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Individual‐, neighborhood‐, and state‐level socioeconomic predictors of cervical carcinoma screening among U.S. black women
Author(s) -
Datta Geetanjali D.,
Colditz Graham A.,
Kawachi Ichiro,
Subramanian S.V.,
Palmer Julie R.,
Rosenberg Lynn
Publication year - 2005
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21660
Subject(s) - medicine , socioeconomic status , demography , cervical cancer , residence , odds ratio , confidence interval , cancer screening , papanicolaou stain , poverty , logistic regression , gynecology , cancer , gerontology , population , environmental health , sociology , economics , economic growth
BACKGROUND Cervical carcinoma is the fifth most common cancer among African American women in the U.S. Although the Papanicolaou (Pap) smear is an efficacious screening tool in the early detection of the disease, disparities are known to persist in the utilization of this procedure across socioeconomic groups. METHODS Data regarding cervical carcinoma screening and covariates were obtained from the 59,090 Black Women's Health Study participants across the U.S. via a mailed questionnaire in 1995. Logistic regression and multilevel techniques were used to assess the independent effects of the covariates on nonrecent cervical carcinoma screening. RESULTS In all, 8.3% of the 40,009 women in the present analysis had not undergone a Pap smear examination within the previous 2 years (nonrecent screening). Lower educational attainment, older age, obesity, smoking, and neighborhood poverty were found to be independently related to increased risk of nonrecent screening. The adjusted odds ratio for nonrecent screening was 1.2 (95% confidence interval [95% CI], 1.1–1.4) for women residing in neighborhoods with 20% or more poverty compared with those in neighborhoods with less than 5% poverty. State of residence was also associated with nonrecent cervical carcinoma screening. CONCLUSION These results suggest that among black women, residence in high‐poverty (20%) neighborhoods is associated with an increased risk of nonrecent cervical carcinoma screening, independent of individual level risk factors. Cancer 2006. © 2005 American Cancer Society.