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Original Article
Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population†
Article first published online: 25 OCT 2004
DOI: 10.1002/cncr.20671
Copyright © 2004 American Cancer Society
Volume 101, Issue 11, pages 2650–2659, 1 December 2004
Additional Information
How to Cite
Paskett, E. D., Tatum, C., Rushing, J., Michielutte, R., Bell, R., Foley, K. L., Bittoni, M. and Dickinson, S. (2004), Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population. Cancer, 101: 2650–2659. doi: 10.1002/cncr.20671
- †
The views expressed herein do not necessarily reflect the opinions of the National Cancer Institute or the U.S. Government.
Publication History
- Issue published online: 16 NOV 2004
- Article first published online: 25 OCT 2004
- Manuscript Accepted: 18 AUG 2004
- Manuscript Revised: 15 JUL 2004
- Manuscript Received: 1 APR 2004
Funded by
- National Cancer Institute. Grant Numbers: CA72022-04, CA57707-08
- Abstract
- Article
- References
- Cited By
- racial differences;
- cancer screening;
- rural population;
- mammography
Low-income, minority, and rural women face a greater burden with regard to cancer-related morbidity and mortality and are usually underrepresented in cancer control research. The Robeson County Outreach, Screening and Education Project sought to increase mammography use among low-income, minority, and rural women age > 40 years. The current article reports on racial disparities and barriers to screening, especially those related to knowledge, attitudes, and behaviors.
A baseline survey was administered to 897 women age > 40 years who lived in rural Robeson County in North Carolina. The sample consisted of three principal racial groups: whites, African Americans, and Native Americans. Survey comparisons were made among racial groups with respect to knowledge, attitudes, and behaviors regarding breast and cervical carcinoma screening.
Overall, Native American and African-American women had lower levels of knowledge, more inaccurate beliefs, and more barriers to screening compared with white women. Among the notable findings were that 43% of the patient population did not mention mammograms and 53% did not mention Pap smears as breast and cervical carcinoma screening tests, respectively; furthermore, compared with white women, significantly fewer African-American and Native American women mentioned these tests (P < 0.001). Sixty-seven percent of all women reported that a physician had never encouraged them to receive a mammogram, although 75% reported having received a regular checkup in the preceding year.
Although all low-income rural women experienced significant barriers to receiving cancer screening tests, these barriers were more common for minority women compared with white women. More research is needed to identify ways to overcome such barriers, especially among Native American women. The results of the current study have important implications with respect to the designing of interventions aimed at improving cancer screening for all women. Cancer 2004. © 2004 American Cancer Society.
The American Cancer Society estimates that there were 211,300 new breast carcinoma cases and 39,800 deaths due to breast carcinoma among women in the United States during 2003.1 Despite increases in early detection and improved treatment, breast carcinoma mortality rates have remained relatively stable for the past 50 years, with a slight decrease (2.3%) occurring between 1999 and 2000.2 Women of lower socioeconomic status (SES), compared with women of higher SES, have a lower incidence of breast carcinoma but experience higher mortality rates, mainly due to a higher prevalence of late-stage tumors at diagnosis.3
Early detection of small, curable lesions has been shown to reduce breast carcinoma morbidity and mortality rates. The use of clinical breast examination (CBE) and mammography has been demonstrated to reduce breast carcinoma mortality rates by up to 30% in women age ≥ 50 years4–6 and women age > 40 years.7–10 Although screening mammography usage rates have improved over the last several years, estimates indicate that only 41% of women age ≥ 50 years (approximately half of the national goal of 80%) undergo annual mammography.11, 12 In addition, minority women, older women, and women with low SES have had poorer mammography usage rates.13
With regard to minority populations, African-American women have lower breast carcinoma screening examination usage rates and higher breast carcinoma mortality rates compared with white women. Reasons for these differences are believed to include lack of insurance, lack of a regular source of health care, communication barriers, poverty, and late stage of disease at diagnosis.1, 14–17 In North Carolina, racial differences in screening and mortality rates are believed to be even more pronounced among rural women, because these women are more likely to be poor. Data from a study conducted in 2 rural eastern North Carolina counties found that white women ages 50–74 years were twice as likely to have ever had a mammogram compared with African-American women of similar age (54% vs. 27%).18 Even among these rural white women, screening rates are slightly lower than national estimates.
Studies have demonstrated that Native Americans exhibit the poorest cancer screening rates of any racial group in the United States. Dignan et al.19 reported that 33% of rural, non-reservation-dwelling Native American women (Lumbees from Robeson County, NC) had not undergone a Papanicolaou (Pap) smear in the preceding year. Among Southwestern American Indian women age > 40 years, 61% reportedly received a yearly CBE, only 45% had ever received a mammogram, and only 26% had received a mammogram in the preceding 2 years.20
The goal of the Robeson County Outreach, Screening and Education (ROSE) Project was to improve breast carcinoma screening in specific population groups—namely, rural, white, African-American, and Native American women who were traditionally underserved by cancer control efforts and services. The current study was designed to assess the effects that an individualized health education intervention delivered to three racial groups had on mammography use. The purpose of the current study was to describe the baseline characteristics of the study population, with a focus on differences among the three racial groups in terms of knowledge, beliefs, and behaviors related to cancer screening.
Robeson County, a rural county in southeastern North Carolina, has a population of 123,339,21 and it contains the largest concentrated Native American population east of the Mississippi River. There are 3 primary racial groups in the county: Native Americans (population, 46,896 [38%]), most of whom are Lumbees; African Americans (population, 30,973 [25%]); and whites (population, 40,460 [33%]). Hispanics and Asians/Pacific Islanders account for the remaining 4% of the population. The county is 80% rural and had the eighth highest statewide poverty rate (24.7%, compared with 13% for the state overall) at the time of the study.21 In addition, the unemployment rate of 7.5% was 2.4 percentage points higher than the state unemployment rate and 0.8 percentage points higher than the national rate, and fewer than one-half of all adults in the county were high school graduates. Due to the lack of a countywide public transportation system, access to health care was limited for Robeson County residents. As a result, morbidity and mortality rates were higher than overall state rates for many diseases.
Robeson Health Care Corporation (RHCC), a major health care provider in Robeson County, administers four sites. Collectively, RHCC served approximately 12,778 patients in 1996. RHCC clients represented the 3 largest racial groups within Robeson County: 15% were white, 26% were African American, and 59% were Native American (1996 data). Approximately 68% were women, 51% of whom were 15–44 years old. The majority (63%) of RHCC clients had incomes below the poverty level, compared with 24% of the Robeson County population. One-third of all RHCC users had no health insurance, and another 32% were covered by Medicaid. Noninsured patients received services based on a sliding scale schedule.
Sample Selection
Women were selected randomly from a list of RHCC patients age > 40 years. To be eligible, women were required to have been RHCC clients for at least 2 years before chart review. A total of 2954 women were selected randomly for review. To be enrolled in the study, a woman had to be in need of a mammogram (i.e., she had not received a mammogram in the previous 12 months) as of the date of her chart review. For each potential participant, Lumberton Radiology Associates (Lumberton, NC), the main mammography facility in the study area, was contacted to ascertain whether a mammogram had recently been obtained. A total of 1503 (51%) women were identified as being eligible to participate in the trial.
The primary care physician for each identified eligible patient was sent a letter stating that the patient had been selected to participate in the ROSE Project and asking whether the physician had any objections. If no objection was received after 1 week, the woman was sent a recruitment letter from the medical director of the RHCC. The letter described the study and informed the woman that an interviewer would contact her within the next few days. A trained study interviewer from the community contacted each woman for a telephone screening interview. If a contacted patient was eligible and willing, an in-person visit was arranged to obtain informed consent and to complete the baseline interview. Women were then randomized to either the lay health educator group (i.e., the intervention group) or the comparison group. As an incentive and as a token of appreciation for completing the survey, each woman received a $10.00 grocery store gift certificate.
After the telephone screening interview, 353 women were deemed ineligible to participate (i.e., they had moved, were deceased, or were mentally/physically unable). Of the remaining 1150 women, 1022 (89%) were contacted. Of these 1022 women, 901 were interviewed and randomized, for a response rate of 88%. The remaining 121 women refused to participate.
As a quality-control measure, 10% of all participants were recontacted by phone to verify the interviewer's visit and survey status, and no problems were reported. All women received their usual medical care from RHCC, regardless of their status in the project. The study was approved by the institutional review boards at the Wake Forest University School of Medicine (Winston-Salem, NC) and The Ohio State University (Columbus, OH).
Statistical Analysis
After randomization, 4 women were found to have received a mammogram and were not included in the study, leaving 897 women to be randomized to 1 of the 2 study groups. Of these, 453 were placed in the intervention group, and 444 were placed in the comparison group. Because there were no differences between groups in terms of any of the baseline variables, treatment group was not included as a factor in the analysis. The sample consisted of 295 African-American women, 371 Native American women, 226 white women, and 5 women who were classified as being multiracial. The five multiracial participants were excluded from the analyses so as to provide large cell counts and so that the study would focus on the three primary racial groups of interest. Thus, data from 892 women were analyzed in the current study.
Women in each racial group were compared with regard to demographics, cancer screening habits, breast carcinoma risk factors, and mammography adherence, as well as with regard to barriers to and beliefs and knowledge regarding cancer screening. Two-sided chi-square tests were used to evaluate the association between each categoric variable and race. If a significant relation was found (α = 0.05), then pairwise comparisons were conducted to assess the specific differences among racial groups. Significance levels for these comparisons were interpreted according to the Bonferroni correction for multiple comparisons.22 A significance level of P = 0.0167 (0.05/3) for each of the 3 comparisons provided an overall type I error rate of 0.05. Analysis of variance was used to assess age differences across racial groups. All analyses were performed using SAS statistical software (Version 8.2; SAS Institute, Cary, NC).23
Demographic data for the 892 women who completed the baseline survey are summarized in Table 1. Women ages 40–49 years represented the largest age group in the current study (42%); another 27% of all participants were 50–59 years old, and 30% were ≥ 60 years old. There was a statistically significant difference in age across racial groups (P = 0.016). White women had a higher average age (57.2 years) compared with both African-American women (54.5 years; P = 0.009) and Native American women (54.7 years; P = 0.012).
|% of patients
|P valueb
|African American (n = 295)
|Native American (n = 371)
|White (n = 226)
|All (n = 892)
|Age (yrs)
|0.016 (African American vs. Native American 0.051; African American vs. white 0.037)
|Mean (SD)
|54.5 (11.6)
|54.7 (10.7)
|57.2 (12.0)
|55.3 (11.4)
|0.016 (African American vs. white 0.009; Native American vs. white 0.012)
|Less than high school graduate
|0.002 (African American vs. Native American 0.001; Native American vs. white 0.044)
|High school graduate
|Some college/college graduate
|Work status
|Work full-time/part-time
|Highest SESa
|15 (43/292)
|15 (55/370)
|24 (53/219)
|17 (151/881)
|0.006 (African American vs. white 0.007; Native American vs. white 0.005)
|Marital status
|Married/living together
|< 0.001 (African American vs. Native American < 0.001; African American vs. white < 0.001; Native American vs. white 0.014)
|Never married
|0.012 (African American vs. white 0.014; Native American vs. white 0.004)
|No private insurance
The data in Table 1 also show that white women were significantly more likely to report having private health insurance (45%) compared with African-American women (34%; P = 0.014) and Native American women (32%; P = 0.004). White women also were more likely (24%) to be in the highest SES group (private insurance, high school graduate, and household income > $20,000 per year) compared with African-American women (15%; P = 0.007) and Native American women (15%; P = 0.005).
Approximately 44% of the sample reported receiving less than a high school education, with Native Americans (51%) differing significantly from both whites (41%; P = 0.044) and African Americans (38%; P = 0.001) in terms of this characteristic. Although there were no significant racial differences in employment status, significant differences in terms of marital status were documented (P < 0.001). White women were more likely to be married or living with a partner (54%) and less likely to have never been married (2%) compared with all other participants. In addition, compared with African Americans, Native Americans were more likely to be currently married or living with a partner (50% vs. 35%) and less likely to have never been married (7% vs. 15%).
Women were asked about breast and cervical carcinoma screening awareness and behaviors. Although, due to study eligibility requirements, all women were in need of a mammogram, information regarding previous screening was obtained. When asked to name a breast carcinoma screening test, 43% of all women did not mention mammography (data not shown); compared with African-American (54%; P < 0.001) and Native American women (52%; P < 0.001), significantly more white women (70%) did mention mammography in response to this question. Before asking about previous mammography use, the study interviewer carefully explained what a mammogram was. The data in Table 2 show that approximately one-fourth of all participants had never received a mammogram (24%) and that there were significant differences in previous mammography use by racial group (P = 0.003). Compared with Native American (19%; P < 0.001) and white women (26%; P = 0.054), a larger proportion of African-American women (28%) had never received a mammogram. Greater than one-half of all women (58%) had received a mammogram within the preceding 3 years. In addition, one-half of all women reported having received a CBE within the preceding year, and 43% reported having received a CBE > 1 year before the time of the survey, with no significant differences observed across the 3 racial groups.
|% of patients
|P valuea
|African American (n = 295)
|Native American (n = 371)
|White (n = 226)
|All (n = 892)
|0.003 (African American vs. white 0.054; African American vs. Native American < 0.001)
|Within last 3 yrs
|> 3 yrs ago
|Pap test
|Within last 3 yrs
|> 3 yrs ago
|Clinical breast examination
|Within last yr
|> 1 yr ago
Fewer than one-half of all participants (47%) mentioned the Pap smear as a cervical carcinoma screening test (data not shown), although more white women (60%) than African-American women (42%; P < 0.001) or Native American women (42%; P < 0.001) did mention this screening technique. After the interviewers explained what a Pap smear was, almost all of the women (98%) reported having received a Pap smear, with 81% reporting having received one within the preceding 3 years (Table 2). There were no significant differences by race in terms of Pap smear use.
Table 3 presents information on breast carcinoma risk factors. Only 2% of all participants had reportedly been treated for colon, ovarian, or breast carcinoma. Approximately 21% of them— 27% of all white women, 21% of all Native American women, and 16% of all African-American women (P = 0.023 overall; P = 0.006 for white vs. African-American women)—reported having a family history of breast carcinoma in a first-degree relative. Only 11% of all women reported never having given birth or reported a late age at first birth. Thirty percent of the participants were current smokers, and there were no significant differences across racial groups in terms of current smoking status.
|% of patients
|P valueb
|African American (n = 295)
|Native American (n = 371)
|White (n = 226)
|All (n = 892)
|Ever treated for cancer (colon, ovarian, or breast)
|Family history of breast carcinoma
|16 (47/285)
|21 (74/358)
|27 (55/206)
|21 (176/849)
|0.023 (African American vs. white 0.006)
|Early age at menarche (< 12 yrs)a
|15 (40/264)
|15 (51/336)
|16 (31/190)
|15 (122/790)
|Nulliparity/late age at first birth
Data on barriers to and beliefs and knowledge regarding mammography use are summarized in Tables 4–6. Overall, 23% of women reported having insufficient time to receive a mammogram, and there were statistically significant differences across racial groups (P = 0.003). White women were more likely to report experiencing this barrier than were African-American women (30% vs. 17%; P < 0.001) or Native American women (30% vs. 24%; P = 0.035). Approximately 27% of women reported not wanting to receive a mammogram at an institution other than the institution at which they received medical care. Only 10% of women did not know where to go to receive a mammogram. Two-thirds of women reported that they had not been "encouraged by a physician to get a mammogram" (as stated in the survey), despite the fact that 75% of them reported having had a regular checkup within the preceding 12 months (data not shown). African Americans were the most likely to receive checkups (81%), whereas Native Americans were the least likely (69%; P < 0.001; data not shown). Among women who had ever received a mammogram, 29% reported receiving one without being instructed to do so by a physician. Relatively few women (13%) reported having asked a physician to order a mammogram. Differences across racial groups were noted (P = 0.009) in terms of the proportion of women reporting that they had never been encouraged by anyone to receive a mammogram (overall proportion, 45%); fewer African-American women (48%) had ever been encouraged to receive a mammogram compared with white (62%; P = 0.002) and Native American women (56%; P = 0.070). In most cases, the encouragement was reported to have come from a physician, a family member, or a friend.
|% of patients
|P valuec
|African American (n = 295)
|Native American (n = 371)
|White (n = 226)
|All (n = 892)
|Too hard to find time
|0.003 (African American vs. white < 0.001; African American vs. Native American 0.035)
|Would rather not receive mammogram at different placea
|28 (75/270)
|29 (100/348)
|24 (51/216)
|27 (227/834)
|Unaware of where to go to receive mammograma
|10 (30/287)
|11 (38/360)
|8 (17/220)
|10 (85/867)
|Physician did not encourage mammography
|Ever had mammogram without physician ordering it?ab
|29 (63/214)
|29 (87/300)
|27 (46/168)
|29 (196/682)
|Ever asked physician to order mammogram?
|Ever been encouraged by someone to receive a mammogram?
|0.009 (African American vs. white 0.002)
|No insurance
|0.016 (Native American vs. white 0.005)
|Never heard of BCCDP
|% of patients who agreed
|P valuec
|African American (n = 295)
|Native American (n = 371)
|White (n = 226)
|All (n = 892)
|Too embarrassing to receive a mammograma
|13 (37/287)
|27 (99/364)
|30 (66/219)
|23 (202/370)
|< 0.001 (African American vs. white < 0.001; African American vs. Native American < 0.001)
|Radiation from mammogram can cause cancera
|16 (33/203)
|19 (50/260)
|15 (25/170)
|17 (108/633)
|Mammogram is painfula
|33 (71/216)
|39 (116/300)
|40 (68/169)
|37 (255/685)
|I feel healthy—why bother receiving mammogram?
|Self-rating of breast carcinoma risk:b
|Much lower or somewhat lower than average
|Somewhat or much higher than average
|Amount of concern about developing breast carcinoma
|< 0.001 (African American vs. Native 0.002; Native American vs. white 0.002)
|Slight or not at all
|% of patients who knew whether statement was true or false
|P valued
|African American (n = 295)
|Native American (n = 371)
|White (n = 226)
|All (n = 892)
|Women should begin receiving screening mammograms at age 40 yrsa
|Women should never stop receiving mammogramsb
|0.007 (African American vs. white 0.009; African American vs. Native American 0.006)
|Women should receive screening mammograms at least once yearly
|A woman can self-detect breast carcinomac
|0.086 (Native American vs. white 0.030)
|Black women are more likely to develop breast carcinomac
|The only good treatment for breast carcinoma is breast removalc
|0.002 (African American vs. Native American 0.034; Native American vs. white < 0.001)
|Women who have never had children are less likely to develop breast carcinomac
|0.043 (African American vs. Native American 0.048; Native American vs. white 0.029)
|Older women are more likely to develop breast carcinoma than are younger women
With regard to insurance coverage for mammography, 28% of women reported not being covered. Differences were apparent by racial group (P = 0.016), with more Native American women than white women (32% vs. 22%; P = 0.005) reporting a lack of insurance coverage. Eighty-nine percent of participants had never heard of the Breast and Cervical Cancer Detection Program (BCCDP), which provides free mammography to low-income women.
Data on beliefs regarding mammography are summarized in Table 5. Approximately one-fourth of the women believed that receiving a mammogram was an embarrassing experience (P < 0.001). African Americans were less likely to report embarrassment (13%) than were whites (30%; P < 0.001) or Native Americans (27%; P < 0.001). Seventeen percent of women believed that radiation from a mammogram could cause cancer, and 37% believed that mammograms were painful. Thirty percent believed that if they did not feel unwell, then mammographic screening was unnecessary. When women were asked to rate their perceived risk of developing breast carcinoma, racial differences were marginally significant (P = 0.057). Native American women rated their risk as being "somewhat or much higher than average" slightly more often (24%) than did white women (16%; P = 0.066). Differences by racial group were more prominent in terms of how concerned women were about developing breast carcinoma (P < 0.001). Native American women expressed the most worry, with 22% listing their level of concern as "extreme or quite a bit", compared with 14% of African-American women (P = 0.002) and 11% of white women (P = 0.002).
The data presented in Table 6 relate to patients' knowledge regarding breast carcinoma and mammography. When asked at what age they believed women should begin receiving mammograms, only 32% of all women provided the correct response (40–44 years). When asked at what age women should stop receiving mammograms, almost three-fourths correctly answered that they should "never stop." Racial differences in terms of the response to this question were documented (P = 0.007), with more African-American women (34%) than white (23%; P = 0.009) or Native American women (24%; P = 0.006) selecting an age at which they could stop receiving screening. Almost three-fourths of women knew that mammograms should be obtained annually. Seventy-nine percent disagreed with the statement that a woman could self-diagnose breast carcinoma. Fifty-nine percent of all participants correctly indicated that African-American women were not more likely to develop breast carcinoma. Fifty-six percent of respondents disagreed with the statement that "the only good cure for breast carcinoma is to have the breast removed." White women (65%) disagreed with this statement more often than did African-American women (56%; P = 0.034) or Native American women (51%; P < 0.001). Sixty-one percent of women were aware that giving birth decreases one's chances of developing breast carcinoma. White women were more likely to be aware of this fact (65%) than were African-American women (63%; P = 0.048) or Native American women (56%; P = 0.029). Finally, 54% of women were aware that older women are more likely to develop breast carcinoma than are younger women.
Breast carcinoma is a serious public health problem in the United States.1 Although regular mammographic screening has been proven to reduce breast carcinoma–related mortality,24–27 mammography use is not sufficiently widespread to lead to a significant reduction in mortality rates.28 Certain subgroups of women— namely, older women, women in lower socioeconomic groups, and minority women—underuse mammography,29 and this disparity has been the focus of numerous researchers and health care agencies.
The population included in the ROSE study was underserved, with almost 30% not having health insurance, the majority having annual incomes < $20,000, and most lacking a high school degree. Overall, knowledge about breast and Pap smear screening was poor; however, almost all women reported receiving regular checkups. Nonetheless, two-thirds of these women reported not having mammography recommended to them by their physicians. Other studies have also reported this phenomenon of a "missed opportunity" for conducting or recommending screening.30–32
The rural women in the current study reported real barriers to receiving mammograms, such as "no time to get the test" and "having to go to a different facility to get the test." In general, women knew where to go to receive mammographic screening. However, they reported lacking encouragement, time, and the funds to do so. Despite the existence of the BCCDP, few women knew of and/or took advantage of this program. This is unfortunate, as this program would serve most women in this population and would address the cost barrier. Pain and embarrassment associated with the test were reported by approximately 30% of respondents. Overall, perceived risk of and levels of concern regarding breast carcinoma development were low, which may reflect either poor knowledge of the risk factors for breast carcinoma or competing demands in respondents' lives.33
Because all of the women in the current study were in need of a mammogram, comparisons with previous studies examining overall and recent mammography use are not truly appropriate. In general, however, previous studies have found that women who are older, have lower SES, lack insurance, are unmarried, smoke, lack a regular source of health care, and have a lower risk of developing breast carcinoma are less likely to have ever or to have recently received a mammogram.28, 34–38 The current cohort can be characterized in the same way as previous study populations, in that barriers and lack of knowledge have also been reported to hinder adherence to mammographic screening guidelines in past studies.28, 35, 39, 40
Racial disparities were evident among the current population of underserved women. In comparison with other patients, whites were significantly more likely to have private insurance, to have graduated from high school, to have a higher SES, and to be married. White women also showed a greater awareness of screening tests for breast and cervical carcinoma and demonstrated greater knowledge of breast carcinoma risk factors. With regard to screening barriers, white women cited insufficient time significantly more often than did women in the other two groups.
African Americans reported experiencing the least mammography-related embarrassment but were significantly less likely to report encouragement from a physician or family member regarding screening. African-American women also underestimated their risk of cancer significantly more often compared with other women and were less likely than white women to have accurate knowledge regarding breast carcinoma. Compared with all other women, Native American women had the lowest levels of education, insurance coverage, and accurate knowledge regarding breast carcinoma, as well as the highest perceived breast carcinoma risk and elevated levels of concern regarding the development of this malignancy. Although more research is needed to clarify the reasons for these findings, our results may nonetheless assist others in designing future interventions aimed at improving cancer screening.
To our knowledge, few studies of breast carcinoma screening in Native American populations have been conducted.41 Gilliland et al.42 reported that even after vigorous implementation of breast carcinoma screening programs that lowered the barriers of cost, availability, and access to Native American and Hispanic women in New Mexico, the annual screening rates for women age > 50 years remained low (37% and 40%, respectively). Those investigators stressed the need for research aimed at identifying barriers and designing effective intervention strategies for the women in their study. Another report revealed that older Native American women in the United States were less likely to be screened for breast and cervical carcinoma and that those with less formal education had even lower screening rates.43 However, women who had visited a physician in the preceding year were more likely to be screened. Additional barriers that have been reported are geographic isolation, rural residence, lack of transportation, poverty, unemployment, language barriers, lack of knowledge, and cultural factors.20, 43, 44
In conclusion, the current study describes the characteristics of women in a poor, rural county who did not adhere to mammographic screening guidelines. Barriers to mammography use varied among the three racial groups studied, with significant disparities evident among African-American and, especially, Native American women compared with white women. The results of the current study point to groups of women who require interventions to change their beliefs, minimize their barriers, and improve their level of knowledge, thereby making them more likely to adhere to screening guidelines. In addition, according to our findings, low-income women are in need of encouragement to be screened and of information regarding opportunities to obtain low-cost mammography.
The authors thank the Robeson Health Care Corporation's physicians, staff, and patients for making the current study possible.
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- 21U.S. Department of Commerce, Bureau of the Census. United States census, 2000. Washington, DC: U.S. Government Printing Office, 2001.
- 22Statistical theory of classes and calculation of probabilities]. Pub R Ist Superiore Sci Econ Commerc Firenze. 1936; 8: 36–62.. [
- 23SAS Institute. SAS/STAT version 8.2 [computer program]. Cary, NC: SAS Institute, 2001.
- 2414 years of follow-up from the Edinburgh randomised trial of breast-cancer screening. Lancet. 1999; 353: 1903–1908., , , et al.
- 25An ecological study of the effectiveness of mammography in reducing breast cancer mortality. Am J Public Health. 1998; 88: 281–284., , , et al.
- 26Efficacy of breast cancer screening by age. New results from the Swedish Two-County Trial. Cancer. 1995; 75: 2507–2517., , , et al.
- 27
- 28Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst. 2001; 93: 1704–1713., , , , .
- 29A meta-analysis of mammography screening promotion. Cancer Detect Prev. 2001; 25: 147–160., , , , .
- 30[No author listed]. Screening mammography: a missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey Studies. JAMA. 1990; 264: 54–58.
- 31Clinical strategies for breast cancer screening: weighing and using the evidence. Ann Intern Med. 1995; 122: 539–547., .
- 32Community-based interventions to improve breast and cervical cancer screening: results of the Forsyth County Cancer Screening (FoCaS) Project. Cancer Epidemiol Biomarkers Prev. 1999; 8: 453–459., , , et al.
- 33Factors related to perceptions of breast cancer risk among low income women. Clin J Womens Health. 2001; 1: 132–138., .
- 34Has the use of cervical, breast, and colorectal screening increased in the United States? Am J Public Health. 1995; 83: 53–60., .
- 35Progress in cancer screening in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003; 47: 1528–1540., , , , .
- 36Correlates of screening mammography among women from high and low socioeconomic groups. Prev Med. 1995; 24: 149–158., , , .
- 37Demographic predictors of mammography and Pap smear screening in US women. Am J Public Health. 1993; 83: 53–60., , , .
- 38Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med. 1996; 12: 82–90., , ,
- 39Cancer screening practices from the National Health Interview Surveys: past, present and future. J Natl Cancer Inst. 2002; 94: 1837–1846., , , , .
- 40Predictors of screening for breast and colorectal cancer among middle-aged women. Fam Med. 2003; 35: 349–354., .
- 41
- 42Patterns of mammography use among Hispanic, American Indian, and non-Hispanic white women in New Mexico, 1994-1997. Am J Epidemiol. 2000; 152: 432–437., , , , .
- 43Breast and cervical cancer screening practices among American Indian and Alaska Native women in the United States, 1992-1997. Prev Med. 1999; 29: 287–295., , .
- 44Native American recruitment into breast cancer screening: the NAWWA project. J Cancer Educ. 2000; 15: 28–32., , , , .


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January-February Observer Contents
Special focus
Special focus: depression
New feature takes a look at this insidious disease.
Jan.-Feb. '05
Pay-for performance takes off in California
First bonus checks are slim, but physicians plan to stay the course to improve quality.
Jan.-Feb. '05
Texas tort reform: One year later, some physicians say they're reaping big benefits
However, not all liability carriers here have dropped premium rates.
Jan.-Feb. '05
Overcoming resistance to disease management
Key factors that drive acceptance are collaboration, competition and positive results.
Jan.-Feb. '05
Web only:
Managing disease: a healthy—and growing—trend?
Jan.-Feb. '05
Annual Session: showcasing internists' artistic talents
The College is soliciting exhibit entries from physicians who are about a lot more than practicing medicine.
Jan.-Feb. '05
Your Practice
How to fill for the new "Welcome to Medicare" exam
Billing tips and covered benefits for the new Medicare initial preventive physical exam.
Jan.-Feb. '05
College Watch
President's Column
A New Year's resolution: Tackle the problem of obesity
For many of us, the holidays mean overeating and an intemperate use of alcohol.
Jan.-Feb. '05
Washington Perspective
The brave new world of pay-for-performance programs
Are physicians ready for pay-for-performance?
Jan.-Feb. '05
College Briefs
ACP's MLE wins first place-place award.
Jan.-Feb. '05
ACP Ethics Committee member receives national ethics award.
Jan.-Feb. '05
College expands online recertification resources.
Jan.-Feb. '05
Policy Briefs
ACP: MedPAC should champion payment changes.
Jan.-Feb. '05
College-backed sickle-cell bill becomes law.
Jan.-Feb. '05
Member News
Chapters present Laureate Awards, others
Jan.-Feb. '05
The MKSAP Challenge
A young pregnant woman has a two-hour episode involving sudden onset of severe anterior chest pain that radiates to her neck.
Jan.-Feb. '05
Chapter Meetings
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Internist Archives Quick Links
MKSAP 16® Holiday Special: Save 10%
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Maintenance of Certification:
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subset: commoncrawl


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PENDING – 530 N Russet St, Portland | 3 BR | 1 & 1/2 Baths | NEW PRICE – $389,900
PENDING – 530 N Russet St, Portland | 3 BR | 1 & 1/2 Baths | NEW PRICE – $389,900
1134 SE 60th Ave | 3 BR | 3 BA | 2621 sf | $539,900 | MLS# 14109017
Enjoy this beautifully updated Mt. Tabor just minutes to Division, Hawthorne, and Belmont hotspots. Extensively updated from top to bottom, inside and out. Perched off the street for maximum light, this home retains lots of original charm, with some modern elements thrown in for a smart contrast. Great flow inside, two car attached garage, and the huge private backyard is a sweet retreat.
SOLD. 7828 SE 119th Dr | 2699 sf | 3 BR 2 1/2 Baths
This smartly updated retreat will call you home. Sited perfectly to embrace abundant light & mountain views, just simply unpack and enjoy! Updates include modern cook's kitchen, powder room, carpet, furnace, exterior and interior paint. Nicely flowing floorplan invites a myriad of living options inside, and outside offers two decks – including one overlooking a peaceful koi pond & lush landscaping. Great proximity to Brookside Park, Leach Botanical Garden and Springwater Corridor; easy commute downtown, Max Green Line, Clackamas, and PDX. MLS#14399145
TOO LATE! But let me help you find your own modern space. I'm an Accredited Buyer's Agent too.
1131 SE River Forest Rd, Milwaukie | 4 BR, 3 Bath | Over 3,600 square feet | $450,000 | MLS# 13146317
Peacefully sited on a lush 1/2+ acre lot, this immaculate mid-century home is move-in ready. Recently remodeled and updated with new flooring, windows, high-efficiency furnace, circular paver drive & more. Scaled nicely for day-to-day living, yet large enough for any need – open floor plan in main house, expansive daylight basement, separate office, family/music room and guest apartment over garage. Sellers have loved the warm and engaging neighborhood community with monthly book group and potlucks – and being close to the public boat ramp to boot! Enjoy the natural and serene setting, while living within super-easy reach to Portland. Additional MLS detail here.
By Steve Strode, originally published in PQ Monthly, November, 2013
It's the question always asked at a cocktail party, when one learns there's a realtor in their midst. People are used to hearing daily news on the macro-level—national foreclosure rates, price appreciation, inventory shortages. But what they really want to know is: How are things in their neighborhood? So now my standard response is, "Where do you live?" While that's sometimes interpreted as a pick up line, it's a completely necessary question.
Nothing is more local than real estate. Chiefly, it's how we build community—one block at a time. Coming out of the recession, the majority of foreclosures were confined to a handful of states. But we still felt collectively paralyzed—that it was doom and gloom everywhere. And then we noticed. Places like Portland were starting to do okay; then later, doing well.
As I'm writing this article, I'm sitting in a hotel lobby in San Francisco, about to attend a Symposium on Sustainable Development. The program reads, "Sustainable development begins from the ground up. The first step is to change the way we think." And I smile, knowing that what we live and breathe in Portland is not quirky or weird. It's the future, but we've been experiencing it for years.
The National Association of Realtors just published survey results entitled, "Neighborhood Preferences are Changing," which provides further support that Portland is getting it right—in the big picture. Sixty percent of respondents want a mix of housing, shops and services that are walkable. The majority responded they would give up a larger yard or would buy a smaller home if they could have a shorter commute. Seventy-eight percent said the neighborhood is more important than the house size. Having access to different types of transportation modes also rank very highly.
And what we're seeing are buyers and renters willing to walk the talk. In major cities everywhere, Millennials are leading the charge. They are trading the car-dependent suburban culture they grew up in, exchanging them for an urban lifestyle, choosing micro-apartments of 400 square feet or less. The apartment is a place to sleep; the neighborhood and its amenities have become the living room.
These trends are playing out daily with buyers and colleagues I know. Professionally-marketed homes in close-in Portland are getting offers soon after hitting the market—often multiple ones. We're seeing hot building trends in Portland, too. For example, every vacant lot along Southeast Division appears to be an apartment construction zone. A few builders are selling their formulaic "McInfill" homes on every available lot (I'm trying to coin that term as an urban version of "McMansion"—you read it here first). We all have friends desperately seeking an apartment, or know first-time buyers competing for homes.
All is not perfect. Re-development and new urban development is often viewed as a zero-sum game. The LGBT community is often associated with gentrification. We've moved into areas that have been maligned by the majority, renovated homes, and created vibrant neighborhoods. But these same neighborhoods have also been home to other groups for generations—and they often reach a tipping point where it becomes too costly for long-term residents to remain.
In the nationwide public radio show "State of the Re:Union," host Al Letson featured Portland, discussed the North Williams corridor and interviewed African-American residents who have experienced the changes. In an only-in-Portland fashion, it was the bike lane proposals that helped bring racial issues to the surface, but also brought an opportunity for dialogue. Imagine being a multi-generational black resident, getting frequent calls to sell your house. You see this as your family's neighborhood—and while the white callers meant no harm, they are not realizing that same call has been received dozens of times previously. (Disclaimer: as a realtor I am not suggesting "black" and "white" neighborhoods, but sharing an anecdote from Letson's program.) As affordability has waned, we see various population shifts. And unfortunately, the same things that people like best about living close-in are not yet prevalent in neighborhoods on the periphery. Children have lost their sidewalks. Commute times are longer.
Local community is built through local involvement, and as someone on that radio show quipped, "If you don't have a seat at the table, you don't get fed." Engagement has to be at the neighborhood level. If surveys indicate that we want walkable neighborhoods, this cannot be tied to income. On the whole, we're getting it right in Portland and we're well-poised for the future. But to create a sustainable model for all, we have to create that same sense of "local" in all Portland neighborhoods.
Steve Strode is a realtor in the Portland metro area, and co-founder of rEqual – an LGBT housing and advocacy organization. Steve is also President of Portland Frontrunners. He can be reached at email@example.com.
Originally published in PQ Monthly, August, 2013.
Maybe it's because the campaign for "Hillary 2016" already seems to be full swing that the title of her 1996 book came to mind. But it does tie in nicely to the theme for this month's article. Over the course of the our queer civil rights movement, our tent has continued to enlarge (and get more fabulous); in my lifetime I've seen the evolution from "Gay & Lesbian," to LGB, to LGBT to LGBTQ — and the initialism continues to grow.
On the home front, our needs and wants continue to evolve, too. No longer marginalized to specific neighborhoods, our housing choices tend to mirror the public at-large. Some of us want to walk/bike/bus to work, some want that extra space and privacy in the suburbs, while others seek a little place in the country — "Brokeback Mountain"-style. And more commonly, our households have become more multi-generational; we're having or adopting children, or moving in parents during their final years. And in higher cost-of-living places like Portland, countless of us have housemates to share expenses.
Portland is city of in-migration. How often do we find ourselves simply asking, "Where are you from originally?" It's almost presumptive that that person came from elsewhere. "I'm a Portlandia interloper, so you must be too!" Many of us have biological families far outside of Portland, which we visit as often as we can. But on a day-to-day basis, it's our chosen family that we see, rely on, and love as our own. We form these chosen families through joining groups or getting involved in community organizations. In my case, one of those is Portland Frontrunners. Most of the group has moved to Portland from elsewhere, so newbies are warmly welcomed. The same can be said for groups like the Portland Gay Men's Chorus, the Amazon Dragons, OutKayaking, our synagogue, and so on.
We also embrace the concept of intentional living. Intentional living is the desire to live in a manner that is consistent with our core beliefs and values. Whether it be an ecological consciousness, concern for fair trade, or social equality, Oregonians see the global big picture in how we live locally. Basically, we want to walk the talk.
In the world of real estate, nowhere are the ideas of "chosen family" and "intentional living" better manifested than in cohousing. Cohousing is not a hippie commune. With cohousing, people buy and sell their homes just as any other condominium. But there are inherent features that set it apart from most condos; for many this is exactly what they are looking for in their community. Recently, my running buddy turned client, Bill Cunnighame, bought a unit at Daybreak Cohousing. He offered to share his reason for buying and his experience thus far.
Steve: Why compelled you to buy?
Bill: I knew I wanted to downsize so I went to an open house. It was conducted by both the homeowner community and the realtors. The room was packed with interested parties.
Steve: What caught your attention about cohousing vs. a regular condo?
Bill: The intentional way of living in the community. You have to buy in to the concept. You're not just sharing common walls — but share maintenance, landscaping, garden spaces, group dinners. Everyone knows the children.
Steve: What do you like most about the community?
Bill: The pleasant surprises — it's truly multi-generational. I work from home during the day and I crank open my windows just to hear the kids playing. In some ways it's an extension of my First Unitarian Church community — inclusiveness, concern for sustainable environments, or shared spaces like the woodworking room, which minimize excessive possessions.
Steve: What appeal do you see for the LGBTQ community?
Bill: It's very diverse — straight, gay, lesbian, bisexual. A single lesbian just had a baby and the community offered to chip in with babysitting. I wanted it to be a mixed environment with all ages and types of people, with lots to learn from each other.
Steve: Any advice or things you would've done differently?
Bill: Just be very thorough. Attend group dinners before buying; ask tons of questions. Meet everyone.
As Bill summed up, cohousing is not for everyone. You interact much more with neighbors than a conventional condominium, and there is an expectation that everyone is engaged in operations to the best of their ability. But it fills an important niche for the homebuying segment who seeks something just a little bit different and a little bit more. How Portland indeed!
Steve Strode is Portland-area realtor with Meadows Group Inc., Realtors. He is also co-founder of a newly forming non-profit organization called rEqual, a nationwide LGBT real estate coalition.
I am also an Accredited Buyer's Representative. Please contact me to find your next home.
4242 SW Condor Ave | 3 BR, 2 and 1/2 Baths | 2 Car Garage | $550,000 | MLS 13597446
Dialed-in and ready, this sweet contemporary is priced to move. Complete renovation & stellar addition completed in 2008. Perfectly scaled with open floorplan & loaded with goodies – 11′ ceilings, malaccan floors, quartz countertops & extensive tilework. Owners' en suite is a true delight. Making an irresistible home even more irresistible – unobstructed Mt. Hood views, and great proximity to OHSU, downtown and waterfront.
4878 SW Garden Home | 3 BR | 2 Bath | MLS 13120446
Attention modern lovers! Multnomah Village, Northwest Contemporary – nestled on over 1/4 acre private wooded lot, overlooking Woods Creek. All the right updates inside – walnut hardwood floors on main level, remodeled kitchen and baths, new wool carpet upstairs, and freshly painted throughout. Excellent proximity to downtown.
***SOLD, $160,000 | 11834 SE Pine | Portland | List Price $159,900 | MLS 13385323
Bring your ideas for highest & best use (buyer to do due diligence). Scrape or renovate. Buildable up to four units, in area with many newer properties. Or, update this cosmetic fixer with good bones; nice clearance in basement for additional square footage – on a large lot for urban-gardening types. Great proximity to MAX, one block to park.
I attended the BC Real Estate Convention last week in Vancouver, BC. In addition to a number of informative educational sessions, the Expo included a nice mix of private business professionals and public officials. If you're interested in diversifying your real estate portfolio, or take advantage of dynamic investment opportunities, please call or email me. Great options abound!
***SOLD. $555,000, closed 2/19/13*** I am also an Accredited Buyer's Representative and love working with buyer clients. Please contact me if you need assistance finding your next home.
7208 SW 34th Ave, Portland | 3 BR, 2.5 Baths | $539,900 | All the Work Has Been Done – And Done WELL
Every so often, a home just speaks to you. This pristine Multnomah Village bungalow is one of those times. Seller has overlooked no detail in this top-to-bottom, inside & out renovation. You will appreciate the perfect flow for entertaining, quality materials, meticulous workmanship, and thoughtful details in every room. You'll love it all – cook's kitchen, sweet owner's suite, and spacious living spaces. Freshly remodeled lower level offers additional space for theater or game room. Completing the package is an expansive deck & gorgeous gardens.
And to boot, you're just a stone's throw from the heart of Multnomah Village shops, restaurants and services. Enjoy!


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We all know waffles are one part of the holy trinity of hot breakfast sweets. Flanked by pancakes and French toast, the waffle has earned its place at the breakfast table, what with its built in syrup traps and attractive modern design, like a Piet Mondrian painting in batter form. (See how we just ... More >>
Meet the Iraqi Angelino and observant Jew who returned to 19th-Century Ukraine by way of Australia


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The Reduced Shakespeare Company is due to kick off its latest UK tour by presenting The Bible: The Complete Word of God (abridged) at the Theatre at the Mill on 29 and 30 January.
The venue is run by the local council, leading to the issue being raised at a meeting earlier this week.
The Newtownabbey Times reports that DUP Alderman Billy Ball called for the play to be pulled from the theatre by the Artistic Board.
"It should never have been accepted in the first place," he told the paper.
"The Artistic Board have offended a lot of people in Newtownabbey and further afield by letting this play go ahead."
For Christians, the Bible is the infallible word of God and it's not something to be made fun of. These people are treating something sacred with irreverence and disrespect.Billy Ball, DUP
For Christians, the Bible is the infallible word of God and it's not something to be made fun of. These people are treating something sacred with irreverence and disrespect.
Billy Ball, DUP
But the Alliance Party's John Blair, who praised the theatre for its facilities and professional production, has countered with his own concerns of "censorship".
He told UTV: "Programmes are planned by an Artistic Board which was appointed and approved by the full council and with which the council has a positive and open working relationship.
"Late, ad hoc, or intermittent political interference in the work of that Board could easily be perceived as political censorship and would not be conducive to good theatre management."
Alderman Blair added: "Like other mainstream arts venues, Theatre at the Mill has to offer a wide range of attractions and productions which may not suit all of the people all of the time but are, in general terms, exactly what the paying public expects from such a facility."
The show at the centre of the row is billed as "an affectionate, irreverent roller coaster ride from fig leaves to final judgement".
According to the promoters, it tackles the great theological questions like "Did Adam and Eve have navels? Did Moses really look like Charlton Heston?"
Maybe Councillor Ball should come and see our show before denouncing it as unholy. But he'd better be quick as all his comments have done is increase ticket sales.Davey Naylor, producer
Maybe Councillor Ball should come and see our show before denouncing it as unholy. But he'd better be quick as all his comments have done is increase ticket sales.
Davey Naylor, producer
They say: "Whether you are Catholic or Protestant, Muslim or Jew, Atheist or Jedi, you will be tickled by the RSC's romp through old time religion."
The show's producer Davey Naylor told UTV the production has toured extensively around the world over the past 20 years and been very successful.
"The company has even performed the show at the Jerusalem Festival in Israel without objection," he said.
"Hundreds and hundreds of clergy members of all denominations have seen the show since its premiere in 1995 and have both endorsed it and recommended it to their congregations."
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Seagrove Beach Condo Rental Photos and Description
Condo, 1 Bedrooms, 2 Baths (Sleeps 6)
The Palms at Seagrove offers its guests large 1-bedroom, 2-bath condos that are perfect for your special family vacation. This unit is fully equipped with washer and dryer and the kitchen was updated in 2011. Sleeping up to 6 people, this beautiful ground floor vacation rental has a king bedroom, hall bunks and a queen sleeper sofa, if needed. Your perfect vacation awaits you at the Palms of Seagrove! You will enjoy strolling along the sugar white sands, while enjoying your favorite tropical drink, or just relax poolside. Walk to shopping and fine dining from the Palms or take a bike ride along the bike path that meanders along 30-A. Do not wait to book this one though, it will not last long! * Saturday to Saturday rental in season.
* Parking for 1 car. * Sorry, pets are not allowed.
- Suitability:
- Minimum Age Limit for Renters
- children welcome
- non smoking only
- pets not allowed
- wheelchair inaccessible


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We took the 2 bedroom apartments from 19th - 21st September. Our apartment was situated at the 10th floor. This is an average apartment, a budget apartment which is suitable if you are here with your family and don't mind the old and worn out furniture. There is a dining table fit for six people and medium sized hall. The... More
- Reservation Options:
- TripAdvisor is proud to partner with Expedia, Booking.com, Hotels.com, Travelocity, Agoda, TripOnline SA, Odigeo, Despegar.com and Tingo so you can book your The Krystal Suites reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- The Krystal Hotel Bayan Lepas
- The Krystal Suites Penang/Bayan Lepas


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1-10 of 36 properties for sale found
3 bed flat for sale
4 bedroom flat for sale Nascot Street, North Kensington, W12
Recently refurbished to an exceptionally high standard, this stunning four bedroom maisonette is beautifully decorated throughout and provides bright, neutral rooms and stylish accommodation. More details ›
3 bedroom maisonette for sale Eynham Road, London, W12
A large period maisonette (circa 1,227 square feet) benefitting from an abundance of natural light. Set on the first and second floor of a Victorian terrace the property benefits from its own private entrance and direct access to a shared garden and further communal wild garden. Accommodation i... More details ›
2 bedroom maisonette for sale Eynham Road, North Kensington, London, W12
This spacious upper maisonette is offered is fantastic condition throughout and offers flexible accommodation over 2 floors of an end of terrace Edwardian property. With two double bedrooms and two bathrooms (one en-suite) the property has the added benefits of an eat in kitchen with (contd...) More details ›
2 bedroom maisonette for sale Eynham Road, North Kensington, London
Situated on a corner plot location in this much sough after residential area of North kensington we are delighted to offer for sale this extremely bright and spacious two double bedroom duplex maisonette which has access to its own small but private rear garden and a garage for storage. More details ›
2 bedroom maisonette for sale Eynham Road, London, W12
A simply stunning two bedroom split level maisonette with a private garden and garage. More details ›
Marketed by Winkworth, Shepherds Bush. Call: 020 8012 3577 Local call rate
2 bedroom flat for sale Nascot Street, North Kensington
A two double bedroom first floor purpose built period style maisonette which is situated along this sought after residential road just off Wood Lane and within close proximity to the local amenities of Shepherds Bush including multiple transport facilities and Westfield shopping centre. More details ›
3 bedroom end of terrace house for sale Maurice Street, Shepherds Bush, London
This recently refurbished semi-detached house is conveniently located midway between East Acton and White City underground stations and offers easy access to local schools and to Central London. Accommodation comprises of a very large reception room, a modern fitted kitchen, two bathrooms to the ... More details ›
3 bedroom house for sale Bentworth Road, Shepherds Bush
Offered to the market is this beautifully presented end of terrace family home. The property consists of three double bedrooms, two reception rooms, modern shower room and a separate kitchen leading onto an expansive rear garden. The property is in great order and further benefits from off street... More details ›
£559,950 Offers in Region of
Offers in Region of £559,950
3 bedroom semi-detached house for sale Bentworth Road, Shepherds Bush
A perfect home for the growing family. Presented in fantastic decorative order, this beautifully maintained end of terrace property comprises 2 spacious interconnecting reception rooms via double doors, fully fitted kitchen, 3 well proportioned bedrooms and modern shower room. Further benefits do... More details ›
3 bedroom end of terrace house for sale Westway, Shepherds Bush, London
A fantastic opportunity to acquire this 3 bed end of terrace house. Located conveniently for white city underground station (central line zone 2) and Westfield shopping complex. The property is currently being utilised for investment purposes and has been internally remodelled to provide maximum ... More details ›
Thank you.
Your information has been sent to 0 out of 16 agents who have property to sell in the area you specified.


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Win Butler got the director of his favorite film (Brazil) to direct his very own concert. Famous documentary filmmaker D.A. Pennebaker did it earlier this year with The National, now Terry Gilliam has his turn. AP is reporting that the Brazil, 12 Monkeys and Imaginarium of Dr. Parnassus director will direct the live webcast of Arcade Fire's August 5th show Madison Square Garden in NYC.
This will be the first in a series of five streamed concerts (John Legend and The Roots planned so far) titled Unstaged. American Express is sponsoring the YouTube-streamed concert, which will begin at 10pm EST on Aug. 5th.
Check out Pennebaker's National concert here, but I'm sure Gilliam will bring a much different taste. It is unknown whether he directed the teaser for the concert below, but check it out nonetheless (click if it is not loading for you).
Arcade Fire's latest album The Suburbs (which I'm absolutely loving) hits stores August 3rd. You can stream the concert live on YouTube at 10pm EST on August 5th and I'm sure they will have the clips up later.
UPDATE: You can stream the full concert here when the time comes. Meanwhile, check out the promo video featuring the closing track of their new album.
Are you a fan of Arcade Fire? Are you excited to see Terry Gilliam direct their concert?
Every week we dive into the cream of the crop when it comes to home releases, including Blu-ray and DVDs, as well as recommended deals of the week. If we were provided screener copies, we'll have our own write-up, but if that's not the case, one can find official descriptions from the distributors. Check out […]
Welcome to the latest episode of our official podcast, The Film Stage Show. This week, editor Nick Newman, writer Danny King, and I are joined by The Playlist's Cory Everett (@modage) and TFS editor-in-chief Jordan Raup to discuss a number of new films. First up, however, we discuss the career of the late Mike Nichols. Then we […]
With a seemingly endless amount of streaming options — not only the titles at our disposal, but services themselves — we've taken it upon ourselves to highlight the titles that have recently hit the interwebs. Every week, one will be able to see the cream of the crop (or perhaps some simply interesting picks) of streaming […]
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text:
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main index
Here's a list of the main characters of Agarest Senki or known to the US as Record of Agarest War and Agarest Generations of War in EU. Please put the tropes of characters that appear in other generations in their own categories.Be warned that there WILL be spoilers in this page.
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Characters from Agarest Senki :
Characters debuting in Generation 1
Leonhardt Raglen
The woman who gave Leonhardt and his descendants their destiny. Not much is known about her when you first encounter her. She is actually one-half of Chaos sent by Chaos himself to destroy and rebuild the world because he sees that the world itself is getting out of hand.
The first female character encountered in the game. She was cornered by a group of soldiers and was saved by Leonhardt. Falls in love with him and promises to take care of his descendants
A larva accidentally summoned by Ellis. Leonhardt sees him and thinks he's an enemy who is going to eat Ellis; obviously he fights him. The fight gets cut short after Ellis clears up the misunderstanding. He at first does not have any emotion whatsoever, but begins to develop emotions the farther the story goes.
An onerthes who could see the future, but cannot anymore due to the visions being dark. All she sees is Leonhardt, his fate, and his descendants. She has a third eye which she does not bother hiding even though her kind is being hunted.
A syrium who fights against the Gridamas due to the fact that his kind has been persecuted. He's also the older brother of Fyuria. Initially, he hates Leonhardt due to the fact that his kind is being persecuted, but later develops a strong sense of friendship with him. He later promises Leonhardt that he would take care of his descendants.
A normal human who stole the Bracelet of the Covenant and is cursed to live a long life and that it slowly turns him into one of the Dark Knights. Whoever holds the bracelet is tasked to give it to the evil god and therefore cannot die until his purpose is finished. Of course, Winfield wouldn't want any of that so he joins the party.
One of the three love interests of the first generation. She is a syurium herself and is the younger sister of Zerva. She initially hates Leonhardt mainly due to the fact that she hates humans, but as time goes on, she accepts Leonhardt and even loves him by the end of the first generation.
One of the three love interests of the first generation. She meets the party while she was surrounded by monsters. Trying to act like a Damsel in Distress, she thinks she could manipulate the party. She grants them an audience to the king of Rigulus.
Elaine Reinbach
One of the three love interests of the first generation. She is a general of Gridamas who initially reluctantly fights against the party, but switches sides for the sake of Lucrellia.
Characters debuting in Generation 2
Ladius Raglen/Ladifour Von Busser
Vashtor noteA man Ladius found in a beach one day. Since he has an amnesia, he decides to say with Ladius until his memories come back. During that time, he teaches Ladius on swordsmanship and is well-known in Graccea as the best swordsman in that country. He is pretty much considered to be the greatest threat to the Von Busser household. He's actually the Dark Knight who curb stomped Leo when he first encountered him.
ArbolA ryulent who accompanies Ladius and his descendants, just so that he could see the outside world and that he can find his resting place.
SharonaThe chief of a syrium village, she wants to escape it all and go outside for an adventure of a lifetime. Just don't ask her age.
One of the three love interests of the second generation. A childhood friend of Ladius, their friendship gets tested when Ladius decides to break free from prison and fulfill his destiny. At first, she feels betrayed but soon enough she gets to accompany him later on and become one of the three chosen women.
One of the three love interests in the second generation. She is a priestess of Yamato in Alzai Fen who was supposed to be sacrificed to a "god", but was rescued by Ladius and the gang after finding out that it's only a larva who got Drunk on the Dark Side. She then accompanies Ladius in his quest to save Graccea/
One of the three love interests of the second generation. She is one-half neocollom and one-half human with the blood of a priest related to god (or so it goes). She accompanies Ladius on his adventure to save Graccea, but she does not want to fight at all.
Characters debuting in Generation 3
Thoma Raglen
PlumA nelth girl who the party meets at Paillene. She is the only one who could design the Achilles' Heel of Winfield's bracelet and as such goes off with the party on an adventure to help build it.
GanzA greer the party meets at Twulan. He claims that he's the only one who could build the very thing that could destroy Winfield's bracelet but only if he has the materials for it. He joins the party to look for said materials.
AlbertiA young man who fell in love with The Chief's Daughter (said chief is also considered to be That One Boss fyi). Unfortunately, when he saw that the Chief was having a deal with the Dark Knight, he got exiled for it. He plans to bring her back when Thoma shows up.He is also the only normal human and thus, he ages quite noticeably.
One of the three love interests of the third generation. She is one half high elf and one half dark elf which unfortunately, dark elves are considered to be evil and so she was ostracized by other high elves. She first meets the party at Tweda Forest and was "rescued" by Winfield and Thoma. She takes them to Lus Soleil where she was reunited with her younger sister Faina. After saving her home, she accompanies Thoma on his mission to look for materials to break Winfield's bracelet and to save the continent.
One of the three love interests of the third generation and Lavinia's younger sister. From a very long time, she's a sickly girl who always collapses for some weird reason. She gets reunited with her sister after a long time and joins the party specifically to be with Lavinia, but also longs for the outside world.
One of the three love interests in the third generation. She first meets up with the party at Aulis Lake while the party is looking for one of the ingredients for the MacGuffin to destroy Winfield's bracelet. She is an adventurer due to the fact that she just loves adventuring and that she can tell stories to one of the kids at the orphanage.
Characters debuting in Generation 4
Duran Raglen
QuaA neocollom the party meets near Tenedos. At first, she tries to attack the party but is later saved by the very people she attacked. Since then, she joins the party just to tag along.
FerThe best treasure hunter in the world (or so he claims). He meets the party at Crystal Lake while he was looking for treasure. He joins the party because he think he could find more treasure if he joins with the party.
ReverieA yulishee who the party meets at Crystal Lake when they were looking for a Rainbow Shard. She decides to help them, aware of the fact that she gets exiled if she helps them out. She goes with it nonetheless due to the fact that she wants to travel around the world anyway.
Hilda/HildegardeOne of the three love interests of the fourth generation and captain of the Death-Cross. She will lend her boat only if the party gives her a Marfile fruit. When she does finally receive one, she joins the party to search for the Rainbow Shard and along the way develops an interest with Duran.
SilviOne of the three love interests of the fourth generation. She first meets the party while the party themselves were looking for the Marfile fruit. She claims she knows the location and after which, after getting herself exiled, joins the party.
RyuryuOne of the three love interests of the fourth generation, she is hailed as the most powerful fortune-teller of Enhambre. She at first tells a fortune that Duran will be with Hilda, Silvi, and herself and that Duran will have to marry him. Unfortunately, she also got picked to be the sacrifice for the local demon until Duran and the party save her. She then joins due to the stipulations she placed with Dyshana.
Characters debuting in Generation 5
Rex Raglen
BeatriceA woman who has sailed from the different parts of the continent thanks to her eye patch. She is the granddaughter of Alberti only if you save Nastassja.
MurminaThe sole survivor of the harpuia race in Aegisthus. She is out for revenge on the one who killed her family led by Vashtor. Depending on your actions, you could save her, or she dies from exhaustion and from injuries.
NPC Of The First Generation
MelchiorThe current head of House Klavis and King Hertzfeldt's second in command. He has quite the history with Leonhardt and proves to be the biggest thorn in the party's side throughout the first generation.
King Hertzfeldt
NPC Of The Second Generation
NPC Of The Third Generation
NPC Of The Fourth Generation
NPC Of The Fifth Generation
Forces Of Darkness
SummerillThe Big Bad of the game itself and the Final Boss of the fifth generation. He's the reason why the darkness is spreading throughout the continent.
The Dark KnightThis is the guy who curb stomped Leo while he makes Ellis flee the scene. For his other tropes, see Vashtor.
GurgThese are the other Dark Knights that are roaming around the other continents to spread the darkness. Originally, there were twelve of them, but six got killed off before the game starts.
The Six Gods Of Darkness
These gods are the true final bosses of the game provided that you have reached the True Ending. While they were alluded in the prologue itself, they're more of a Giant Space Flea from Nowhere. At first.
MercuryOne of the six gods of darkness, though he regrets it deeply. He at first was at the side of light, until Mobius tempted him to the dark side. He wants to go back to the light, but he can't because of his loyalty to the dark.
MobiusThe god of space and time, he is also responsible for the war of the gods thousands of years ago. He did this to kick out both Lenion and Chaos so he could become the ruler. If anything, every single conflict of the gods can be traced back to him. He is sealed in Graccea.
DeethOne of the six gods/goddesses that were sealed, she represents Fortune. She can appear to other people either as a man, or as a woman and just so happens to encounter Dyshana who is one-half of Chaos. Sealed at Fendias.
NemesisThe goddess of revenge. Ironically enough, she is the most composed out of all the gods and the only reason why she even sided with the dark was just to balance things out. She is sealed in Enhambre
MayastiaThe god of battle. He seeks to have more battles just so that progress can be made. He is sealed in Aegisthus.
ChaosThe lord of the dark night, and the god of destruction and rebirth. He initially fought against Lenion due to the fact that Lenion married the girl of his dreams and that Mobius was pushing for it. He gets to be special in that he's sealed in the Boundary Plane.In Agarest Senki 2, Weiss kills him as a Cutscene Boss in the opening. Or Does He?
Characters from Agarest Senki Zero :
Characters debuting in Generation 1
Tetora /Lemona Hoch
Characters debuting in Generation 2
NPC Of The First Generation
NPC Of The Second Generation
Hass Calinou
Forces Of Darkness
Universal Dark Knight Tropes
Dark Knight Vashtor
Dark Knight Giganda
Dark Knight Arzest
Gods of Darkness
Characters from Agarest Senki 2 :
Characters debuting in Generation 1
Voiced by: Takuya SatouA man who ventures into the tower along with an archaeologist named Fasti. He kills a god but unfortunately, gets the whole world into trouble so he must sacrifice his life along with three women to revive the god as penance.
Voiced by: Marina InoueA woman who appears to Weiss and tells him that he has killed a god and must atone for his sins.
Voiced by: Masayuki KatouA mercenary working for the guild. He then invites Weiss, Aina and Eva to his party so Weiss can gather clues of his past.
Voiced by: Kana AsumiA child the party found while on a quest in the forest of Lucrellia. Claims she is from Mystetia and that she's looking for her parents. The party then accompanies her to look for them and decides to adopt her.
Voiced by: Sayuri YahagiOne of the three heroines of the first generation. A young girl who found Weiss injured on the ground, she accompanies him since then.
Voiced by: Yui SakakibaraOne of the three heroines of the first generation. She first resents Weiss for possessing the Veldafard and later on, killing her older sister even if it was an accident. She however forgives him and joins the party till she is sacrificed along with the other three people.
Voiced by: Aya EndoOne of the three heroines of the first generation. She is a princess in the Aegisthus continent, but doesn't want to be one and just wants to be seen as a normal person by other people. She travels with Vice and the consequences were that she's no longer of royalty.
Characters debuting in Generation 2
SchwarzThe second generation protagonist. He hates his father, and his own destiny to die just like his dad just to save the world. He can either have violet hair, yellow with brown hair, or blue green hair depending on who you choose as your wife in the first generation.
JudeThe son of Jainus and Chloe and Schwarz's best friend. He is a half dark elf and half human and dark elves are usually discriminated in society. Despite the fact however, Jude doesn't even care about it.
IgnisA young elf who accompanies the party at the behest of their leader in Enhambre. He at first despises all dark elves for having dark powers and is quite rude to everyone, including the party. He then mellows out after meeting with Cynthia, a woman who migrated to Flensberge.
MervinaA syrium who at first opposes the party. Her entire reason is to please her father so that she can get recognized. After her father abandons her, she then joins the party and sometimes assists Sena in the Item shop.
VanessaOne of the three heroines of the second generation. She's a bounty hunter who's looking for the monster that killed her little brother. At first, she and Schwarz would always quarrel whenever they see each other, but as time goes on, she develops feelings for him.
Li Ra-LuaAn onerthes who was sent by her leader to find Jainus' group because the Fendias tower gets invaded by dark forces. After it gets liberated, she is then asked by Jule to accompany the party.
YumilOne of the three heroines of the second generation. A Winged Humanoid who asks for help to cure her brother's sickness because of some curse inflicted on him. She travels along with the other party members to gather the materials needed by Danaos to help out Rasta.
Characters debuting in Generation 3
GrayThe third generation protagonist. He's continuing to investigate as to who Weiss is and is trying to go to the Zendrook Pillar to find answers.Depending on who you married, he can either have a black longcoat, a violet longcoat with a different hair style, or a white longcoat with wings.
Lieselotte/LielGray's childhood friend and the daughter of Ignis and Shinshia. At first, Ignis tells her to go home and be with her mom but Liel would like to travel with her dear older brother instead.
SofiaA woman sent by Enhambre's leader to join Gray's party. She then meets with her older brother Ignis who has a kid.
GeorgAn old man who Schwarz encounters in the mountains. He then challenges Schwarz to a duel to see who was stronger between the two. One generation later, he shows up again to challenge his rival only to find out that he's dead. He then joins Gray's party.
NPC Living in Frensberge
Tropes relating to all of them:
The Five Guardian Leaders of Agarest
Tropes relating to all of them:
GnadeLeader of the Alister people and is also an elf, descendants of high elves.
FyurenLeader of the Gruut people living at Aegisthus.
HelshaftLeader of the Yurle clan living at Aegisthus.
NPC Of The First Generation
Fastie/FazAn archaeologist who traveled with Weiss in the prologue. He seeks to go back to Zendrook to find out whether the ruins are intact.The end of his story? Not quite. He's actually Mobius in disguise and is responsible for everything that has happened in the game.
SirusA man under the service of the royal family of Aegisthus. He has been suspected that he was in cahoots with the dark forces only to save the party by coming in with reinforcements. Thanks to his actions, he becomes king of the Aegisthus region.
WolfgangThe king of Signihardt Castle in the first generation and Victoria's father.
NPC Of The Second Generation
DanaosA syrium residing in the Graccea region and also assists the leader of the tower. He first appears in the first generation lending a hand to the party members.In the second generation, he has the party gather materials for him to save Rasta from his death. In truth, he is secretly trying to revive Summerill.
NPC Of The Third Generation
Forces Of Darkness
Six Gods of Darkness
MobiusThe true form of Fastie. He is the god of space and time and is the reason why everything happened in the game in the first place.
ChaosThe god of destruction and rebirth and lord of the dark night. He was sealed in Zendrook when the game starts and Weiss killed him.The end of the story? Nope. What had happened was that he and Weiss were talking with each other when Fasti back stabbed Weiss to stab Chaos.
Other Characters
LeinaAn NPC who you'll never see in the game because she's already dead by the time you start the game. Revealed to be Real!Weiss' sister
VarnaThe light goddess who Lenion and Chaos both yearn for.


text:
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Crime, courts and legal issues in Milwaukee and throughout Wisconsin
Ron Johnson getting heat over block on Shorewood nominee
Sen. Ron Johnson has been blocking consideration of Shorewood resident Victoria Nourse's nomination to the federal appeals court, and her supporters have begun making more noise about the delay.
The Journal Sentinel's Washington bureau chief, Craig Gilbert, has the story over on the All Politics blog.
Comments »
Read and share your thoughts on this story.


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Some of our backups failed over the weekend, and again when I re-ran them manually today, with errors about being unable to reach the destination device, a Buffalo Terastation. I tried accessing it via a mapped drive and browsing to it, but couldn't reach it. I could access the management agent, so logged in and was presented with a message about changing the time zone settings to enable synchronisation (or something like that). I pulled it forward an hour, and the backups then started running and the mapped drives worked again.
Did anyone else encounter anything similar, and is the issue with BackupAssist or the Buffalo?
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Group Interventions for Breast Cancer Survivors
This study is currently recruiting participants. (see Contacts and Locations)
Verified August 2014 by Memorial Sloan-Kettering Cancer Center
Memorial Sloan-Kettering Cancer Center
American Cancer Society, Inc.
Information provided by (Responsible Party):
Memorial Sloan-Kettering Cancer Center
ClinicalTrials.gov Identifier:
First received: January 21, 2013
Last updated: August 21, 2014
Last verified: August 2014
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
No Study Results Posted on ClinicalTrials.gov for this Study
|Study Status:
|This study is currently recruiting participants.
|Estimated Study Completion Date:
|January 2015
|Estimated Primary Completion Date:
|January 2015 (Final data collection date for primary outcome measure)