title: Cultural and educational disparities in the use of primary and preventive health care services among midlife women in Israel.
abstract: OBJECTIVE
  This study aimed to assess rates of primary and preventive healthcare use among women in midlife from different cultural origins and to identify sociodemographic and health characteristics that could explain cultural differences in health care utilization.
  
  
  METHODS
  Data were collected for the Women's Health in Midlife National Study in Israel, in which women aged 45-64 were randomly selected according to age and ethnic/origin group strata: Long-term Jewish residents (n = 540), immigrants from the former Soviet Union (n = 151), and Arab women (n = 123). Interviews included measures of primary and preventive visits, clinical screening services (mammogram, Pap smear, bone density), health and lifestyle, and sociodemographics.
  
  
  RESULTS
  Long-term residents reported more preventive visits and screening tests and lower use of primary care, compared with immigrants and Arab women. In multivariate analyses, cultural group, education, self-rated health, and health motivation were significantly associated with utilization of primary and preventive care. Ethnic/origin group differences were mostly related to cultural differences and not to financial barriers or medical factors. For example, among the more traditional group, namely, Arab women, low use of preventive gynecologic care seemed to be related to the lack of physicians of the same culture and gender.
  
  
  CONCLUSIONS
  The findings underscore the importance of the primary care physician, especially in minority groups, as a provider who can identify at-risk groups and serve as a gateway to health promotion. The findings also suggest that the lack of female providers may be one explanation for the low utilization of gynecologic services among women from traditional cultures.
authors.affiliation: Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel. benyael@post.tau.ac.il
authors.forename: Yael
authors.initials: Y
authors.lastname: Benyamini
authors.forename: Tzvia
authors.initials: T
authors.lastname: Blumstein
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
mesh_terms: D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000706:statistics & numerical data*; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016387:Women's Health