OBJECTIVE: This study examines new socio-ecological variables reflecting community context as predictors of mammography use. METHODS: The conceptual model is a hybrid of traditional health-behavioral and socio-ecological constructs with an emphasis on spatial interaction among women and their environments, differentiating between several levels of influence for community context. Multilevel probability models of mammography use are estimated. The study sample includes 70,129 women with traditional Medicare fee-for-service coverage for inpatient and outpatient services, drawn from the SEER-Medicare linked data. The study population lives in heterogeneous California, where mammography facilities are dense but utilization rates are low. RESULTS: Several contextual effects have large significant impacts on the probability of mammography use. Women living in areas with higher proportions of elderly in poverty are 33% less likely to use mammography. However, dually eligible women living in these poor areas are 2% more likely to use mammography than those without extra assistance living in these areas. Living in areas with higher commuter intensity, higher violent crime rates, greater land use mix (urbanicity), or more segregated Hispanic communities exhibit -14%, -1%, -6%, and -3% (lower) probability of use, respectively. Women living in segregated American Indian communities or in communities where more elderly women live alone exhibit 16% and 12% (higher) probability of use, respectively. Minority women living in more segregated communities by their minority are more likely to use mammography, suggesting social support, but this is significant for Native Americans only. Women with disability as their original reason for entitlement are found 40% more likely to use mammography when they reside in communities with high commuter intensity, suggesting greater ease of transportation for them in these environments. CONCLUSIONS: Socio-ecological variables reflecting community context are important predictors of mammography use in insured elderly populations, often with larger magnitudes of effect than personal characteristics such as race or ethnicity (-3% to -7%), age (-2%), recent address change (-7%), disability (-5%) or dual eligibility status (-1%). Better understanding of community factors can enhance cancer control efforts.
OBJECTIVE: This study examines new socio-ecological variables reflecting community context as predictors of mammography use. METHODS: The conceptual model is a hybrid of traditional health-behavioral and socio-ecological constructs with an emphasis on spatial interaction among women and their environments, differentiating between several levels of influence for community context. Multilevel probability models of mammography use are estimated. The study sample includes 70,129 women with traditional Medicare fee-for-service coverage for inpatient and outpatient services, drawn from the SEER-Medicare linked data. The study population lives in heterogeneous California, where mammography facilities are dense but utilization rates are low. RESULTS: Several contextual effects have large significant impacts on the probability of mammography use. Women living in areas with higher proportions of elderly in poverty are 33% less likely to use mammography. However, dually eligible women living in these poor areas are 2% more likely to use mammography than those without extra assistance living in these areas. Living in areas with higher commuter intensity, higher violent crime rates, greater land use mix (urbanicity), or more segregated Hispanic communities exhibit -14%, -1%, -6%, and -3% (lower) probability of use, respectively. Women living in segregated American Indian communities or in communities where more elderly women live alone exhibit 16% and 12% (higher) probability of use, respectively. Minority women living in more segregated communities by their minority are more likely to use mammography, suggesting social support, but this is significant for Native Americans only. Women with disability as their original reason for entitlement are found 40% more likely to use mammography when they reside in communities with high commuter intensity, suggesting greater ease of transportation for them in these environments. CONCLUSIONS: Socio-ecological variables reflecting community context are important predictors of mammography use in insured elderly populations, often with larger magnitudes of effect than personal characteristics such as race or ethnicity (-3% to -7%), age (-2%), recent address change (-7%), disability (-5%) or dual eligibility status (-1%). Better understanding of community factors can enhance cancer control efforts.
Authors: Roger T Anderson; Tse-Chang Yang; Stephen A Matthews; Fabian Camacho; Teresa Kern; Heath B Mackley; Gretchen Kimmick; Christopher Louis; Eugene Lengerich; Nengliang Yao Journal: Health Serv Res Date: 2013-09-30 Impact factor: 3.402
Authors: Robin Taylor Wilson; Jennifer Giroux; Kathryn Rita Kasicky; Bethany Hemlock Fatupaito; Eric C Wood; Renee Crichlow; Neil A Sun Rhodes; Jennifer Tingueley; Andrea Walling; Kathryn Langwell; Nathaniel Cobb Journal: Public Health Rep Date: 2011 Nov-Dec Impact factor: 2.792
Authors: Mandeep K Virk-Baker; Michelle Y Martin; Robert S Levine; Xin Wang; Tim R Nagy; Maria Pisu Journal: Cancer Causes Control Date: 2013-12 Impact factor: 2.506
Authors: Huabin Luo; Gloria L A Beckles; Xinzhi Zhang; Sergey Sotnikov; Ted Thompson; Barbara Bardenheier Journal: J Public Health Manag Pract Date: 2014 Jul-Aug
Authors: Tracy Onega; Christoph I Lee; David Benkeser; Jennifer Alford-Teaster; Jennifer S Haas; Anna N A Tosteson; Deirdre Hill; Xun Shi; Louise M Henderson; Rebecca A Hubbard Journal: J Am Coll Radiol Date: 2016-03-22 Impact factor: 5.532
Authors: Lee Mobley; Tzy-Mey Kuo; Matthew Urato; John Boos; Nancy Lozano-Gracia; Luc Anselin Journal: Cancer Causes Control Date: 2009-11-28 Impact factor: 2.506