@article{ref1,
title="Multilevel Analysis of the Determinants of Receipt of Clinical Preventive Services Among Reproductive-Age Women",
journal="Women's health issues",
year="2012",
author="McCall-Hosenfeld, Jennifer S. and Weisman, Carol S. and Camacho, Fabian and Hillemeier, Marianne M. and Chuang, Cynthia H.",
volume="22",
number="3",
pages="e243-51",
abstract="BACKGROUND: We investigated the impact of individual- and county-level contextual variables on women's receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities. METHODS: Outcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004-2005) were appended to prospective survey data from the Central Pennsylvania Women's Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women's preventive care. Multilevel analyses were performed. RESULTS: We found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations. CONCLUSIONS: Women's receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women's receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.<p /> <p>Language: en</p>",
language="en",
issn="1049-3867",
doi="10.1016/j.whi.2011.11.005",
url="http://dx.doi.org/10.1016/j.whi.2011.11.005"
}