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Background Previous studies have examined the impact of material financial hardship on cancer screening but without focusing on the psychological aspects of financial hardship. Purpose This study examined the effects of different types of financial anxiety on adherence to breast cancer screening in women at high risk of breast cancer. Adherence to cervical cancer screening was also examined to determine whether associations between financial anxiety and screening adherence were unique to breast cancer screening or more general. Methods Women (n = 324) aged 30–50 and at high risk for inherited breast cancer completed a survey on general financial anxiety, worry about affording healthcare, financial stigma due to cancer risk, and adherence to cancer screening. Multivariate analyses controlled for poverty, age, and race. Results More financial anxiety was associated with lower odds of mammogram adherence (odds ratio [OR] = 0.97, confidence interval [CI] = 0.94, 0.99), Pap smear adherence (OR = 0.98, CI = 0.96, 0.996), and clinical breast examination adherence (OR = 0.98, CI = 0.96, 0.995). More worry about affording healthcare was associated with lower odds of clinical breast examination adherence (OR = 0.95, CI = 0.91, 0.9992) but not mammogram or Pap smear adherence (p > .05). Financial stigma due to cancer risk was associated with lower odds of Pap smear adherence (OR = 0.87, CI = 0.77, 0.97) but no other cancer screenings (p > .07). Conclusions Financial anxiety may impede cancer screening, even for high-risk women aware of their risk status. Clinical interventions focused on social determinants of health may also need to address financial anxiety for women at high risk of breast cancer.

The history of US government action on HIV/AIDS offers important lessons concerning the limits and possibilities of US public health policy. Yet only the first decade of this history has previously been well-documented. This article updates the history by constructing a macro-level account of policies that have been considered and implemented, along with the discourses and debates that have shaped them. This account is generated through systematic study of many dozens of policy making moments, drawing on >70 original interviews, >20,000 daily news reports and hundreds of contemporaneous policy documents. The paper chronicles HIV/AIDS policy from the initial years when the federal government resisted addressing the crisis; through subsequent periods shaped by alternating Republican and Democratic administrations; to contemporary policy making in an era when broader health policy transitions offer hope of normalized treatment and coverage for people with HIV, and scientific innovations offer the possibility of ending HIV/AIDS itself. It also illuminates how national HIV/AIDS policy is not only a series of responses to the concrete challenges of a health crisis, but also a malleable political product and a resource used to wage broader social and ideological battles.

Recent scholarship on ideational dynamics in policy development has yielded a deeper understanding of policy-making processes previously illuminated by interest- and institution-based analyses, and even more importantly, a newfound ability to account for processes and outcomes those prior approaches failed to explain. Gender scholars have made particularly strong contributions to the case that we cannot understand policy development without its cultural determinants. This new scholarship has laid a solid foundation for approaching culture, ideas, and discourses as constitutive elements of social policy, and we must now move forward to situate these causal arguments within a broader picture of policy development. This article explores four points of connection that help re-position these processes within the larger endeavor of understanding social policy formation. These are: (a) interaction between ideational and other causal dynamics, (b) the interdependence of these processes and its implications for notions of causality in policy analysis, (c) the ways contemporaneous meanings are connected with one another, which reflects the multiplicity of cultures, ideas, and discourses, and (d) the connections between these meanings and discourses across time, which are critical to instances of significant policy change. Each section also explores the empirical and theoretical scholarship on gender that helps illustrate the need to examine these connections.