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Multilevel Analysis of the Determinants of Receipt of Clinical Preventive Services among Reproductive-Age Women

  • Jennifer S. McCall-Hosenfeld
    Correspondence
    Correspondence to: Jennifer S. McCall-Hosenfeld, MD, MSc, Penn State Hershey College of Medicine, 500 University Drive, Mailcode: A210, Hershey, PA 17033. Phone: 717-531-8161; fax: 717-531-7726.
    Affiliations
    Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

    Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Carol S. Weisman
    Affiliations
    Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

    Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Fabian Camacho
    Affiliations
    Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Marianne M. Hillemeier
    Affiliations
    Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

    Department of Health Policy and Administration, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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  • Cynthia H. Chuang
    Affiliations
    Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

    Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Published:January 24, 2012DOI:https://doi.org/10.1016/j.whi.2011.11.005

      Abstract

      Background

      We investigated the impact of individual- and county-level contextual variables on women’s receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities.

      Methods

      Outcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004–2005) were appended to prospective survey data from the Central Pennsylvania Women’s Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women’s preventive care. Multilevel analyses were performed.

      Results

      We found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations.

      Conclusions

      Women’s receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women’s receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.
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      Biography

      Jennifer S. McCall-Hosenfeld, MD, MSc, is Assistant Professor of Medicine and Public Health Sciences. Her research focuses on improving primary care for rural women, including survivors of intimate partner violence.

      Biography

      Carol S. Weisman, PhD, is Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology. She is a sociologist and health services researcher with a special interest in women's primary and preventive care.

      Biography

      Fabian Camacho, MS, is a data analyst and statistical programmer who has experience in applying and interpreting statistical methods used in the social sciences, including longitudinal, multilevel, survival and latent variable analysis.

      Biography

      Marianne M. Hillemeier, PhD, MPH, is Associate Professor of Health Policy and Administration and Public Health Sciences. She is a sociologist and demographer with research interests in maternal and child health disparities.

      Biography

      Cynthia H. Chuang, MD, MSc, is Associate Professor of Medicine and Public Health Sciences. She is a general internist with research interests in reproductive health care for women with chronic medical conditions.