ABSTRACT
PURPOSE: To assess the association between geographic access to mammography facilities and women's mammography utilization frequency. METHODS: Using data from the population-based 1995-2007 Wisconsin Women's Health study, we used proportional odds and logistic regression to test whether driving times to mammography facilities and the number of mammography facilities within 10 km of women's homes were associated with mammography frequency among women aged 50-74 years and whether associations differed between Rural-Urban Commuting Areas and income and education groups. RESULTS: We found evidence for nonlinear relationships between geographic access and mammography utilization (nonlinear effects of driving times and facility density, P-values .01 and .005, respectively). Having at least one nearby mammography facility was associated with greater mammography frequency among urban women (1 vs. 0 facilities, odds ratio 1.26, 95% confidence interval, 1.09-1.47), with similar effects among rural women. Adding more facilities had decreasing marginal effects. Long driving times tended to be associated with lower mammography frequency. We found no effect modification by income, education, or urbanicity. In rural settings, mammography nonuse was higher, facility density smaller, and driving times to facilities were longer. CONCLUSIONS: Having at least one mammography facility near one's home may increase mammography utilization, with decreasing effects per each additional facility.
Subject(s)
Ambulatory Care Facilities/organization & administration , Ambulatory Care Facilities/supply & distribution , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/prevention & control , Health Services Accessibility/statistics & numerical data , Mammography/statistics & numerical data , Mass Screening/statistics & numerical data , Residence Characteristics , Transportation , Aged , Aged, 80 and over , Breast Neoplasms/epidemiology , Early Detection of Cancer , Female , Health Care Surveys , Humans , Middle Aged , Population Surveillance , Rural Population , Time Factors , Urban Population , Wisconsin/epidemiologyABSTRACT
Childhood obesity is a complex problem influenced by policies, systems, and environments, and its prevention requires changes across a range of community settings. To address this, we developed an obesity prevention strategy menu and an ongoing study to pilot its use and provide technical support for its implementation. The strategy menu is comprised of a set of effective approaches communities can use to develop tailored, context-specific health interventions based on local community needs and capacity. It was developed by a multidisciplinary team of researchers and practitioners who reviewed evidence and organized it to incorporate effective policy, systems, and environmental changes for reducing and preventing childhood obesity. Eventually, it will be part of a web-based point of access that complements the foundational relationships built between communities, researchers, and practitioners. By developing a framework to engage communities in the selection and implementation of multisetting obesity prevention strategies, we aim to create and sustain momentum toward a long-term reduction in obesity in Wisconsin children.
