used to design patient intake forms to alert tribal health and IHS providers to current and potentially non-adherent. 2. Using this information, providers can design interventions to move non-adherent and potentially non-adherent women toward persistent mammographic screening participation. An intervention study will be funded by the Minnesota Department of Health through its Eliminating Health Disparities Initiative. Citation Format: Wesley O. Petersen, Ann M. Nicometo, Robert A. Vierkant, Corinna Sabaque. Elements of theoretical models of health behavior: Planning for breast cancer screening interventions in an American Indian tribe. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B83.

Abstract Purpose: American Indian (AI) women have lower rates of cancer, but later stages of diagnosis and higher mortality than the US general population. We hypothesized that mediators found within different theoretical models of health behavior differentiate women who adhere to mammographic screening guidelines from those who do not. Such mediators may be useful in the design of interventions to increase adherence. Experimental Procedures: As a community-based participatory research project, tribal health, Indian Health Service representatives, and community representatives worked with the Mayo Clinic team to design a survey derived from 53 interviews with documented adherent and non-adherent women from one Bemidji Area tribe. The survey explored demographic characteristics and six theoretical mediators: Health Literacy, Social Networks, Planned Behavior, Social Norms, Social Support, and Health Beliefs. The survey was mailed to 1200 women with the goal of obtaining 600 responses. Women completing the survey were provided a modest gift card through an impartial third party who not know their names or responses. Responses were analyzed using Fisher's Exact Test or the Chi-square test where appropriate. Summary of Data: To date, we have achieved a 30% response rate (91 self-described non-adherent and 91 self-described adherent breast cancer screening (mammography) respondents). Mediators from the six theoretical models and demographic features do differentiate AI adherent and non-adherent screeners and may be useful for developing interventions to expand screening adherence. Among significant differences were the following with which adherence associates: (1) Demographic (≤0.01): being married, full-time employed, living at greater distances from health care facility, surgical menopause, and having had a breast biopsy. (2) Health Literacy (≤ 0.001): accurate conceptual understanding of annual mammogram, ultrasound, and family history as a risk factor. (To accommodate the survey format, we replaced the usual measures of health literacy (Short Test of Functional Health Literacy and Rapid Estimate of Adult Literacy in Medicine) for understanding of basic breast screening and breast cancer concepts.) (3) Social Networks (≤ 0.03): having mothers who have encouraged good health. (4) Planned Behavior (≤ 0.001): behavioral beliefs, and intentions. a.) Behavioral Beliefs : looking forward to getting my mammogram; getting my scheduled mammogram rather than accepting an invitation to be with friends; viewing my mammogram as very important. b) Intentions: expecting to screen in each of the next five years, and getting my next mammogram when it is scheduled. (5) Social Norms (≤ 0.001): role of family as a positive influence on my life. (6) Social Support (≤ 0.001): availability of family to comfort one in times of worry. (7) Health Beliefs (≤ 0.001): discounting physical limitations and exam discomfort as justifications for avoiding screening and believing there are no justifications for avoiding mammogram; knowing: how to prepare for a mammogram, what happens during the mammogram process, knowing a mammograms importance, knowing what to do if one feels something unusual in the breast, and knowing someone who has been diagnosed with breast cancer. Conclusions: No single theoretical model appears to differentiate adherent from non-adherent screeners, but mediators associated with each of the various models do differentiate these screeners. These differentiating mediators should be considered for how they might guide development of interventions to improve screening behavior. The self-report nature of the survey demands that results be considered as tentative and limited, in any case, to the respondents of this tribe. Citation Format: Wesley O. Petersen, Ann M. Nicometo, Corinna Sabaque. Do demographic characteristics and theoretical mediators of health behavior differentiate American Indian adherent mammographic screeners from non-adherent screeners? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B98.

Abstract Purpose: Low breast cancer screening participation and adherence to guidelines is problematic. Our prior work found that on average 18% of women from four tribes adhered to Indian Health Service (IHS) mammographic screening guidelines over five years (study funded by Native American Research Centers for Health (NARCH IV). We sought to identify how adherent (persistent) and non-adherent (sporadic) screeners may differ by demographic and theoretical mediators that have successfully guided interventions in other health disparities populations. As part of planning interventions to increase AI/AN women's persistent screening, we characterized differences in persistent and sporadic screeners' responses to Social Norms and Health Beliefs in the context of social networks. Methods: From 2013-2014, we interviewed 55 recruited women (41 sporadic screeners and 14 persistent screeners) who had been randomly assigned unique identifiers. Data from interviews included demographic characteristics, assessments of health literacy, and social relationships from theoretical perspectives of: Theory of Planned Behavior, Social Support, Social Norms, Health Beliefs, and Social Networks. In this study, we examined areas that distinguished persistent from sporadic screeners—social norms and health beliefs--and we conceptualized the make-up of screeners' social networks to consider members by their generational status relative to the screener. We coded and categorized data; Fisher's Exact Test and Kruskal-Wallis Test were applied as appropriate. Results: We identified three mediators with four significant differences. 1. Social Norms: (A) Persistent screeners were significantly more likely to believe reservation women favored getting an annual mammogram while sporadic screeners were more likely to believe women were against getting annual mammograms (P = 0.03). Responses are consistent with Social Norms theory, but screeners' beliefs about friends' screening participation appear less consistent with the theory. (B) Persistent screeners by a large proportion believed friends obtained fewer mammograms than themselves while sporadic screeners had no prevailing view (P = 0.02). 2. Health Beliefs (susceptibility to breast cancer): (C) While sporadic screeners expressed considerable uncertainty about their susceptibility, persistent screeners expressed no uncertainty (P = 0.02). 3. Social Networks: (D) Examination of the generational membership of screeners' Social Networks showed that sporadic screeners' networks had significantly more members from generations younger than themselves compared to persistent screeners' networks ( P = 0.01). Conclusions: Screeners with younger social networks may in part be influenced to be sporadic screeners because they do not benefit from exposure to more mature and experienced individuals in their social networks. The excess of younger generation members in sporadic screeners' networks may expose them generally to people who do not screen (or have limited screening experience) due to age. This exposure would confirm for them that reservation women generally do not favor screening and would explain their mixed view of friends' screening behavior. The younger membership of sporadic screeners' networks also may explain why this group would express substantial uncertainty about their own susceptibility to breast cancer relative to other women. If the network is not of an age where breast cancer and screening are pertinent topics, screeners may not have a knowledgebase (accurate or not) from which to build their views. We anticipate further testing to ascertain the role of social networks in the views and behaviors of sporadic and persistent screeners before considering any interventions. Citation Format: Corinna Sabaque, Ann M. Nicometo, Robert Vierkant, Wesley O. Petersen. Do generational cohort differences in social networks influence persistent and sporadic screeners' perceptions of breast cancer screening? [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B73.

Abstract Purpose: The ultimate purpose of these studies and the proposed study is to use community-based interventions to increase overall use of mammographic services and to increase adherence with tribes' screening guidelines. Our immediate purposes by study: For Study 1, the purpose was to understand the risk and screening adherence profiles of women from four Bemidji Area tribes; for Study 2, the purpose was to ascertain whether non-adherent screeners and adherent screeners could be differentiated on any of six theoretical mediators of health behavior; in the proposed Study 3, the purpose is to use theoretical mediators that distinguish adherent and non-adherent screeners to design and test interventions to increase screening participation and adherence with tribes' screening guidelines. Experimental Procedures: All studies were designed to reflect principles of community-based participatory research. Study 1 was a chart review study that involved four tribes. Each tribe desired different levels of involvement that ranged from close control of all elements of the chart review to assigning the investigators to do the retrieval, review, and replacement of the medical records, and all elements of the analysis. All tribes managed the unique identifiers book which was a list of all women who were 40 years and older who had no prior history of breast cancer. Investigators retained only the unique identifiers and each individual's associated screening history and risk factors. Tribes received aggregated results from the study, but did not receive information on individual women's screening adherence or risk factors. Study 2, is guided by a community advisory committee that meets quarterly and involves one tribe. The study employs one tribal member and one tribal subcontractor, and has supported one student participant. The study team interviewed 55 women and used the results to develop a survey that is being administered to approximately 1400 women who are age 40 and older. Both the interviews and the survey are designed to examine the influence of six theoretical mediators (social norms, social networks, social support, health literacy, health beliefs, and theory of planned behavior) and demographic features on the behaviors of adherent and non-adherent mammographic screeners. Study 3 will involve four tribes and is designed to use the findings from Study 2 to develop and test interventions based on influential screening mediators. Each tribe has identified members who will serve on tribal research and advising units that will determine the specific interventions and receive training and mentoring to design and administer the interventions. The proposed interventions will be based on a case-control intervention design. Unpublished Data to Date: STUDY 1 showed that there were few significant differences (p = 0.05) based between adherent and non-adherent screeners based on risk factors. STUDY 2 interview results have shown some significant differences (p= 0.05) between adherent and non-adherent screeners related to self-efficacy (health beliefs model), perceived community support for annual mammograms (social norms), presence of 3rd degree relatives in social networks. There were no significant differences associated with health literacy, social support, and the theory of planned behavior. Conclusions: Findings in Study 2 show that potential differences between adherent and non-adherent screeners justify continuation to the survey phase. Should results of the survey demonstrate significant differences in the influential mediators of adherent compared to non-adherent screeners, follow-up with the intervention study (Study 3) will be an important next step. Citation Format: Wesley Petersen, Ann Nicometo, Robert Vierkant. Advancing toward interventions: Summary of two projects and a proposed intervention to improve mammography participation in Bemidji area native women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B91. doi:10.1158/1538-7755.DISP13-B91

Abstract Purpose: The study purpose is to learn whether theoretical mediators (Planned Behavior/Reasoned Action, Social Norms, Social Support, Social Networks, Health Beliefs, Health Literacy) can be used to distinguished American Indian women who are adherent with Indian Health Service (IHS) mammographic screening guidelines from those who are not adherent with these guidelines. Women in the Bemidji Area of the Indian Health Service have mammographic screening rates much lower than the IHS average for all IHS areas. Bemidji Area women are diagnosed at later stage and have higher mortality than is seen in the overall IHS. Our ultimate goal is to develop interventions to increase adherence among non-adherent screeners. Experimental procedures: In phase one, we have identified 64 women for interviews. Based on women's risk factors and screening histories, women were assigned to one of four groups: high risk/adherent, low risk/adherent, high risk/non-adherent, and low risk/non-adherent. Our goal is to have 16 women in each group. Currently, we have interviewed and conducted preliminary analysis of 19 women (4 higher risk/ adherent; 7 lower risk/non-adherent, 4 higher risk, non-adherent, 4 lower risk/adherent). Interview responses have been coded for themes, then categorized and descriptively quantified. Preliminary results: Adherent and non-adherent mammographic screeners can be differentiated by: 1) Theory of Planned Behavior (personal attitudes toward screening; perceived attitudes of family/friends and tribe toward annual screening; and past screening behavior). 2) Social Norms (perceptions of general health of respondents, family/friends, and tribe; health behaviors; barriers to screening; influences on attitudes and behaviors; healthy behaviors; health values; perceptions of common cancers among tribal members and women; the mammography experience; and influential members within social networks). 3) Social Support (emotional support for worry and fear and companionship. 4) Health Beliefs (susceptibility and severity of cancer). In other regards, these mediators and Health Literacy do not distinguish between adherent and non-adherent screeners. Conclusions: Theoretical mediators may be a useful way to distinguish between adherent and non-adherent screeners and point to potential avenues to intervene in the non-adherent population of American Indian women. Citation Format: Wesley Petersen, Ann M. Nicometo. Do theoretical mediators differentiate adherent and nonadherent American Indian mammographic screeners? Preliminary results from one tribe. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A32.