Targeting the underserved for breast and cervical cancer screening: the utility of ecological analysis using the National Health Interview Survey.

Wells, Barbara L.; Horm, John W.

doi:10.2105/ajph.88.10.1484

Cited by 83 publications

(72 citation statements)

References 9 publications

(1 reference statement)

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“…Studies have shown that persons with lower health literacy are less likely to undergo routine cancer screening (7-9). The current results agree with those of prior research involving data from the National Health Interview Study in which women in counties with a lower percentage of residents with high school diplomas were found to have lower cervical cancer screening rates (23).…”

Section: Discussionsupporting

confidence: 90%

Cervical Cancer Screening among Women in Metropolitan Areas of the United States by Individual-Level and Area-Based Measures of Socioeconomic Status, 2000 to 2002

Coughlin

King

Richards

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

109

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Background: Few studies have examined cancer screening among women residing in metropolitan areas in relation to both individual-level and area-based measures of socioeconomic status (SES). To learn more, we examined selfreported rates of Papanicolaou (Pap) testing among women living in metropolitan areas in relation to individual-level measures of SES (household income and education), and area-based measures of SES (percentage of residents living in poverty, percentage with low education, and percentage working class). Methods: Data were obtained from women who were interviewed by telephone during 2000 and 2002 as part of the Behavioral Risk Factor Surveillance System (BRFSS). Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas. Only BRFSS respondents who resided in 35 metropolitan statistical areas with a population of z1.5 million in 2000 were included in this analysis. Analyses were limited to women ages z18 years with no history of hysterectomy (n = 49,231). Area-based measures of SES were obtained

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Section: Discussionsupporting

confidence: 90%

Cervical Cancer Screening among Women in Metropolitan Areas of the United States by Individual-Level and Area-Based Measures of Socioeconomic Status, 2000 to 2002

Coughlin

King

Richards

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

109

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“…Neighborhood-level data are derived from a methodology developed by Wells and Horm (1998) of the National Center for Health Statistics (NCHS). To protect respondents, NCHS excludes small geographic identifiers from public release data sets.…”

Section: Methods Datamentioning

confidence: 99%

Race Differentials in Obesity: The Impact of Place

et al. 2005

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This article reveals race differentials in obesity as both an individual-and neighborhood-level phenomena. Using neighborhood-level data from the 1990-1994 National Health Interview Survey, we find that neighborhoods characterized by high proportions of black residents have a greater prevalence of obesity than areas in which the majority of the residents are white. Using individual-level data, we also find that residents of neighborhoods in which at least one-quarter of the residents are black face a 13 percent increase in the odds of being obese compared to residents of other communities. The association between neighborhood racial composition and obesity is completely attenuated after including statistical controls for the poverty rate and obesity prevalence of respondents' neighborhoods. These findings support the underlying assumptions of both institutional and social models of neighborhood effects.The causes of obesity, including the social relationships that mediate and moderate the relationship between various risk factors and obesity, are complex (Weinsier et al. 1998;Whitaker 2002;Bloomgarden 2002). As research consistently demonstrates that behaviors affecting health are rooted within individuals' social environments (Berkman and Kawachi 2000), it is critical to broaden the scope of inquiry such that health is understood not only as a function of individual traits, but also as related to the environments in which people live (MacIntyre and Ellaway 2003;Robert 1999). These environments include physical space as well as community attitudes and behaviors that characterize these places (Frolich, Corin, and Potvin 2001). Although literature linking residential context to health has increased sharply in recent years (see Kawachi and Berkman 2003 for an overview), little work has examined obesity as an outcome. This article contributes to the growing body of work focusing on the ecological correlates of health and makes a timely contribution to the recent focus on obesity in both academic and popular settings.It is important to fully understand obesity because obesity prevalence among U.S. adults has increased to epidemic levels; has contributed to an increased risk of disease, disability, and death; and has led to an escalation in health care costs (Allison, Zannolli, and Narayan 1999; Wang et al. 2002). Over the last 25 years, the prevalence of adult obesity has more than doubled; in 1976 only 15 percent of the adult population was obese, but by 2000 adult obesity rates surpassed 30 percent (NCHS 2003). This increase is particularly problematic because obesity is associated with an increased risk of serious health problems including type-2 diabetes, gallbladder disease, high blood pressure, and heart disease (Flegal et al. 2002;Calle et al. 2003;Kaplan 2000;Must et al. 1999). More importantly, obesity increases the risk of a number of causes of death and is believed to contribute to approximately 14 and Fontaine et al. 1999;McGinnis and Foege 1993;Rogers, Hummer, and Krueger 2003;Sturm 2002). NI...

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“…24 In another analysis, again controlling for individual social and economic characteristics, the odds of never having a mammogram among women residing in areas (roughly corresponding to census block groups) in which the median education was less than 12 years, compared to areas in which the median education was more than 15 years, were increased by 69%. 25 A recent study using Surveillance, Epidemiology, and End Results (SEER) program data from three U.S. metropolitan areas found that among women diagnosed with breast cancer, those who resided in highpoverty census tracts (i.e., census tracts with 40% or more of residents with incomes below poverty) were 39% more likely than those residing in lower-poverty census tracts (i.e., neighborhoods with less than 20% of residents with incomes below poverty) to have late-stage disease. 26 In a study of women diagnosed with breast cancer in New York City, the odds of an advanced-stage diagnosis were increased by 50% for African American women and by 75% for White women who lived in areas with lower levels of education and income compared to women living in other areas.…”

Section: Introductionmentioning

confidence: 99%

“…Previously proposed explanations for neighborhood effects on breast cancer screening rates and late-stage diagnosis address access issues, principally focusing on supply of health care services. [24][25][26]28 Geographic location of mammography facilities-creating neighborhood differences in distance or travel time to mammography services-may be an additional explanation for lower utilization of mammography and heightened risk of late-stage diagnosis among residents of economically disadvantaged neighborhoods. Two studies, including one in a major metropolitan area, have found that people who lived farther away from facilities were less likely to undergo mammography than those who lived closer to facilities.…”

Section: Introductionmentioning

confidence: 99%

Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

Zenk

Tarlov²,

Sun³

2006

J Urban Health

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Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low-or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African-Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low-or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures-distance and public transportation travel time-is less strong in African-American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African-American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African-American residents. Thus, it appears that the spatial accessibility of low-and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.

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Targeting the underserved for breast and cervical cancer screening: the utility of ecological analysis using the National Health Interview Survey.

Cited by 83 publications

References 9 publications

Cervical Cancer Screening among Women in Metropolitan Areas of the United States by Individual-Level and Area-Based Measures of Socioeconomic Status, 2000 to 2002

Cervical Cancer Screening among Women in Metropolitan Areas of the United States by Individual-Level and Area-Based Measures of Socioeconomic Status, 2000 to 2002

Race Differentials in Obesity: The Impact of Place

Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

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