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Womens Health Issues. 2012 May-Jun;22(3):e243-51. doi: 10.1016/j.whi.2011.11.005. Epub 2012 Jan 24.

Multilevel analysis of the determinants of receipt of clinical preventive services among reproductive-age women.

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Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.



We investigated the impact of individual- and county-level contextual variables on women's receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities.


Outcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004-2005) were appended to prospective survey data from the Central Pennsylvania Women's Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women's preventive care. Multilevel analyses were performed.


We found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations.


Women's receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women's receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.

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