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County-Level Poverty and Barriers to Breast and Cervical Cancer Screening in a Health Education and Patient Navigation Program for Rural and Border Texas Residents

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Abstract

The study examined the impact of (1) county-level poverty rates and (2) patient navigation on breast and cervical cancer screening outcomes for women in rural and border counties in Texas reporting barriers to screening.

Univariate analyses described the distribution and screening prevalence rates in the sample, while a series of random intercept logistic regression models analyzed mammogram (N = 2326 women aged 40+) and Papanicolaou (Pap; N = 2959 women aged 21–64) screening separately.

Mammogram and Pap screening prevalence rates were highest among women who were aged 40–64, Spanish-speaking Latinas, lower educated, attending cancer education events because of the cost of the screenings, patient navigation recipients, living in the south region of Texas, and in counties with high poverty. Although models indicated significant variability in screening rates by county, county-level poverty was only significantly associated with odds of getting Pap screening in adjusted models. Not receiving patient navigation vs. receiving it was associated with lower odds for both mammogram (OR: 0.51, CI: 0.38–0.70) and Pap (OR: 0.69, CI: 0.50–0.94) screenings.

County-level variation in screening rates exists for both mammogram and Pap tests and should be considered in the development and implementation of screening interventions in rural and border areas. However, other factors beyond poverty levels may explain the variation.

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Acknowledgments

The authors would like to thank the team of patient navigators, program specialists, research assistants, and women who participated in the program and its evaluation.

Funding

Dr. Falk was supported by grant, T32CA122061, Training Grant in Cancer Prevention and Control from the National Cancer Institute and the Doctoral Training Grant in Oncology Social Work (125672-DSW-14-115-01-SW) from the American Cancer Society. Dr. Cubbin was supported by grant, P2CHD042849, Population Research Center, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Evidence-Based Prevention Programs and Services grants, PP120099 and PP150089, from the Cancer Prevention Research Institute of Texas provided the funding for the program and its evaluation.

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Authors and Affiliations

  1. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Derek Falk

  2. Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA

    Catherine Cubbin & Barbara Jones

  3. Departments of Health Social Work, Oncology, Population Health, and Psychiatry, Dell Medical School, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA

    Barbara Jones

Authors
  1. Derek Falk
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  2. Catherine Cubbin
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Correspondence to Derek Falk.

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Appendix

Appendix

Table 4 Chi-square tests comparing the proportions of Friend to Friend + Patient Navigation participants without follow-up interviews to participants with follow-up interviews reporting barriers to screening (n = 4743), 3/1/12–11/5/16
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Falk, D., Cubbin, C. & Jones, B. County-Level Poverty and Barriers to Breast and Cervical Cancer Screening in a Health Education and Patient Navigation Program for Rural and Border Texas Residents. J Canc Educ 37, 421–429 (2022). https://doi.org/10.1007/s13187-020-01832-z

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  • DOI: https://doi.org/10.1007/s13187-020-01832-z

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