Tomolo A, Litaker D, Aron D; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 3007.
Louis Stokes Cleveland DVAMC, Medicine, 10701 East Boulevard, 170A (W), Cleveland, OH 44106 Tel. 216-231-3292 Fax 216-421-3008
RESEARCH OBJECTIVE: Screening tests for cervical and breast cancers are valuable in maintaining women's health because of their association with lower mortality through early detection and treatment. Although having a usual source of care and health insurance are characteristics of the individual associated with higher screening rates, the extent to which characteristics of the local health care system (HCS) and the social and economic context in which women live also influence receipt of these services has not been fully explored. We examined the independent association between contextual factors and breast and cervical cancer screening in women. STUDY DESIGN: The Ohio Family Health Survey, a cross-sectional survey conducted in 1998 by telephone with a 53.1% response rate assessed demographics, insurance status, socioeconomic status, and health care needs of Ohio residents. These data were linked at the county-level using data from the 1998 Area Resource File and the 1990 U.S. Census. Guided by the Behavioral Model of Health Care Utilization, we identified operational measures for individual-level and contextual characteristics potentially associated with our outcome measure, the receipt of either breast or cervical cancer screening in age-eligible women. Characteristics reflecting the social and economic context included urbanization, residence in an Appalachian county, and the proportion of 1) residents living in poverty, 2) residents completing high school, and 3) households headed by a woman. HCS attributes included the supply of primary care physicians (PCPs), the proportion of all physicians engaged in primary care, the presence of a residency-training program, designation as a medically underserved county, and the level of managed care activity (MCA). Nested hierarchical logistic regression models tested associations between contextual factors and receipt of either breast or cervical cancer screening tests, adjusting for individual-level characteristics. POPULATION STUDIED: A state-representative sample of 8473 women between the ages of 18-75 years old, living in urban, suburban, and rural settings throughout Ohio. PRINCIPAL FINDINGS: The weighted proportion of women screened by either test was 60.1% (N=5094). There were significant bivariate associations between receipt of screening and individual characteristics: having a high school diploma, continuous insurance, higher family income, a usual source of care, being married/coupled, current employment, and better rating of general health; and county characteristics: greater supply of PCPs, presence of a physician-training program, greater MCA, and increased urbanization (all p <0.001). After accounting for both individual and contextual characteristics, the following county characteristics were independent predictors of receipt of either screening procedure: MCA (adjusted Odds Ratio [AOR], 1.01 (1.00-1.01); p<0.01) and poverty (AOR, 0.97 (0.95-0.99); p<0.01). Significant associations remained with an individuals current health status, insurance status, education, and having a usual source of care. CONCLUSIONS: Characteristics of the HCS and those reflecting economic context are associated with the likelihood a woman will receive cancer screening services. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Although we cannot infer the mechanisms through which this effect occurs, our findings underscore the importance of context on the health of the individual in developing more effective future interventions that improve delivery of preventive services to women.
Publication Types:
Keywords:
- Breast Neoplasms
- Cross-Sectional Studies
- Early Diagnosis
- Female
- Health Services Needs and Demand
- Humans
- Insurance Coverage
- Insurance, Health
- Logistic Models
- Mass Screening
- Odds Ratio
- Ohio
- Poverty
- Primary Health Care
- Social Class
- economics
- methods
- hsrmtgs
UI: 103622470
From Meeting Abstracts