Use of Preventive Services in a Population of Very Low-Income Women

BACKGROUND: Compared with higher income women and Caucasian women, low-income women (even those who receive Medicaid) and women of color tend to receive fewer Pap smears and mammograms, present with more advanced disease, and have poorer outcomes. Little information has been available on the receipt of age- and gender-specific preventive services by very low-income women who do not receive Medicaid. The purpose of this study was to assess baseline cancer screening rates among a cohort of very low income uninsured women prior to their enrollment in the state of California's General Relief Health Care Program; to assess whether racial/ethnic differences existed in receipt of screening services; and to identify other factors that might prevent very poor uninsured women from receiving such services. METHODS: Women who became eligible for and enrolled in the General Relief Program completed a 31-item health history questionnaire (in English or Spanish), developed by the Los Angeles County Department of Health Services at a 6-th grade reading level. The questionnaire assessed prior use of services, self-reported health status, housing status, access to transportation, receipt of last mammogram (for women over 50) and Pap smear, and perceived need for services. Data were analyzed using bivariate analysis and multivariate logistic regression. RESULTS: The average respondent was African American, 36 to 40 years of age, a high school graduate whose native language was English, domiciled, reliant on public transportation, and a smoker; did not use alcohol or drugs; reported fair or poor health; and had no history of mental illness. The majority reported a clinic as their usual source of care, and 81 percent had seen a physician in the preceding 12 months. Of the 47 percent who had received a Pap smear in the preceding year, African American women, younger women, women who did not use alcohol regularly, and women who reported excellent health status were significantly more likely to have received one. Of respondents over 50, 35 percent reported receipt of a mammogram in the preceding year: Latinas, domiciled women, nonsmokers, and those who reported excellent health and did not drink regularly were significantly more likely to have had a mammogram. CONCLUSIONS: Very low-income women continue to have unmet needs for Pap smears and mammograms, even though a large proportion have seen a physician within the preceding year. These findings suggest that such visits could serve as an opportunity to provide cancer screening. Many of the women studied appeared to lack a regular source of care, resulting in poor continuity of care. Patient education (and possibly referrals with specific appointments for providers who could provide screening) should be supplied at all encounters. In addition, programs that have succeeded in increasing screening rates for African American and Latina women may need to be adapted for low-income Caucasian and Asian/Pacific Islander women.