Women with safety concerns report fewer gender-specific preventive healthcare services.
BACKGROUND
Violence and safety exposures, primarily in the form of intimate partner violence (IPV) exposures, have been associated with increased healthcare utilization in women and variable associations with preventive services. It remains unknown, however, if broader measures of violence and safety exposures are associated with preventive healthcare utilization.


METHODS
Data from the 2004 The Philadelphia Health Management Corporation survey were used to compare self-reported utilization of preventive healthcare services for participants who did and did not report exposures to violence or have safety concerns during the past year, using novel but nonvalidated measures of violence and safety concerns. The sample included women aged 18-96 years who reported having a usual source of care. Measures of preventive healthcare utilization included timing of last mammogram, cervical cytology, breast examination, blood cholesterol testing, blood pressure measurement, and screening for colon cancer.


RESULTS
The survey had an American Association for Public Opinion Research response rate of 30.4%. Of the 6285 women surveyed who reported having a usual source of care, 456 (7.3%) reported either an exposure to violence or safety concerns, and 5821 did not. Using logistic regression models, women aged 18-65 years who reported safety concerns were less likely to report having cervical cancer testing in the past 12 months (OR 0.68, 95% CI 0.49-0.94). Women > or =40 years who reported safety concerns in the last year were less likely to report having clinical breast examinations (OR 0.63, 95% CI 0.43-0.93) or mammography (OR 0.57, 95% CI 0.39-0.83). Physical violence exposure was not significantly associated with preventive healthcare utilization.


CONCLUSIONS
In this large population-based sample, women with recent self-reported safety concerns report receiving fewer recommended gender-specific preventive services.
Cronholm
Peter F
PF
Department of Family Medicine and Community Health, Leonard Davis Institute of Health Economics, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA. peter.cronholm@uphs.upenn.edu
Bowman
Marjorie A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010414:Pennsylvania; D015143:Philadelphia; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012449:Safety; D012959:Socioeconomic Factors; D014754:Violence / Q000706:statistics & numerical data*; D016387:Women's Health / Q000706:statistics & numerical data*; D055815:Young Adult