Disability and Preventive Cancer Screening: Results from the 2001 California Health Interview Survey (American Journal of Public Health)

Am J Public Health. 2005; 95(11): 2057-2064. The 2001 California Health Interview Survey (CHIS 2001) is the largest geographically complex multidimensional state health survey ever conducted in the United States and was designed to generate demographic and health estimates including cancer-related measures for the non-institutionalized household population of California. The present article draws on these data to evaluate demographic and health-related characteristics, reported needs, and utilization of preventive cancer screening procedures within recommended intervals among a statewide population-based sample of adults with and without probable indications of disability. The primary findings were that statistically significant inverse relationships between disability and the likelihood of receiving cervical, breast, and prostate cancer screening exist and remained statistically significant after control for potential demographic and health-related confounds and competing for variance with other significant intervening factors. Previous research has found similar differences in cancer screening utilization among populations with disabilities. However, to our knowledge, the present report is the first to extend the understanding of these relationships by taking initial steps to assess whether the preventive cancer screening disparities observed were a function of individual characteristics, health promoting behaviors, social, or clinical factors; the limited empirical evidence available in this report points to the latter. Given that neither individual health behaviors nor the structural factors measured and analyzed in this study accounted for the cancer screening disparities found indicate that other forces are at work. Additional results suggest the clinical setting may be an important part of the answer. Additional research into the clinical experiences of adults with disability and additional factors beyond those traditionally included in health services and utilization models is warranted. Persons with disabilities constitute one of the largest and most diverse subpopulations in the country and transcend age, ethnic, geographic, political, racial, and socioeconomic groups in our society. Moreover, their life expectancy appears to be similar to the general population and, therefore, compliance with routine cancer screenings is essential to reducing overall morbidity and mortality because of cancer disease. Toward this goal, the present article identified and evaluated significant differential relationships between the presence of disability and the likelihood of receiving routine preventive cancer screening within recommended guidelines in California. Findings suggested that individual health behaviors played a subordinate role to structural and clinical factors underpinning significant differences in preventive cancer screenings. Despite demonstrable improvements in health care access resulting from the Americans with Disabilities Act also evident in the present results (i.e., significantly higher rates of health insurance coverage and more stable venues of health care), significant differences in preventive cancer screening services by persons with disabilities in California persist.

Publication Authors:

• Anthony Ramirez
• Gail C. Farmer
• David Grant, PhD
• Theodora Papachristou