title: Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico.
abstract: Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown.
  
  
  
  Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect.
  
  
  
  Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001).
  
  
  
  Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).
authors.affiliation: Department of Geography, College of Geosciences, Texas A&M University, College Station, Texas.
authors.forename: Yolanda J
authors.initials: YJ
authors.lastname: McDonald
authors.affiliation: Department of Geography, College of Geosciences, Texas A&M University, College Station, Texas.|Department of Computer Science & Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, Texas.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Goldberg
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama, Birmigham, Alabama.
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Scarinci
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Department of Pathology, House of Prevention Epidemiology (HOPE), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors.forename: Michael
authors.initials: M
authors.lastname: Robertson
authors.affiliation: Department of Pathology, House of Prevention Epidemiology (HOPE), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.|Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009516:New Mexico / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012424:Rural Population / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D014505:Urban Population / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control*
keywords: cervical cancer; cervical cancer prevention; geographic accessibility; health care accessibility; health service delivery