Adherence of low-income women to cancer screening recommendations.
BACKGROUND
African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts.


OBJECTIVE
To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening.


METHODS
Random-digit-dial and targeted household telephone survey of a population-based sample.


METHODS
Washington, D.C. census tracts with > or =30% of households below 200% of federal poverty threshold.


METHODS
Included in the survey were 1,205 women over age 40, 82% of whom were African American.


METHODS
Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age.


RESULTS
The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.)


CONCLUSIONS
Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships are likely to improve inner-city, low-income women's adherence to cancer screening recommendations.
O'Malley
Ann S
AS
Department of Oncology, Georgetown University Medical Center, 2233 Wisconsin Ave. NW, Suite 440, Washington, D.C. 20007, USA. omalleya@georgetown.edu
Forrest
Christopher B
CB
Mandelblatt
Jeanne
J
D000328:Adult; D016223:Advance Directives; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D005833:Genital Neoplasms, Female / Q000517:prevention & control*; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011203:Poverty; D011320:Primary Health Care / Q000191:economics / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology