Women’s Compliance with Public Health Guidelines for Mammograms and Pap tests in Canada and the United States: An Analysis of Data from the Joint Canada/United States Survey of Health

doi:10.1016/j.whi.2007.10.006

Women's Health Issues

Volume 18, Issue 2, March–April 2008, Pages 85-99

https://doi.org/10.1016/j.whi.2007.10.006 Get rights and content

Objectives

We use the Joint Canada/United States Survey of Health (JCUSH) to examine use of mammograms and Pap tests among Canadian and US women during 2002 and 2003. Unlike previous data, the JCUSH data are bi-nationally comparable, in that the same instrument was used for interviewing both Canadian and US respondents at the same time. Furthermore, when appropriately weighted, these data are representative of the populations of both countries.

Methods

Descriptive statistics were used to provide a basic profile of screening practices among women in Canada and the United States. Logistic regression was then used to examine the determinants of compliance with mammogram and Pap test guidelines in the 2 countries, statistically controlling for demographic and socioeconomic characteristics, health status, and other indicators suggested from previous research. To increase comparability, these analyses were restricted to the age ranges covered in common by the screening guidelines of both countries.

Results

Among women covered by the guidelines in both countries, screening rates were higher in the United States than in Canada at all ages, which is puzzling given the existence of Canada’s universal health care system. Multivariate analyses revealed that whether a woman had had a mammogram within the last 2 years (when predicting last Pap test) or had had a Pap test within the last 3 years (when predicting last mammogram) were the strongest and most consistent predictors of compliance in both countries. Race/ethnicity, nativity, marital status, socioeconomic status, insurance coverage in the United States, and various health status indicators also predicted compliance in some, but not all, models.

Section snippets

Background

Previous research has shown that a number of factors are related to women’s use of mammograms and Pap tests in Canada and the United States. Higher education, higher income, being married, not smoking, being black, having a regular source of care, having health insurance, being in excellent or very good health, and engaging in vigorous exercise were consistently associated with higher rates of use (Bancej et al 2005, Carrasquillo and Pati 2004, Coughlin et al 2004, Coughlin et al 2004,

Data Source and Analysis Variables

The 2002–2003 JCUSH was designed to collect the same information in the same manner from both Canadian and US residents so that accurate comparisons between the 2 populations can be made regarding health status and access to or utilization of health care services (Lavigne and Mathieu 2005, Simile and Rama 2004, Sanmartin et al 2004, Sanmartin et al 2006). The JCUSH was conducted in 2002–2003 as a 1-time telephone survey by Statistics Canada and by the National Center for Health Statistics of

Descriptive Statistics

Table 2 shows weighted percents for Canadian and US women aged ≥18 for each independent variable used in the multivariate analyses.⁶ The statistical significance of differences between percentages was evaluated using 2-sided t-tests at the .05 level and assuming independence.

Canadian women were more likely to be married or cohabiting and less likely to be divorced or separated than US women; they were also more likely to have a regular source of medical care than US women (Table 2). American

Mammogram Analysis

As Table 2 indicates, the JCUSH data set contained 1,895 female respondents from Canada and 2,959 female respondents from the United States. Limiting the mammogram models to only female respondents aged 50–69—the age range covered by the mammogram guidelines of both countries—sharply reduced the number of cases available for analysis, particularly so for the Canadian sample (Canadian analysis sample = 471; US analysis sample = 782). Nevertheless, an array of factors predicted compliance with

Conclusion

The availability of data from the JCUSH has enabled us to evaluate and compare mammogram and Pap test screening rates in Canada and the United States. Descriptive statistics indicated that age-specific utilization rates in the United States were consistently higher than those in Canada, even among those age groups for which the national screening recommendations were the same in both countries. In particular, we detected substantial gaps in mammography and Pap testing between Canadian and US

Notes

1
Response categories for the Pap test question included “<6 months ago,” “6 months to <1 year ago,” “1 year to <3 years ago,” “3 years ago to <5 years ago,” and “≥5 years ago.” Response categories for the mammogram question included “<6 months ago,” “6 months to <1 year ago,” “1 year to <2 years ago,” “2 years ago to <5 years ago,” and “≥5 years ago.”
2
Previous research indicates that sexual activity among Canadian and US women is likely to begin before age 21. For example, according to findings

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: The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the views of the National Center for Health Statistics, Centers for Disease Control and Prevention.

¹: Debra L. Blackwell, PhD, is a statistician/demographer at the National Center for Health Statistics (NCHS) in Hyattsville, Maryland. She works extensively on the National Health Interview Survey, particularly on family structure, demographic indicators, and health status and limitations.

²: Michael E. Martinez, MPH, MHSA, is an epidemiologist at NCHS. His areas of interest include health insurance coverage status and Latino health issues.

³: Jane F. Gentleman, PhD, has been Director of the NCHS Division of Health Interview Statistics since 1999. Prior to that, she was at Statistics Canada, and before that, she was a faculty member at the University of Waterloo in Canada. Her current research interests are in survey methodology and data analysis.

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ArticleWomen’s Compliance with Public Health Guidelines for Mammograms and Pap tests in Canada and the United States: An Analysis of Data from the Joint Canada/United States Survey of Health

Objectives

Methods

Results

Section snippets

Background

Data Source and Analysis Variables

Descriptive Statistics

Mammogram Analysis

Conclusion

Notes

Social Science and Medicine

Preventive Medicine

Preventive Medicine

Archives of Physical Medicine and Rehabilitation

Preventive Medicine

British Journal of Obstetrics and Gynaecology

Preventive Medicine

New cervical cancer early detection guidelines released

Diagnostic and statistical manual of mental disorders

Mammography Utilization in Canadian Women aged 50–69

Canadian Journal of Public Health

Hysterectomy prevalence by Hispanic ethnicity: Evidence from a national survey

American Journal of Public Health

Combo approach to breast cancer screening a woman’s best defense—October is breast cancer awareness month

Next Steps: Schedule a physical

Breast cancer screening practices among women in the United States, 2000

Cancer Causes and Control

Nonadherence to breast and cervical cancer screening: What are the linkages to chronic disease risk?

Preventing Chronic Disease

Predictors of screening mammography: Implications for office practice

Archives of Family Medicine

Breast and Cervical cancer screening in obese minority women

Journal of Women’s Health

Body weight and cancer screening among women

Journal of Women’s Health & Gender-Based Medicine

Who doesn’t get a mammogram?

Health Reports

Health services utilization among Latinos and white non-Latinos: Results from a national survey

Journal of Health Care for the Poor and Underserved

Healthy behaviors among women in the United States and Ontario: The effect on use of preventive care

American Journal of Public Health

Mammography self-report and mammography claims: Racial, Ethnic, and socioeconomic discrepancies among elderly women

Medical Care

Beliefs about sexual behavior and other predictors of Papanicolaou smear screening among Latinas and Anglo women

Archives of Internal Medicine

Article
Women’s Compliance with Public Health Guidelines for Mammograms and Pap tests in Canada and the United States: An Analysis of Data from the Joint Canada/United States Survey of Health