title: Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. black women: a multilevel analysis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA. gdatta@hsph.harvard.edu
authors.forename: Geetanjali D
authors.initials: GD
authors.lastname: Datta
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Julie R
authors.initials: JR
authors.lastname: Palmer
authors.forename: Lynn
authors.initials: L
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009765:Obesity; D065006:Papanicolaou Test; D010349:Patient Compliance; D011203:Poverty; D012111:Residence Characteristics; D012907:Smoking; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics*; D014626:Vaginal Smears; D001741:Black or African American