%0 Journal Article %J J Am Geriatr Soc %D 2023 %T Breast and prostate cancer screening rates by cognitive status in US older adults. %A Schoenborn, Nancy L %A Cidav, Tom %A Boyd, Cynthia M %A Pollack, Craig E %A Sekhon, Vishaldeep Kaur %A Yasar, Sevil %K Aged %K Breast Neoplasms %K Cognition %K Dementia %K Early Detection of Cancer %K Humans %K Male %K Mass Screening %K Medicare %K Prostate-Specific Antigen %K Prostatic Neoplasms %K United States %X

INTRODUCTION: For most older adults with dementia, the short-term harms and burdens of routine cancer screening likely outweigh the delayed benefits. We aimed to provide a more updated assessment of the extent that US older adults with dementia receive breast and prostate cancer screenings.

METHODS: Using the Health and Retirement Study (HRS) Wave 12 (2014-2015) linked to Medicare, we examine rates of breast and prostate cancer screenings in adults 65+ years by cognitive status. We used claims data to identify eligibility for screening and receipt of screening. We used a validated method using HRS data to define cognitive status.

RESULTS: The analytic sample included 2439 women in the breast cancer screening cohort and 1846 men in the prostate cancer screening cohort. Average ages were 76.8 years for women and 75.6 years for men, with 9.0% and 7.6% with dementia in each cohort, respectively. Among women with dementia, 12.3% were screened for breast cancer. When stratified by age, 10.6% of those 75+ and have dementia were screened for breast cancer. When stratified by predicted life expectancy, 10.4% of those with predicted life expectancy of <10 years and have dementia were screened for breast cancer. Among men with dementia, 33.9% were screened for prostate cancer. When stratified by age, 30.9% of those 75+ and have dementia were screened for prostate cancer. When stratified by predicted life expectancy, 34.4% of those with predicted life expectancy of <10 years and have dementia were screened for prostate cancer. Using multivariable logistic regression, dementia was associated with lower odds of receiving breast cancer screening (OR 0.36, 95% CI 0.23-0.57) and prostate cancer screening (OR 0.58, 95% CI 0.36-0.96).

DISCUSSION: Our results suggest potential over-screening in older adults with dementia. Better supporting dementia patients and caregivers to make informed cancer screening decisions is critical.

%B J Am Geriatr Soc %V 71 %P 1558-1565 %G eng %N 5 %R 10.1111/jgs.18222 %0 Journal Article %J The Journal of Strength and Conditioning Research %D 2022 %T Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans %A Klawitter, Lukus %A Brenda Vincent %A Choi, Bong-Jin %A Smith, Joseph %A Hammer, Kimberly D. %A Donald A Jurivich %A Lindsey J Dahl %A Ryan P McGrath %K Chronic disease %K Exercise %K Mass Screening %K Risk Factors %K sarcopenia %X Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006–2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength >10% between hands had HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered as weak. Subjects reported the presence of healthcare provider–diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04–1.14) and 1.27 (CI: 1.11–1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29–1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk. %B The Journal of Strength and Conditioning Research %V 36 %P 106-112 %G eng %N 1 %R 10.1519/JSC.0000000000004166 %0 Journal Article %J J Aging Health %D 2017 %T Do Regular Cholesterol Screenings Lead to Lower Cholesterol Levels and Better Health Behaviors for All? Spotlight on Middle-Aged and Older Adults in the United States. %A Choi, Yool %A Lee, Hyo Jung %K Aged %K Aged, 80 and over %K Cholesterol %K Female %K Health Behavior %K Humans %K Longitudinal Studies %K Male %K Mass Screening %K Middle Aged %K Preventive Health Services %K United States %X

OBJECTIVE: This study investigates how the causal effects of cholesterol screening differ by likelihood of using this preventive care service in terms of accessibility gaps and effects on health-related outcomes across groups with advantaged and disadvantaged backgrounds.

METHOD: We use propensity score matching to analyze a nationally representative sample using data from 2008, 2010, and 2012 waves of the Health and Retirement Study ( N = 3,907).

RESULTS: We find that respondents who are least likely to get their cholesterol tested benefit most from the use of cholesterol screening when they do use it, while its effects are smallest for those who are most likely to use this service.

DISCUSSION: Understanding the heterogeneous effects of preventive health service has important policy implications, particularly in terms of how to maximize the public health benefits of preventive care.

%B J Aging Health %V 29 %P 389-414 %8 2017 Apr %G eng %U http://europepmc.org/abstract/MED/26921271 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26921271?dopt=Abstract %R 10.1177/0898264316635588 %0 Journal Article %J Soc Work Health Care %D 2017 %T Psychosocial correlates of cervical cancer screening among older Hispanic women. %A Tamara J. Cadet %A Stewart, Kathleen %A Howard, Tenial %K Adult %K Aged %K Aged, 80 and over %K Attitude to Health %K Early Detection of Cancer %K Female %K Hispanic Americans %K Humans %K Logistic Models %K Mass Screening %K Middle Aged %K Uterine Cervical Neoplasms %X

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

%B Soc Work Health Care %V 56 %P 124-139 %8 2017 02 %G eng %U https://www.tandfonline.com/doi/full/10.1080/00981389.2016.1263268 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27960632?dopt=Abstract %! Social Work in Health Care %R 10.1080/00981389.2016.1263268 %0 Journal Article %J J Diabetes Complications %D 2015 %T Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death. %A Chen, Yiqun %A Frank A Sloan %A Arseniy P Yashkin %K Aged %K Aged, 80 and over %K Combined Modality Therapy %K Diabetes Complications %K Diabetes Mellitus %K Early Diagnosis %K Female %K Health Promotion %K Health Surveys %K Humans %K Hypoglycemic Agents %K Longitudinal Studies %K Male %K Mass Screening %K Medicare Part A %K Medicare Part B %K Medication Adherence %K Motor Activity %K Patient Compliance %K Practice Guidelines as Topic %K Risk %K United States %X

AIMS: Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality.

METHODS: Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8).

RESULTS: Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95% CI: 0.68-0.94); renal failure (OR=0. 82; 95% CI: 0.71-0.95); and death (OR=0.86; 95% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95% CI: 0.45-0.90), renal failure (OR=0.71; 95% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95% CI: 0.11-0.85), and death (OR=0.56, 95% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95% CI: 0.13-0.93).

CONCLUSIONS: Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.

%B J Diabetes Complications %I 29 %V 29 %P 1228-33 %8 2015 Nov-Dec %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/26316423?dopt=Abstract %2 PMC4656150 %4 Diabetes complications/Mortality/health status/adherence interventions/adherence interventions/Physical activity/Guidelines %$ 999999 %R 10.1016/j.jdiacomp.2015.07.005 %0 Journal Article %J Prev Chronic Dis %D 2015 %T Prostate Cancer Screening Among American Indians and Alaska Natives: The Health and Retirement Survey, 1996-2008. %A R. Turner Goins %A Marc B Schure %A Carolyn Noonan %A Dedra S. Buchwald %K Aged %K Alaska %K Analysis of Variance %K Black or African American %K Health Behavior %K Health Surveys %K Healthcare Disparities %K Humans %K Indians, North American %K Male %K Mass Screening %K Middle Aged %K Prevalence %K Prostatic Neoplasms %K Regression Analysis %K Retirement %K Self Report %K Surveys and Questionnaires %K United States %K White People %X

INTRODUCTION: Among US men, prostate cancer is the leading malignancy diagnosed and the second leading cause of cancer death. Disparities in cancer screening rates exist between American Indians/Alaska Natives and other racial/ethnic groups. Our study objectives were to examine prostate screening at 5 time points over a 12-year period among American Indian/Alaska Native men aged 50 to 75 years, and to compare their screening rates to African American men and white men in the same age group.

METHODS: We analyzed Health and Retirement Study data for 1996, 1998, 2000, 2004, and 2008. Prostate screening was measured by self-report of receipt of a prostate examination within the previous 2 years. Age-adjusted prevalence was estimated for each year. We used regression with generalized estimating equations to compare prostate screening prevalence by year and race.

RESULTS: Our analytic sample included 119 American Indian/Alaska Native men (n = 333 observations), 1,359 African American men (n = 3,704 observations), and 8,226 white men (n = 24,292 observations). From 1996 to 2008, prostate screening rates changed for each group: from 57.0% to 55.7% among American Indians/Alaska Natives, from 62.0% to 71.2% among African Americans, and from 68.6% to 71.3% among whites. Although the disparity between whites and African Americans shrank over time, it was virtually unchanged between whites and American Indians/Alaska Natives.

CONCLUSION: As of 2008, American Indians/Alaska Natives were less likely than African Americans and whites to report a prostate examination within the previous 2 years. Prevalence trends indicated a modest increase in prostate cancer screening among African Americans and whites, while rates remained substantially lower for American Indians/Alaska Natives.

%B Prev Chronic Dis %I 12 %V 12 %P E123 %8 2015 Aug 06 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/26247423?dopt=Abstract %2 PMC4552140 %4 prostate cancer/Screening/native Americans/african Americans/minorities %$ 999999 %R 10.5888/pcd12.150088 %0 Journal Article %J Alzheimers Dement %D 2014 %T Development and validation of a brief dementia screening indicator for primary care. %A Deborah E Barnes %A Alexa S. Beiser %A Anne Lee %A Kenneth M. Langa %A Alain Koyama %A Sarah R Preis %A John Neuhaus %A Ryan J McCammon %A Kristine Yaffe %A Seshadri, Sudha %A Mary Haan %A David R Weir %K Aged %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Mass Screening %K Predictive Value of Tests %K Primary Health Care %K Proportional Hazards Models %K Risk Assessment %X

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

%B Alzheimers Dement %I 10 %V 10 %P 656-665.e1 %8 2014 Nov %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/24491321?dopt=Abstract %2 PMC4119094 %4 Dementia/Primary care/Risk prediction modeling/Screening/Cognitive Impairment %$ 999999 %R 10.1016/j.jalz.2013.11.006 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2009 %T Statistical design and estimation for the national social life, health, and aging project. %A O'Muircheartaigh, Colm %A Eckman, Stephanie %A Smith, Stephen %K Aged %K Aged, 80 and over %K Aging %K Bias %K Data collection %K Data Interpretation, Statistical %K Female %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Mass Screening %K Middle Aged %K Research Design %K Sampling Studies %K Sexual Behavior %K Social Behavior %K United States %X

OBJECTIVES: The paper discusses the sample design of the National Social Life, Health, and Aging Project (NSHAP) and how the design affects how estimates should be calculated from the survey data. The NSHAP study allows researchers to study the links between sexuality and health in older adults. The goal of the design was to represent adults aged 57-85 years in six demographic domains.

METHODS: The sample design begins with a national area probability sample of households, carried out jointly with the 2004 round of the Health and Retirement Study. Selection of respondents for NSHAP balanced age and gender subgroups and oversampled African Americans and Latinos. Data collection was carried out from July 2005 to March 2006.

RESULTS: The survey obtained an overall response rate of 75.5%.

DISCUSSION: The complex sample design requires that the selection probabilities and the field implementation be accounted for in estimating population parameters. The data set contains weights to compensate for differential probabilities of selection and response rates among demographic groups. Analysts should use weights in constructing estimates from the survey and account for the complex sample design in estimating standard errors for survey estimates.

%B J Gerontol B Psychol Sci Soc Sci %I 64B %V 64 Suppl 1 %P i12-9 %8 2009 Nov %G eng %N Suppl 1 %L newpubs20091202_OMuircheartaigh.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19567827?dopt=Abstract %2 PMC2763522 %4 Survey Methods/Statistics and Numerical Data/Demographics %$ 21180 %R 10.1093/geronb/gbp045 %0 Journal Article %J Alzheimers Dement %D 2009 %T Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. %A Tamara G Fong %A Michael A Fearing %A Richard N Jones %A Peilin Shi %A Edward R Marcantonio %A James L Rudolph %A Frances Margaret Yang %A Dan K Kiely %A Sharon K Inouye %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cognition Disorders %K Disability Evaluation %K Female %K Geriatric Assessment %K Health Status %K Humans %K Interviews as Topic %K Male %K Mass Screening %K Models, Statistical %K Neuropsychological tests %K Predictive Value of Tests %K Psychiatric Status Rating Scales %K Remote Consultation %K Reproducibility of Results %K Sensitivity and Specificity %X

BACKGROUND: Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point scores to rate global cognitive function.

METHODS: The MMSE, TICS-30, and TICS-40 scores from 746 community-dwelling elders who participated in the Aging, Demographics, and Memory Study (ADAMS) were analyzed with equipercentile equating, a statistical process of determining comparable scores based on percentile equivalents for different forms of an examination.

RESULTS: Scores from the MMSE and TICS-30 and TICS-40 corresponded well, and clinically relevant cut-point scores were determined. For example, an MMSE score of 23 is equivalent to 17 and 20 on the TICS-30 and TICS-40, respectively.

CONCLUSIONS: These findings indicate that TICS and MMSE scores can be linked directly. Clinically relevant and important MMSE cut points and the respective ADAMS TICS-30 and TICS-40 cut-point scores are included, to identify the degree of cognitive impairment among respondents with any type of cognitive disorder. These results will help in the widespread application of TICS in both research and clinical practice.

%B Alzheimers Dement %I 5 %V 5 %P 492-7 %8 2009 Nov %G eng %N 6 %L newpubs20091013_Fong_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19647495?dopt=Abstract %2 PMC278332 %4 Cognitive Function/Survey Methods %$ 19960 %R 10.1016/j.jalz.2009.02.007 %0 Journal Article %J Health Serv Res %D 2008 %T Identification of dementia: agreement among national survey data, medicare claims, and death certificates. %A Truls Ostbye %A Donald H. Taylor Jr. %A Elizabeth C. Clipp %A Lynn Van Scoyoc %A Brenda L Plassman %K Aged %K Consensus %K Data Interpretation, Statistical %K Death Certificates %K Dementia %K Female %K Health Surveys %K Humans %K Incidence %K Insurance Claim Review %K Male %K Mass Screening %K Medicare %K Research Design %K United States %X

OBJECTIVE: To estimate the proportion of seniors with dementia from three independent data sources and their agreement.

DATA SOURCES: The longitudinal Asset and Health Dynamics among the Oldest Old (AHEAD) study (n=7,974), Medicare claims, and death certificate data.

STUDY DESIGN: Estimates of the proportion of individuals with dementia from: (1) self- or proxy-reported cognitive status measures from surveys, (2) Medicare claims, and (3) death certificates. Agreement using Cohen's kappa; multivariate logistic regression.

PRINCIPAL FINDINGS: The proportion varied substantially among the data sources. Agreement was poor (kappa: 0.14-0.46 depending upon comparison assessed); the individuals identified had relatively modest overlap.

CONCLUSIONS: Estimates of dementia occurrence based on cognitive status measures from three independent data sources were not interchangeable. Further validation of these sources is needed. Caution should be used if policy is based on only one data source.

%B Health Serv Res %I 43 %V 43 %P 313-26 %8 2008 Feb %G eng %N 1 Pt 1 %L newpubs20080229_Ostbye_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18211532?dopt=Abstract %2 PMC2323140 %4 Dementia/Incidence/Cognitive Function/Survey questions/Medicare/Death Certificates %$ 18650 %R 10.1111/j.1475-6773.2007.00748.x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Preventive health behaviors among grandmothers raising grandchildren. %A Lindsey A Baker %A Merril Silverstein %K Aged %K Breast Self-Examination %K Caregivers %K Female %K Health Behavior %K Humans %K Hypercholesterolemia %K Influenza, Human %K Intergenerational Relations %K Logistic Models %K Mass Screening %K Middle Aged %K Papanicolaou Test %K Preventive Health Services %K United States %K Vaccination %K Vaginal Smears %X

OBJECTIVES: We examined differential preventive health behavior among grandmothers who recently began raising a grandchild, grandmothers raising a grandchild for at least 2 years, and grandmothers not raising a grandchild.

METHODS: Data came from the 2000, 2002, and 2004 waves of the Health and Retirement Study. We ran multivariate logistic regression models to assess receipt of influenza vaccination, cholesterol screening, monthly breast self-exam, mammography, and Papanicolaou (Pap) tests among grandmothers aged 50 to 75.

RESULTS: Grandmothers who recently began raising a grandchild were significantly less likely to report influenza vaccination and cholesterol screening than grandmothers not raising grandchildren, even after we controlled for increased emotional and financial strains within the household. We also observed this association for Pap tests, although this finding was only marginally significant. Grandmothers who had been raising a grandchild for at least 2 years were significantly more likely to report influenza vaccination and monthly breast self-exam than grandmothers not raising grandchildren.

DISCUSSION: The enhancement of preventive behavior seen among long-term grandparent caregivers does not fully offset the suppression of preventive behavior during the transition into care; support groups should target a range of interventions toward the promotion of healthy behavior among new grandparent caregivers.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P S304-11 %8 2008 Sep %G eng %N 5 %L newpubs20081014_JoG_S304.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18818451?dopt=Abstract %2 PMC2633920 %4 Health Physical/Caregiving/Grandparents/Grandchildren/Intergenerational Relations %$ 19410 %R 10.1093/geronb/63.5.s304 %0 Journal Article %J Arch Intern Med %D 2008 %T Screening mammography in older women. Effect of wealth and prognosis. %A Brie A Williams %A Lindquist, Karla %A Rebecca L. Sudore %A Kenneth E Covinsky %A Louise C Walter %K Aged %K Breast Neoplasms %K Chi-Square Distribution %K Female %K Humans %K Longitudinal Studies %K Mammography %K Mass Screening %K Prognosis %K Risk Factors %K Social Class %X

BACKGROUND: Wealthy women have higher rates of screening mammography than poor women do. Screening mammography is beneficial for women with substantial life expectancies, but women with limited life expectancies are unlikely to benefit. It is unknown whether higher screening rates in wealthy women are due to increased screening in women with substantial life expectancies, limited life expectancies, or both. This study examines the relationship between wealth and screening mammography use in older women according to life expectancy.

METHODS: A cohort study was performed of 4222 women 65 years or older with Medicare participating in the 2002 and 2004 Health and Retirement Survey. Women were categorized according to wealth and life expectancy (based on 5-year prognosis from a validated prognostic index). The outcome was self-reported receipt of screening mammography within 2 years.

RESULTS: Overall, within 2 years, 68% of women (2871 of 4222) received a screening mammogram. Screening was associated with wealth (net worth, > $100 000) and good prognosis (< or = 10% probability of dying in 5 years). Screening mammography was more common among wealthy women than among poor women (net worth, < $10 000) both for women with good prognosis (82% vs 68%; P < .001) and for women with limited prognoses (> or = 50% probability of dying in 5 years) (48% vs 32%; P = .02). These associations remained after multivariate analysis accounting for age, race, education, proxy report, and rural residence.

CONCLUSIONS: Poorer older women with favorable prognoses are at risk of not receiving screening mammography when they are likely to benefit. Wealthier older women with limited prognoses are often screened when they are unlikely to benefit.

%B Arch Intern Med %I 168 %V 168 %P 514-20 %8 2008 Mar 10 %G eng %N 5 %L newpubs20101112_Williams.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18332298?dopt=Abstract %3 18332298 %4 Mammography/WOMEN/life Expectancy/Wealth/methodology/risk factors %$ 23610 %R 10.1001/archinternmed.2007.103 %0 Journal Article %J Prev Med %D 2007 %T Use of preventive care by the working poor in the United States. %A Joseph S. Ross %A Bernheim, Susannah M. %A Elizabeth H Bradley %A Teng, Hsun-Mei %A William T Gallo %K Cost of Illness %K Cross-Sectional Studies %K Employment %K Female %K Health Promotion %K Health Services Accessibility %K Health Services Needs and Demand %K Humans %K Male %K Mass Screening %K Middle Aged %K Patient Acceptance of Health Care %K Poverty %K Preventive Health Services %K Risk Assessment %K Socioeconomic factors %K United States %K Vulnerable Populations %X

OBJECTIVE: Examine the association between poverty and preventive care use among older working adults.

METHOD: Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200% of the federal poverty level were defined as poor.

RESULTS: Among 10,088 older working adults, overall preventive care use ranged from 38% (influenza vaccination) to 76% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95% CI, 0.86-0.96), prostate cancer (RR 0.89, 95% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95% CI, 0.84-1.01).

CONCLUSION: The older working poor are at modestly increased risk for not receiving preventive care.

%B Prev Med %I 44 %V 44 %P 254-9 %8 2007 Mar %G eng %N 3 %L newpubs20070403_Ross_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/17196642?dopt=Abstract %4 Poverty/Health Care Utilization/screening %$ 17240 %R 10.1016/j.ypmed.2006.11.006 %0 Journal Article %J J Behav Med %D 2006 %T Religious influences on preventive health care use in a nationally representative sample of middle-age women. %A Benjamins, Maureen Reindl %K Aged %K Breast Self-Examination %K Female %K Health Behavior %K Health Status Indicators %K Health Surveys %K Humans %K Mammography %K Mass Screening %K Middle Aged %K Papanicolaou Test %K Preventive Health Services %K Religion and Medicine %K Religion and Psychology %K Social Support %K Socioeconomic factors %K United States %K Utilization Review %K Vaginal Smears %X

Despite the many benefits of preventive services, they are often underutilized. Social factors, such as religion, can figure prominently in these discrepancies by either creating barriers or facilitating use. Using data from the Health and Retirement Survey (HRS, 1992-1996), the current study examines the relationship between religious attendance, religious salience, and denomination and three types of female preventive services in a sample of middle-age women (N = 4253). Findings indicate that women who attend religious services more frequently use more mammograms, Pap smears, and self-breast exams. In addition, women belonging to Mainline Protestant or Jewish denominations use certain preventive services more than Evangelical Protestants. Finally, women with higher levels of religious salience are more likely to conduct self-breast exams. These findings add important information to the public health literature concerning factors that influence preventive service use. They also add to the growing field of religion and health research where preventive health care use is emerging as a possible mechanism linking religion to a wide variety of physical health outcomes.

%B J Behav Med %I 29 %V 29 %P 1-16 %8 2006 Feb %G eng %N 1 %L pubs_2006_BenjaminsJBM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16397821?dopt=Abstract %4 prevention/Health Care/Religiosity/Womens Health %$ 15650 %R 10.1007/s10865-005-9035-2 %0 Journal Article %J J Health Econ %D 2003 %T Sickness and preventive medical behavior. %A Stephen Wu %K Aged %K Anxiety %K Breast Self-Examination %K Cholesterol %K Female %K Health Behavior %K Health Expenditures %K Health Status %K Humans %K Influenza Vaccines %K Male %K Mammography %K Mass Screening %K Middle Aged %K Papanicolaou Test %K Patient Acceptance of Health Care %K Preventive Health Services %K Primary Prevention %K Prostatic Neoplasms %K Retirement %K Risk Factors %K Vaginal Smears %X

Using data from two sources, the Health and Retirement Study (HRS) and the Medical Expenditure Panel Survey (MEPS), I analyze the relationship between health status and the likelihood of engaging in medical screening and other preventive behavior. The results show that individuals who are in poorer health are more likely to get flu shots and cholesterol checks, but less likely to have mammograms, pap smears, breast examinations and prostate checks. There is some evidence that suggests that psychological factors such as fear and anxiety may be important reasons why sicker people are less likely to get cancer screens.

%B J Health Econ %I 22 %V 22 %P 675-89 %8 2003 Jul %G eng %N 4 %L pubs_2003_Wu_SHealthEcon.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12842321?dopt=Abstract %4 Health Status--physical, mental, and emotional/screening/prevention/anxiety %$ 11032 %R 10.1016/S0167-6296(03)00042-0