title: Effect of health care system distrust on breast and cervical cancer screening in Philadelphia, Pennsylvania.
abstract: OBJECTIVE
  We investigated whether health care system distrust is a barrier to breast and cervical cancer screening and whether different dimensions of distrust-values and competence-have different impacts on cancer screening.
  
  
  METHODS
  We utilized data on 5268 women aged 18 years and older living in Philadelphia, Pennsylvania, and analyzed their use of screening services via logistic and multinomial logistic regression.
  
  
  RESULTS
  High levels of health care system distrust were associated with lower utilization of breast and cervical cancer screening services. The associations differed by dimensions of distrust. Specifically, a high level of competence distrust was associated with a reduced likelihood of having Papanicolaou tests, and women with high levels of values distrust were less likely to have breast examinations within the recommended time period. Independent of other covariates, individual health care resources and health status were associated with utilization of cancer screening.
  
  
  CONCLUSIONS
  Health care system distrust is a barrier to breast and cervical cancer screening even after control for demographic and socioeconomic determinants. Rebuilding confidence in the health care system may improve personal and public health by increasing the utilization of preventive health services.
authors.affiliation: Population Research Institute at the Pennsylvania State University, University Park, PA 16802, USA. tuy111@psu.edu
authors.forename: Tse-Chuan
authors.initials: TC
authors.lastname: Yang
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Matthews
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Hillemeier
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000517:prevention & control*; D003695:Delivery of Health Care; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D065006:Papanicolaou Test; D015143:Philadelphia; D012959:Socioeconomic Factors; D035502:Trust / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000523:psychology; D055815:Young Adult