TARGETING THE UNDERSERVED FOR BREAST AND CERVICAL-CANCER SCREENING - THE UTILITY OF ECOLOGICAL ANALYSIS USING THE NATIONAL-HEALTH INTERVIEWSURVEY

Objectives. This study tested the utility of ecological variables crea ted from the National Health Interview Survey (NHIS) for strategic tar geting of health services for the underserved. Methods. Ecological var iables were created using the 1989-1991 survey years of the NHIS publi c use data files. Segments, the NHIS secondary sampling units, permit computation of secondary sampling characteristics by percentage Black, percentage Hispanic, percentage below poverty, percentage unemployed, median education, median income, median age, and percentage residing in the United States for 5 years or less. These variables were analyze d with the NHIS Health Promotion and Disease Prevention 1990 supplemen t reporting mammogram, clinical breast examination, and Pap test use. Results. Median education of areas was inversely related to never havi ng mammograms. Areas with a high proportion (70%-100%) of Hispanic res pondents also were more likely not to have mammograms. Women residing in areas with moderate or high proportions of Hispanic respondents wer e more likely never to have clinical breast examinations and Pap tests , as were those in areas with low income, poverty, and respondents who had resided ill the United States 5 years or less. Conclusions. The n ew methodology of constructing ecological variables using the NHIS dem onstrates an application that may help identify underserved areas or a reas with underutilized services. More studies using this methodology are warranted.