title: Breast and cervical screening by race/ethnicity: comparative analyses before and during the Great Recession.
abstract: BACKGROUND
  Traditionally, economic recessions have resulted in decreased utilization of preventive health services.
  
  
  OBJECTIVE
  To explore racial and ethnic differences in breast and cervical cancer screening rates before and during the Great Recession.
  
  
  METHODS
  The Medical Expenditure Panel was the source for identifying 10,894 women, ages 50-74 for breast screening and 19,957 women, ages 21-65 for cervical screening. Survey years included 2004-2005 and 2009-2010. Dependent variables were as follows: 1) receipt of mammogram within the past 2 years; and 2) receipt of a Pap smear within the past 3 years. The interaction of the recession and the likelihood of screening between whites and minorities was analyzed. Multivariate regressions were applied to estimate the likelihood of screening for the two time periods while controlling for a recession variable.
  
  
  RESULTS
  Nationally, breast and cervical cancer screening rates dropped during the recession period; white women contributed most to the decline. However, there were significant improvements in timely screening for both cancers among Hispanics during the recession period. After controlling for the recession, African American women were more likely to have timely screenings compared to white women. Screening rates during the recession were lowest in the South, Midwest and West.
  
  
  CONCLUSIONS
  There was a national reduction in the percentages of women who obtained timely breast and cervical screenings during the Great Recession. Outreach efforts are needed to ensure that women who were not screened during the recession are screened. Widespread education about the Affordable Care Act may be helpful.
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland. Electronic address: cking@umd.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: King
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Garza
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland; Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D057172:Economic Recession / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006304:Health Status; D006801:Humans; D007802:Language; D008875:Middle Aged; D065006:Papanicolaou Test; D044469:Racial Groups / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology*