title: Increasing cervical cancer screening among underserved women in a large urban county health system: can it be done? What does it take?
abstract: BACKGROUND
  Further reduction in avoidable cervical cancer morbidity and mortality may require system-wide, integrated approaches implemented in the public health facilities serving the nation's indigent and minority women.
  
  
  OBJECTIVE
  Report on the evaluation of a 5-year demonstration project testing a multicomponent (provider, system, and patient) intervention to increase cervical cancer screening among women who receive their health care through the Los Angeles County Department of Health Services, the second largest County Health Department in the nation.
  
  
  METHODS
  A longitudinal nonequivalent control group design was utilized. Data were collected during a baseline (no intervention) year and 2.5 years of intervention. A large hospital, one feeder Comprehensive Health Centers (CHC), and three of the health center's feeder Public Health Centers (PHC) received the intervention. Another hospital, CHC and its three feeder PHCs (matched on size, patient characteristics, and range of services provided) served as comparison sites. Independent random samples of patients 18 years and older were drawn annually at each site (n = 18,642). The outcome measure was a receipt of a Papanicolaou smear during a 9-month period.
  
  
  RESULTS
  At the Hospital and CHC levels a statistically significant intervention effect was observed after controlling for baseline screening rates and case mix. No intervention effect was observed at the PHCs.
  
  
  CONCLUSIONS
  An intensive multicomponent intervention can increase cervical cancer screening in a large, urban, County health system serving a low-income minority population of under screened women. Retention of program elements in the postresearch phase, and the difficulties and importance of conducting this type of research, is described.
authors.affiliation: From the School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA. bastani@ucla.edu
authors.forename: Roshan
authors.initials: R
authors.lastname: Bastani
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Berman
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Belin
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Marcus
authors.forename: Kiumarss
authors.initials: K
authors.lastname: Nasseri
authors.forename: Nikki
authors.initials: N
authors.lastname: Herman-Shipley
authors.forename: Sol
authors.initials: S
authors.lastname: Bernstein
authors.forename: Carole E
authors.initials: CE
authors.lastname: Henneman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006293:Health Promotion; D006801:Humans; D008137:Longitudinal Studies; D015141:Los Angeles; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011203:Poverty; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D013223:Statistics as Topic; D019037:Urban Health Services / Q000592:standards*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014932:Women's Health Services / Q000592:standards*