title: Regional variations in cancer screening rates found in women with diabetes.
abstract: BACKGROUND
  A review of the literature gives conflicting findings regarding gender-specific cancer screening rates found in women with chronic illness.
  
  
  OBJECTIVE
  The purpose of this study was to determine if women with diabetes have different patterns of cancer screening than women of the general population, and if so, to identify the determinants of these screening patterns guided by the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model.
  
  
  METHODS
  The 12 states using the optional women's health module for the 2003 Behavioral Risk Factor Surveillance System were downloaded into the STATA software. Contingency tables were used to identify the prevalence of cancer screening in women who self-report that they have diabetes in comparison with women who report being nondiabetic. Logistic regression was used to examine the association between the PRECEDE model determinants and the screening behaviors.
  
  
  RESULTS
  No significant association was found between having a diagnosis of diabetes and having mammography screening rates (F = 1.5, p =.22). However, cervical cancer screening rates were statistically significantly different between the two groups of women (F = 39.01, p <.01). A gap in cervical cancer screening rates was identified among women with diabetes as compared with women without diabetes (78% versus 86%, respectively). Regional exceptions were noted between the 12 states. Ten of the 11 PRECEDE variables demonstrated a significant association with Papanicolaou test screening rates. The states demonstrating inadequate screening rates were the states with the most negative PRECEDE factors.
  
  
  CONCLUSIONS
  Research has shown that the primary reason women seek cancer screening is when they are encouraged by a healthcare provider. If other care providers are focused on disease management, nurses who provide holistic care can build on the advocacy role inherent in nursing and encourage screening in underserved areas of the country.
authors.affiliation: Florida A&M University, Tallahassee, FL 32307, USA. janet.marshall@famu.edu
authors.forename: Janet G
authors.initials: JG
authors.lastname: Marshall
authors.forename: Julia M
authors.initials: JM
authors.lastname: Cowell
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Campbell
authors.forename: Diane B
authors.initials: DB
authors.lastname: McNaughton
mesh_terms: D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D016387:Women's Health