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Levine RS, Kilbourne BJ, Sanderson M, Fadden MK, Pisu M, Salemi JL, Mejia de Grubb MC, O’Hara H, Husaini BA, Zoorob RJ, Hennekens CH. Lack of validity of self-reported mammography data. Fam Med Community Health 2019; 7:e000096. [PMID: 32148699 PMCID: PMC6910732 DOI: 10.1136/fmch-2018-000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/06/2019] [Indexed: 11/04/2022] Open
Abstract
This qualitative literature review aimed to describe the totality of peer-reviewed scientific evidence from 1990 to 2017 concerning validity of self-reported mammography. This review included articles about mammography containing the words accuracy, validity, specificity, sensitivity, reliability or reproducibility; titles containing self-report, recall or patient reports, and breast or 'mammo'; and references of identified citations focusing on evaluation of 2-year self-reports. Of 45 publications meeting the eligibility criteria, 2 conducted in 1993 and 1995 at health maintenance organisations in Western USA which primarily served highly educated whites provided support for self-reports of mammography over 2 years. Methodological concerns about validity of self-reports included (1) telescoping, (2) biased overestimates particularly among black women, (3) failure to distinguish screening and diagnostic mammography, and (4) failure to address episodic versus consistent mammography use. The current totality of evidence supports the need for research to reconsider the validity of self-reported mammography data as well as the feasibility of alternative surveillance data sources to achieve the goals of the Healthy People Initiative.
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Affiliation(s)
- Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Barbara J Kilbourne
- Department of Sociology, Tennessee State University, Nashville, Tennessee, USA
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Mary K Fadden
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Maria Pisu
- University of Alabama School of Medicine at Birmingham, Birmingham, Alabama, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Heather O’Hara
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Baqar A Husaini
- Department of Sociology, Tennessee State University, Nashville, Tennessee, USA
| | - Roget J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Charles H Hennekens
- Charles E Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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Hughes DR. Can You Do Health Disparities Research with Publicly Available Datasets? Acad Radiol 2018; 25:552-555. [PMID: 29352641 DOI: 10.1016/j.acra.2017.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES Given the growing importance of identifying and reducing health disparities, it is important for radiologist researchers to engage in this space to promote evidence-based imaging disparities policy. However, researchers are often hindered by access to appropriate data to perform quality research. MATERIALS AND METHODS This paper reviews existing publicly available data sets that may be useful for performing imaging disparities research. RESULTS Multiple data sources are publicly available and have been used by previous researchers to examine imaging disparities. CONCLUSIONS This paper provides an overview of publicly available data sources that radiologists can use for imaging disparities research. Appropriate use of these data sources will require researchers to carefully consider the overall research question and level of analysis.
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Gonzales FA, Willis GB, Breen N, Yan T, Cronin KA, Taplin SH, Yu M. An Exploration of Changes in the Measurement of Mammography in the National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2017; 26:1611-1618. [PMID: 28887296 DOI: 10.1158/1055-9965.epi-17-0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/14/2017] [Accepted: 09/01/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Using the National Health Interview Survey (NHIS), we examined the effect of question wording on estimates of past-year mammography among racially/ethnically diverse women ages 40-49 and 50-74 without a history of breast cancer.Methods: Data from one-part ("Have you had a mammogram during the past 12 months?") and two-part ("Have you ever had a mammogram"; "When did you have your most recent mammogram?") mammography history questions administered in the 2008, 2011, and 2013 NHIS were analyzed. χ2 tests provided estimates of changes in mammography when question wording was either the same (two-part question) or differed (two-part question followed by one-part question) in the two survey years compared. Crosstabulations and regression models assessed the type, extent, and correlates of inconsistent responses to the two questions in 2013.Results: Reports of past-year mammography were slightly higher in years when the one-part question was asked than when the two-part question was asked. Nearly 10% of women provided inconsistent responses to the two questions asked in 2013. Black women ages 50 to 74 [adjusted OR (aOR), 1.50; 95% confidence interval (CI), 1.16-1.93] and women ages 40-49 in poor health (aOR, 2.22; 95% CI, 1.09-4.52) had higher odds of inconsistent responses; women without a usual source of care had lower odds (40-49: aOR, 0.42; 95% CI, 0.21-0.85; 50-74: aOR, 0.42; 95% CI, 0.24-0.74).Conclusions: Self-reports of mammography are sensitive to question wording. Researchers should use equivalent questions that have been designed to minimize response biases such as telescoping and social desirability.Impact: Trend analyses relying on differently worded questions may be misleading and conceal disparities. Cancer Epidemiol Biomarkers Prev; 26(11); 1611-8. ©2017 AACR.
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Affiliation(s)
- Felisa A Gonzales
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Gordon B Willis
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Nancy Breen
- Office of Strategic Planning, Legislation, and Scientific Policy, National Institute of Minority Health and Health Disparities, Bethesda, Maryland
| | | | - Kathy A Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Stephen H Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Mandi Yu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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The Role of Socioeconomic Status and Health Care Access in Breast Cancer Screening Compliance Among Hispanics. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:467-76. [PMID: 25756197 DOI: 10.1097/phh.0000000000000235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Considerable disparities in breast cancer screening exist between Hispanic and non-Hispanic white (NHW) women. Identifying and quantifying the factors contributing to these racial-ethnic disparities can help shape interventions and policies aimed at reducing these disparities. This study, for the first time, identified and quantified individual-level sociodemographic and health-related factors that contribute to racial-ethnic disparities in breast cancer screening using the nonlinear Blinder-Oaxaca decomposition method. METHODS Analysis of the retrospective pooled cross-sectional Medical Expenditure Panel Survey data from 2000 to 2010 was conducted. Women aged 40 years and older were included in the study. Logistic regressions were used to estimate racial-ethnic disparities in breast cancer screening. Nonlinear Blinder-Oaxaca decomposition method was used to identify and quantify the contribution of each individual-level factor toward racial-ethnic disparities. RESULTS Based on the unadjusted analyses, Hispanic women had lower odds of receiving mammogram screening (MS) (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.69-0.80) and breast cancer screening (OR: 0.75; 95% CI: 0.70-0.81) as compared with NHW women. However, the relationship reversed in adjusted analyses, such that Hispanic women had higher odds of receiving MS (OR: 1.27; 95% CI: 1.16-1.40) and breast cancer screening (OR: 1.28; 95% CI: 1.17-1.40) as compared with NHW women. The Blinder-Oaxaca decomposition estimated that improving insurance status, access to care, education, and income will considerably increase screening rates among Hispanic women. CONCLUSIONS The study projects that improving health care access and health education will considerably increase breast cancer screening compliance among Hispanic women. Policies like the Affordable Care Act, and patient navigation and health education interventions, might considerably reduce screening disparities in the Hispanic population.
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Dixit N, Crawford GB, Lemonde M, Rittenberg CN, Fernández-Ortega P. Left behind: cancer disparities in the developed world. Support Care Cancer 2016; 24:3261-4. [DOI: 10.1007/s00520-016-3192-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
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Preventive services for adults: how have differences across subgroups changed over the past decade? Med Care 2013; 51:999-1007. [PMID: 24036996 DOI: 10.1097/mlr.0b013e3182a97bc0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A large literature documents cross-sectional differences in adult preventive services across population subgroups. Less is known, however, about how these differences have changed over time. OBJECTIVES This study tracks changes over time in the distribution of preventive services use across groups defined by poverty status, race/ethnicity, insurance coverage, Census region, and urbanicity. METHODS Data from the 1996-2008 Medical Expenditure Panel Survey are used to examine 5 preventive services: general checkups, blood pressure screening, blood cholesterol screening, Pap smears, and mammograms. Multivariate logistic regression models of preventive services use are used to compute adjusted utilization for each subgroup of adults aged 19-64 in 1996/1998, 2002/2003, and 2007/2008. We then examine the extent to which percentage point gaps in utilization rates across subgroups have changed between 1996/1998 and 2007/2008. RESULTS Our analysis of utilization rates across subgroups and over time identified only rare cases in which subgroup differences narrowed or widened between 1996/1998 and 2007/2008. Rather, differences across subgroups tended to persist over time. Some of the largest (adjusted) gaps are between adults with and without coverage, and only for blood cholesterol screening do we observe significant narrowing of the gap between the uninsured and the privately insured. Regional differences persisted or widened over the study period. CONCLUSIONS On the eve of health reform implementation, a key challenge facing the Affordable Care Act will be to address persistent differences in preventive services use within the US population.
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Lofters AK, Moineddin R, Hwang SW, Glazier RH. Does social disadvantage affect the validity of self-report for cervical cancer screening? Int J Womens Health 2013; 5:29-33. [PMID: 23378784 PMCID: PMC3558311 DOI: 10.2147/ijwh.s39556] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim was to review the international literature on the validity of self-report of cervical cancer screening, specifically of studies that made direct comparisons among women with and without social disadvantage, based on race/ethnicity, foreign-born status, language ability, income, or education. Method The databases of Medline, EBM Reviews, and CINAHL from 1990 to 2011 were searched using relevant search terms. Articles eligible for data extraction documented the prevalence of cervical cancer screening based on both self-report and an objective measure for women both with and without at least one measure of social disadvantage. The report-to-record ratio, the ratio of the proportion of study subjects who report at least one screening test within a particular time frame to the proportion of study subjects who have a record of the same test within that time frame, was calculated for each subgroup. Results Five studies met the extraction criteria. Subgroups were based on race/ethnicity, education, and income. In all studies, and across all subgroups, report-to-record ratios were greater than one, indicative of pervasive over-reporting. Conclusion The findings suggest that objective measures should be used by policymakers, researchers, and public-health practitioners in place of self-report to accurately determine cervical cancer screening rates.
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Affiliation(s)
- Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto ; Department of Family and Community Medicine, St Michael's Hospital, Toronto ; Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto
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Miranda PY, Tarraf W, González P, Johnson-Jennings M, González HM. Breast cancer screening trends in the United States and ethnicity. Cancer Epidemiol Biomarkers Prev 2012; 21:351-7. [PMID: 22147364 PMCID: PMC3415267 DOI: 10.1158/1055-9965.epi-11-0873] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The study objectives were to compare and examine mammography use trends among ethnic/racial women in the context of United States Healthy People 2010 goals. METHODS We analyzed pooled, multistage probability sample data from the 1996-2007 Medical Expenditure Panel Survey. Included in the sample were female respondents of ages 40 to 75 years (N = 64,811) from six ethnic/racial groups (Black, White, Mexican, Other Latinas, Puerto Rican, and Cuban). The primary outcome was self-reported, past two-year mammography use consistent with screening practice guidelines. RESULTS We found that for most U.S. women, the Healthy People 2010 mammography goal (70%) was achieved between 1996 and 2007. Puerto Rican and White women, respectively, had the highest mammography rates, and Black and Cuban women had rates that approached the 2010 goal. CONCLUSION Mexican Latinas reported the lowest rates of past two-year mammography; however, factors enabling healthcare access markedly moderated this lower likelihood. From 2000, Mexican Latinas' mammography use was markedly below (10%) the Healthy People 2010 goal and remained there for the duration. IMPACT Our findings indicate that healthcare equity goals are attainable if efforts are made to reach a sizeable portion of vulnerable populations.
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Affiliation(s)
- Patricia Y Miranda
- Wayne State University, Institute of Gerontology & Department of Family Medicine & Public Health Sciences, Division of Population Health Science, 87 East Ferry Street, Knapp Building, Room 234, Detroit, MI 48202, USA
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Miranda PY, Tarraf W, González HM. Breast cancer screening and ethnicity in the United States: implications for health disparities research. Breast Cancer Res Treat 2011; 128:535-42. [PMID: 21298477 DOI: 10.1007/s10549-011-1367-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/22/2011] [Indexed: 11/29/2022]
Abstract
Ethnic and racial minority women within the U.S. are less likely to use breast cancer screening (BCS) procedures than non-Latina White women, and are more likely to be diagnosed with cancer at later stages of disease. Previous studies examining Latina rates of screening and disease have used aggregated populations for comparison, possibly attenuating important ethnic healthcare disparities and yielding misleading findings. The purpose of this study was to examine if ethnicity matters in understanding current estimates of BCS patterns among U.S. women; to test if healthcare disparities in BCS are present, and if any ethnic/racial groups are primarily affected. The authors used multivariate multinomial regression to examine self-reported mammogram and clinical breast exam in the 2007 full-year U.S. Medical Expenditure Panel Survey. Mexican origin women reported the lowest rates of past-year mammograms and clinical breast examination. Factors enabling healthcare moderated the group's lower likelihood of mammograms and clinical breast examination. Some breast cancer screening parity appears to have been achieved in 2007 for Black and some Latina groups; however, those rates lag behind for the largest Latino ethnic group, Mexican. Factors enabling healthcare access, such as education, income and insurance, attenuated the BCS inequalities found for Mexican origin women. Findings suggest that successful efforts to reduce BCS disparities be strategically redirected to include women of Mexican origin in addition to other underserved populations.
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Affiliation(s)
- Patricia Y Miranda
- Department of Health Policy and Administration, The Pennsylvania State University, 601G Ford Building, University Park, PA 16802, USA
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Vargas Bustamante A, Chen J, Rodriguez HP, Rizzo JA, Ortega AN. Use of preventive care services among Latino subgroups. Am J Prev Med 2010; 38:610-9. [PMID: 20494237 DOI: 10.1016/j.amepre.2010.01.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 12/01/2009] [Accepted: 01/11/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies demonstrate a clear gap in access and receipt of preventive care between Latinos and non-Latino whites. Most of this work, however, pools Latinos together when they compare different racial and ethnic groups. There is currently no information about the consistency of preventive care utilization across major Latino subgroups. PURPOSE This study tests for three bundles of preventive care services to analyze the main determinants of adult preventive care receipt among the largest subgroups of U.S. Latinos and non-Latino whites. It also examines the contribution of observed and unobserved factors in explaining differences in the provision of preventive care services. METHODS The Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2006 were merged in 2009. The sample consisted of 28,781 Latinos and 78,979 non-Latino whites. This study compared disparities in the receipt of adult preventive care services and separately examined differences in the provision of the most cost-effective preventive services. Multivariate models adjust for confounding factors. The decomposition technique was used to parse out differences into observed and unobserved components. RESULTS Latinos of Mexican and Central/South American origin are much less likely to receive guideline-recommended preventive care services than non-Latino whites and other Latino subgroups. Larger disparities were observed for the most cost-effective preventive care services: smoking-cessation advice, colorectal cancer screening, and influenza vaccination. Observed factors accounted for a larger share of disparities across measures (33%-100%), with lack of health insurance coverage and not having a usual source of care as the largest and most consistent factors explaining disparities. CONCLUSIONS Health insurance coverage expansion and more integration of Latinos into primary care practices can substantially reduce disparities in the receipt of preventive care services. Preventive care initiatives should prioritize the availability of cost-effective services among Latinos of Mexican and Central/South American heritage.
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Clark CR, Baril N, Kunicki M, Johnson N, Soukup J, Lipsitz S, Bigby J. Mammography use among Black women: the role of electronic medical records. J Womens Health (Larchmt) 2009; 18:1153-62. [PMID: 19630545 DOI: 10.1089/jwh.2008.1153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS Accurately documenting mammography use is essential to assess quality of care for early breast cancer detection in underserved populations. Self-reports and medical record reports frequently result in different accounts of whether a mammogram was performed. We hypothesize that electronic medical records (EMRs) provide more accurate documentation of mammography use than paper records, as evidenced by the level of agreement between women's self-reported mammography use and mammography use documented in medical records. METHODS Black women aged 40-75 were surveyed in six primary care sites in Boston, Massachusetts (n = 411). Survey data assessed self-reported mammography prevalence within 2 years of study entry. Corresponding medical record data were collected at each site. Positive predictive value (PPV) of self-report and kappa statistics compared data agreement among sites with and without EMRs. Logistic regression estimated effects of site and patient characteristics on agreement between data sources. RESULTS Medical records estimated a lower prevalence of mammography use (58%) than self-report (76%). However, self-report and medical record estimates were more similar in sites with EMRs. PPV of self-report was 88% in sites with continuous access to EMRs and 61% at sites without EMRs. Kappa statistics indicated greater data agreement at sites with EMRs (0.72, 95% CI 0.56-0.88) than without EMRs (0.46, 95% CI 0.29-0.64). Adjusted for covariates, odds of data agreement were greatest in sites where EMRs were available during the entire study period (OR 4.31, 95% CI 1.67-11.13). CONCLUSIONS Primary care sites with EMRs better document mammography use than those with paper records. Patient self-report of mammography screening is more accurate at sites with EMRs. Broader access to EMRs should be implemented to improve quality of documenting mammography use. At a minimum, quality improvement efforts should confirm the accuracy of paper records with supplemental data.
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Affiliation(s)
- Cheryl R Clark
- Center for Community Health and Health Equity, Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Craig BM, Quinn GP, Vadaparampil ST. Sensitivity of self-report mammography use in older women. Am J Prev Med 2009; 37:441-4. [PMID: 19840700 PMCID: PMC3864094 DOI: 10.1016/j.amepre.2009.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/27/2009] [Accepted: 07/14/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent survey evidence indicates a decline in mammography use among older women. PURPOSE The objective of this study was to detect sensitivity of self-reported mammography use and pose evidence-based suggestions to increase survey accuracy. METHODS Using the 1991-2006 Medicare Current Beneficiary Survey, 15,357 women, aged > or =65 years, were selected based on use of mammography services. The women were interviewed in the community setting at random periods after screening and asked, Have you had a mammogram or breast X-ray since [today's date or previous supplement round interview date] a year ago? Statistical analyses were conducted between March 11 and April 28 of 2008. This study tested whether sensitivity (i.e., probability of an affirmative response) was dependent on length of the recall period and on respondent demographic and socioeconomic characteristics. RESULTS Overall, 90.4% of the older women self-reported use; however, sensitivity decreased as the recall period lengthened (90% at 6 months, 80% at 12 months). This time effect was significantly higher among older, economically disadvantaged women. Sensitivity also decreased an additional 13.8% if the event occurred in the previous calendar year, and 3.5% if conducted in a non-English language or by proxy. CONCLUSIONS Greatest sensitivity occurred during the 6-month period after service without straddling calendar years. These findings may aid the tailoring of future surveys for older adults, improving the recall of preventive services.
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Affiliation(s)
- Benjamin M Craig
- Health Outcomes and Behavior Program, Moffitt Cancer Center, University of South Florida, Tampa, FL 33612-9416, USA.
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Trends in Work Hours and Vacation Time Among Radiologists in the United States. AJR Am J Roentgenol 2009; 193:1136-40. [DOI: 10.2214/ajr.09.2508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bodurtha J, Quillin JM, Tracy KA, Borzelleca J, McClish D, Wilson DB, Jones RM, Quillin J, Bowen D. Mammography screening after risk-tailored messages: the women improving screening through education and risk assessment (WISER) randomized, controlled trial. J Womens Health (Larchmt) 2009; 18:41-7. [PMID: 19105686 DOI: 10.1089/jwh.2007.0703] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIMS A randomized trial investigated the impact of risk-tailored messages on mammography in diverse women in the Virginia Commonwealth University Health System's gynecology clinics. METHODS From 2003 to 2005, 899 patients > or =40 years of age were randomized to receive risk-tailored information or general information about breast health. Multiple logistic regression analyses summarize their breast health practices at 18 months. RESULTS At baseline, 576 (64%) women reported having a mammogram in the past year. At 18-month follow-up, mammography rates were 72.6% in the intervention group and 74.2% in the control group (N.S.). Women (n = 123) who reported worrying about breast cancer "often" or "all the time" had significantly higher mammography rates with the intervention (85.0%) vs. the controls (63.5%). No significant differences existed in clinical breast examination, self-examination, or mammography intentions between the two study arms. However, intervention women with lower education reported significantly fewer clinical breast examinations at follow-up. CONCLUSIONS The brief intervention with a risk-tailored message did not have a significant effect overall on screening at 18 months. However, among those who worried, mammography rates in the intervention group were higher. Individual characteristics, such as worry about breast cancer and education status, may impact interventions to improve breast cancer prevention practices.
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Affiliation(s)
- Joann Bodurtha
- Human and Molecular Genetics, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Burgess DJ, Powell AA, Griffin JM, Partin MR. Race and the validity of self-reported cancer screening behaviors: development of a conceptual model. Prev Med 2009; 48:99-107. [PMID: 19118570 DOI: 10.1016/j.ypmed.2008.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 11/19/2008] [Accepted: 11/24/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many estimates of cancer screening are based on self-reported screening behavior. There is growing concern that self-reported screening measures may be less accurate among members of racial and ethnic minority groups. This would have considerable implications for research on racial and ethnic disparities in cancer screening. OBJECTIVES To review the literature on the relationship between race/ethnicity and the accuracy of self-reported cancer screening behavior and develop a conceptual framework that would provide a deeper understanding of factors underlying this relationship. METHODS We developed a conceptual framework drawing from diverse literatures including validation studies examining the accuracy of self-reported cancer screening behaviors and articles on survey response bias. RESULTS AND CONCLUSIONS Evidence suggests that racial and ethnic minorities may be less likely to provide accurate reports of their cancer screening behavior and that overreporting may be particularly problematic. Research conducted in other areas suggests that these sources of measurement error may stem from cognitive and motivational processes and that they can be moderated by question wording and data collection characteristics. At this point, however, the quality of the evidence is not strong and more research is needed before definitive conclusions can be drawn.
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Affiliation(s)
- Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, MN 55417, USA.
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Blackwell DL, Martinez ME, Gentleman JF. Women’s Compliance with Public Health Guidelines for Mammograms and Pap tests in Canada and the United States. Womens Health Issues 2008; 18:85-99. [DOI: 10.1016/j.whi.2007.10.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 09/17/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
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Farmer D, Reddick B, D'Agostino R, Jackson SA. Psychosocial Correlates of Mammography Screening in Older African American Women. Oncol Nurs Forum 2007; 34:117-23. [PMID: 17562638 DOI: 10.1188/07.onf.117-123] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore psychosocial correlates of older African American women's adherence to annual mammography screening, including cancer fatalism, dispositional optimism, social support, knowledge of breast cancer screening guidelines, perceptions of general health, and components of the Health Belief Model (HBM), and to examine factors associated with annual mammography screening. DESIGN Cross-sectional survey. SETTING Central North Carolina. SAMPLE 198 African American women aged 50-98 years living in low-income housing. METHODS Women attended group sessions at low-income housing complexes and completed questionnaires. Differences between women who had or did not have a mammogram in the previous year were explored using correlate variables associated with the HBM. Stepwise multivariable regression models were fit to explore factors associated with social support and significant components of the HBM. MAIN RESEARCH VARIABLES Demographics, cancer fatalism, dispositional optimism, social support, perceptions of general health, components of the HBM, and mammography in the past year. FINDINGS The groups did not differ by age, education, marital status, having a friend or family member with breast cancer, ever having had a clinical breast examination, self-rated health, cancer fatalism, dispositional optimism, or feelings about the seriousness of and their susceptibility to breast cancer. The groups differed significantly on mammogram-related variables, how often women should have clinical breast examinations, benefits and barriers to mammography screening, and social support. Stepwise multivariable regression analyses showed that dispositional optimism and social support were related significantly to perception of benefits; education, dispositional optimism, and cancer fatalism were related to barriers; and dispositional optimism was related to social support. CONCLUSIONS Older, low-income, African American women have perceived barriers to cancer screening, educational and cancer knowledge detriments, and a lack of health-related social support that may decrease adherence to mammography screening. IMPLICATIONS FOR NURSING The next step is to develop culturally appropriate educational interventions that increase knowledge about breast cancer and screening guidelines, enhance health-related social support, and address barriers and perhaps cancer fatalism in older, low-income, African American women.
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Affiliation(s)
- Deborah Farmer
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Hirschman J, Whitman S, Ansell D. The black:white disparity in breast cancer mortality: the example of Chicago. Cancer Causes Control 2007; 18:323-33. [PMID: 17285262 DOI: 10.1007/s10552-006-0102-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Accepted: 12/02/2006] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The black:white disparity in breast cancer mortality has been increasing in the U.S. In order to gain insight into this disparity in Chicago, we examined mortality data together with other important measures associated with breast cancer. METHODS Trends in black:white female breast cancer mortality, incidence, stage at diagnosis, and mammography screening in Chicago were examined using data from the Illinois State Cancer Registry, Illinois Department of Public Health Vital Records, and the Illinois Behavioral Risk Factor Surveillance System. RESULTS The breast cancer mortality rate for black women in Chicago for 1999-2003 was 49% higher than that of white women, but the disparity is a recent phenomenon that is increasing rapidly. In 2003 the black rate was 68% higher than the white rate. Mortality rates were similar in the 1980's and only started to diverge in the 1990's as a result of a sharp improvement in mortality among white women contrasted with no improvement for black women. This lack of progress for black women is perplexing given that self-reported mammography screening rates have been the same for blacks and whites in Chicago since at least 1996 and that the early detection of breast cancer for black women has been increasing. CONCLUSIONS There has been no improvement in mortality from breast cancer for black women in Chicago in 23 years. This study, along with a review of the literature, lends support to the hypothesis that the disparities in breast cancer mortality are due to differential access to mammography, differential quality in mammography, and differential access to treatment for breast cancer. Fortunately, all three are amenable to intervention, which would help ameliorate this unacceptable disparity.
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Affiliation(s)
- Jocelyn Hirschman
- Sinai Urban Health Institute, Sinai Health System, Mount Sinai Hospital, Room K430, 1500 South California Avenue, and Rush University Medical Center, Chicago, IL 60608, USA.
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Fiscella K, Holt K, Meldrum S, Franks P. Disparities in preventive procedures: comparisons of self-report and Medicare claims data. BMC Health Serv Res 2006; 6:122. [PMID: 17010195 PMCID: PMC1592485 DOI: 10.1186/1472-6963-6-122] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 09/29/2006] [Indexed: 12/04/2022] Open
Abstract
Background Racial/ethnic disparities are assessed using either self-report or claims data. We compared these two data sources and examined contributors to discrepancies in estimates of disparities. Methods We analyzed self-report and matching claims data from Medicare Beneficiaries 65 and older who participated in the Medicare Current Beneficiary Survey, 1999–2002. Six preventive procedures were included: PSA testing, influenza vaccination, Pap smear testing, cholesterol testing, mammography, and colorectal cancer testing. We examined predictors of self-reports in the absence of claims and claims in the absence of self-reports. Results With the exception of PSA testing, racial/ethnic disparities in preventive procedures are generally larger when using Medicare claims than when using patients' self-report. Analyses adjusting for age, gender, income, educational level, health status, proxy response and supplemental insurance showed that minorities were more likely to self-report preventive procedures in the absence of claims. Adjusted odds ratios ranged from 1.07 (95% CI: 0.88 – 1.30) for PSA testing to 1.83 (95% CI: 1.46 – 2.30) for Pap smear testing. Rates of claims in the absence of self-report were low. Minorities were more likely to have PSA test claims in the absence of self-reports (1.55 95% CI: 1.17 – 2.06), but were less likely to have influenza vaccination claims in the absence of self-reports (0.69 95% CI: 0.51 – 0.93). Conclusion These findings are consistent with either racial/ethnic reporting biases in receipt of preventive procedures or less efficient Medicare billing among providers with large minority practices.
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kathleen Holt
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sean Meldrum
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Peter Franks
- Center for Health Serv Res in Primary Care, Department of Family and Community Medicine, University of California School of Medicine, Davis, Sacramento, California, USA
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Abstract
BACKGROUND National self-report surveys show minimal racial disparity in mammography, whereas analyses of administrative data show large disparity. METHODS Using the 1998-2002 Medicare Current Beneficiary Surveys, which contain participants' self-report and claims data, we developed multivariable adjusted models examining factors associated with self-reported mammography and self-reported mammography verified by billing records. RESULTS No racial/ethnic disparities were found in self-reported mammography. Verified mammography, however, revealed significant disparities for race, education, income, insurance, and health status. CONCLUSIONS Race, education, income, insurance, and health status are associated with a lower likelihood of self-reported mammography verified by the existence of claims data. These data caution against exclusive reliance on self-report survey data to assess disparity in mammography.
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Affiliation(s)
- Kathleen Holt
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14620, USA.
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Rakowski W, Truchil R, Schneider K, Meersman S, Clark MA. Correlates of mammography in a national analysis compared to results in quintile- and regionally-defined samples. Prev Med 2006; 42:386-9. [PMID: 16504279 DOI: 10.1016/j.ypmed.2006.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 01/06/2006] [Accepted: 01/25/2006] [Indexed: 10/25/2022]
Abstract
BACKGROUND National-level data are often used to identify groups of women at greater risk of not obtaining mammography, who might then receive targeted interventions. An important question, however, is how well results of national-level analyses match results from smaller samples of the same dataset. This study investigated the consistency of results about correlates of mammography from a single national-level analysis versus the results from analyses within each of five quintiles of mammography rates and nine Census subdivisions. METHODS The sample for all analyses were women aged 42-79 from the Year 2002 United States' Behavioral Risk Factor Surveillance System (N = 80,283). Recent mammography was defined as self-report of a mammogram within the 2 years prior to the interview. Independent variables included sociodemographics, health practices, and a combined insurance status/usual source of care variable. RESULTS Only smoking status, Pap testing, dental visit, and health insurance/source of care had consistent results with mammography status across all levels of analysis. Results for the other covariates, including standard sociodemographics, showed varying degrees of consistency. CONCLUSIONS Caution is advised when using national data to inform regional or local intervention planning. Local and regional data are necessary to target programs to groups at greatest need for intervention.
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Affiliation(s)
- William Rakowski
- Department of Community Health, Brown University, Providence, RI 02912, USA.
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Rosenfeld P, Kim H, Londono G, Kovner C, Mezey M. Adult ambulatory care visits to nurses and physicians: methodological limitations of the medical expenditure panel survey data. Policy Polit Nurs Pract 2005; 6:221-8. [PMID: 16443977 DOI: 10.1177/1527154405278472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The 1997 Medical Expenditure Panel Survey (MEPS) data report that approximately 80 million adult ambulatory visits are made to nursing personnel. Adults who visit nursing personnel and who visit physicians are similar with regard to sex and income. As compared to nursing personnel, physician visits are longer and more likely to involve diagnosis or treatment. Older adult visits (ages 65 to 90) to nursing personnel are significantly longer than the visits of younger adults. As compared to physician visits, nursing personnel visits are significantly more likely to be characterized as "other" for all adults and especially for older adults. Although these findings suggest important differences between physician and nurse ambulatory care visits, the undifferentiated use of the term nurse and the significant percentage of uncharacterized visits to nursing personnel signal serious deficiencies in the MEPS data in exploring nonphysician ambulatory care.
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Affiliation(s)
- Peri Rosenfeld
- Office of Special Populations, New York Academy of Medicine, USA
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Franks P, Fiscella K, Meldrum S. Racial disparities in the content of primary care office visits. J Gen Intern Med 2005; 20:599-603. [PMID: 16050853 PMCID: PMC1490148 DOI: 10.1111/j.1525-1497.2005.0109.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Accepted: 01/06/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about racial disparities in primary care at the level of the office visit. OBJECTIVE To assess racial disparities in the receipt of commonly performed/recommended procedures during routine primary care office visits and examine trends in disparities over time. DESIGN, SETTING, AND PATIENTS The sample included 88,303 visits by adults to 3,260 primary care physicians in office-based practices in the National Ambulatory Medical Care Surveys, 1985, 1989, 1990, 1991, 1992, and 1995 to 2001. MEASUREMENTS Adjusted odds for receipt or recommendation of commonly performed office procedures. RESULTS During the years 1985 to 2001, African Americans, compared with whites, had lower odds of receiving a Pap test (odds ratio (OR) 0.81; 95% confidence interval (CI) 0.70 to 0.93), rectal exam (OR 0.67; 95% CI 0.56 to 0.80), smoking cessation counseling (OR 0.80; 95% CI 0.66 to 0.96), and mental health advice (OR 0.51; 95% CI 0.38 to 0.69), but had higher odds for visual screening (OR 1.38; 95% CI 1.08 to 1.77), weight advice counseling (OR 1.27; 95% CI 1.13 to 1.44) and receiving a follow-up appointment (OR 1.45; 95% CI 1.29 to 1.64). These findings were not appreciably altered by adjustment for physician practice characteristics including percent African American or Medicaid patients. Disparities disfavoring African Americans in cholesterol testing and smoking cessation observed during 1985 to 1992 were not observed in 1995 to 2001. CONCLUSIONS The findings suggest that race is associated with the type of primary care received by patients, at least for selected procedures, with evidence that some disparities have diminished over time.
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Affiliation(s)
- Peter Franks
- Department of Family and Community Medicine, Center for Health Services Research in Primary Care, University of California, Davis, Sacramento, CA 95817, USA.
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