title: Breast and cervical cancer screening specific effects of depression and obesity.
abstract: BACKGROUND
  Obesity and depression may each be associated with lower rates of cervical and breast cancer screening. Studies have examined obesity or depression alone, but not together, despite the established link between them.
  
  
  OBJECTIVE
  This article aims to disentangle the effects of depression and obesity on receipt of breast and cervical cancer screening.
  
  
  METHODS
  A stratified sampling design was used to recruit women aged 40-65 years with information on BMI from an integrated health plan in Washington State in 2003-2005. A telephone survey included the Patient Health Questionnaire-9 for depression, weight, and height. Automated data assessed Paps for 3097 women over a 3-year period and screening mammograms over a 2-year period for 2163 women aged > or =51 years. Logistic regression models (conducted in 2008) examined the association between obesity and depression and receipt of screening tests.
  
  
  RESULTS
  In univariate logistic regression models, women were less likely to receive a Pap if they were obese (OR=0.53, 95% CI=0.41, 0.69) or depressed (OR=0.60, 95% CI=0.42, 0.87). Further, women were less likely to receive a screening mammogram if they were depressed (OR=0.45, 95% CI=0.30, 0.67). In multivariable models, only obesity remained significantly associated with a lower likelihood of Pap screening (OR=0.67, 95% CI=0.0.49, 0.93), and only depression remained significantly associated with lower rates of screening mammography (OR=0.49, 95% CI=0.31, 0.76). Obesity and depression did not interact significantly in either model.
  
  
  CONCLUSIONS
  Obesity and depression appear to have specific effects on receipt of different cancer-screening tests.
authors.affiliation: Group Health Research Institute, 1730 Minor Avenue, Seattle, WA 98101, USA. ludman.e@ghc.org
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Laura E
authors.initials: LE
authors.lastname: Ichikawa
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: Paul
authors.initials: P
authors.lastname: Rohde
authors.forename: David
authors.initials: D
authors.lastname: Arterburn
authors.forename: Belinda H
authors.initials: BH
authors.lastname: Operskalski
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Linde
authors.forename: Robert W
authors.initials: RW
authors.lastname: Jeffery
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003863:Depression / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000523:psychology; D008403:Mass Screening / Q000523:psychology; D008875:Middle Aged; D009765:Obesity / Q000523:psychology*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000523:psychology; D014861:Washington