Targeting the underserved for breast and cervical cancer screening: The utility of ecological analysis using the national health interview survey

Objectives. This study tested the utility of ecological variables created from the National Health Interview Survey (NHIS) for strategic targeting of health services for the underserved. Methods. Ecological variables were created using the 1989-1991 survey years of the NHIS public 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 analyzed with the NHIS Health Promotion and Disease Prevention 1990 supplement reporting mammogram, clinical breast examination, and Pap test use. Results. Median education of areas was inversely related to never having mammograms. Areas with a high proportion (70%-100%) of Hispanic respondents also were more likely not to have mammograms. Women residing in areas with moderate or high proportions of Hispanic respondents were 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 in the United States 5 years or less. Conclusions. The new methodology of constructing ecological variables using the NHIS demonstrates an application that may help identify underserved areas or areas with underutilized services. More studies using this methodology are warranted.