title: Neighborhood factors associated with time to resolution following an abnormal breast or cervical cancer screening test.
abstract: BACKGROUND
  The effect of neighborhood and healthcare access factors on cancer outcomes among patients enrolled in navigator programs is not clearly understood. This study assessed associations between: (i) neighborhood factors and diagnostic time to resolution (TTR) and (ii) geographic access and TTR following an abnormal breast or cervical cancer screening test among women participating in the Ohio Patient Navigator Research Program (OPNRP).
  
  
  METHODS
  Patient (demographic, socioeconomic status, home-to-clinic distance) and neighborhood (deprivation, racial segregation) characteristics of 801 women living in one of 285 census tracts (CT) in greater Columbus, Ohio were examined. Randomization to receive navigation occurred at the clinic level. Multilevel Cox regression and spatial analysis were used to estimate effects of various factors on TTR and assess model assumptions, respectively.
  
  
  RESULTS
  TTR increased as neighborhood deprivation increased. After adjustment for age, friend social support, education, and healthcare status, the TTR among women living in a neighborhood with a moderate median household income (between $36,147 and $53,099) was shorter compared with women living in low median household income neighborhoods (<$36,147; P < 0.05). There is little evidence that unmeasured confounders are geographically patterned.
  
  
  CONCLUSIONS
  Increased neighborhood socioeconomic deprivation was associated with longer TTR following an abnormal breast or cervical cancer screening test.
  
  
  CONCLUSIONS
  These results highlight the need for addressing patient- and neighborhood-level factors to reduce cancer disparities among underserved populations.
authors.affiliation: Department of Health Services, School of Public Health, The University of Washington, Seattle, Washington. plascak@uw.edu.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Plascak
authors.affiliation: RBHS-School of Public Health and the Cancer Institute of New Jersey, Rutgers, the State University of New Jersey, New Brunswick, New Jersey.
authors.forename: Adana A
authors.initials: AA
authors.lastname: Llanos
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Pennell
authors.affiliation: Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Rory C
authors.initials: RC
authors.lastname: Weier
authors.affiliation: Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio. Division of Cancer Control and Prevention, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D012959:Socioeconomic Factors; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*