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.
Article info
Publication history
Published online: January 24, 2012
Accepted:
November 22,
2011
Received in revised form:
August 24,
2011
Received:
February 4,
2011
Footnotes
The Central Pennsylvania Women’s Health Study was funded, in part, by grant number 4100020719 from the Pennsylvania Department of Health. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions. Dr. McCall-Hosenfeld's effort on the project described was supported by Award Number K12HD055882 (Penn State BIRCWH Program) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health. Dr. Chuang was supported by K23 HD051634 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Identification
Copyright
© 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
