Modelling Community Disparity in Breast Cancer Screening

描述（由申请人提供）：虽然乳腺癌筛查已被证明可以降低死亡风险，但低收入、被剥夺权利的社区的筛查利用率较低。 研究这些差异的大部分工作都集中在理解个人和社会特征与筛查行为的关联上（例如，社会支持）。 然而，妇女居住的社区的特点却被忽视，尽管这些特点影响健康和相关行为。 为了解决社区差异，必须超越我们目前的观点界限，建立一个新的多层次模式。 多层次方法包括个人的特点以及更广泛的社区一级因素对个人一级的结果。 这种新的模式有可能增加我们对社区之间乳腺癌筛查差异的理解，指出新的干预领域以增加筛查，从而有可能降低死亡风险。 尽管其巨大的潜力，目前还没有研究已经开发出一个多层次的模型，旨在检查乳腺癌筛查的社区变化。 拟议的项目将通过测试不同的途径（医疗基础设施、一般社区基础设施、社会资本）来构建一个概念模型，通过这些途径，在控制个人层面的障碍后，来自物质和社会条件不利的大都市地区的40岁或40岁以上的妇女不太可能接受乳腺癌筛查。 这三个潜在的途径的检查将导致更具体的机制，该地区不利的物质和社会条件的影响筛查乳腺癌的假说的发展。 我们将分析现有的公共使用数据（1999-2000年全国健康访谈调查）的10,000多名妇女从58个大都市地区在整个美国，合并社区数据从各种现有的来源（如美国人口普查，地区资源文件），以构建这个模型。 通过关注构建的多水平模型的特定途径，这项新研究的结果将作为未来癌症控制研究资助申请的基础。 这些应用将侧重于利用基于人口的调查和现有数据来源无法提供的深入数据收集方法，对具体假设进行评价。

DESCRIPTION (Provided by Applicant): Although breast cancer screening has been proven to reduce the risk of mortality, low-income, disenfranchised communities have lower screening utilization. Much of the work examining these disparities has focused on understanding the association of individual and social characteristics with screening behavior (e.g., knowledge, social support). However, characteristics of the community in which women reside have been ignored despite the fact that such characteristics influence health and related behaviors. In order to address community disparities, it is critical to press beyond the current boundaries of our perspectives and develop a new, multilevel model. Multilevel approaches include characteristics of individuals as well as broader community level factors on individual-level outcomes. This new paradigm has the potential to increase our understanding of disparities in breast cancer screening among communities, point to new areas for interventions to increase screening, and thus have the potential to reduce the risk of mortality. Despite its great potential, there are currently no studies that have developed a multilevel model aimed at examining community variation of breast cancer screening. The proposed project will construct a conceptual model by testing the different pathways (medical infrastructure, general community infrastructure, social capital) by which women age 40 or older from metropolitan areas with adverse material and social conditions are less likely to be screened for breast cancer after controlling for individual-level barriers. Examination of these three potential pathways will lead to the development of more specific hypotheses about the mechanisms by which area adverse material and social conditions influence screening for breast cancer. We will conduct analyses of existing public use data (1999-2000 National Health Interview Survey) of more 10,000 women from 58 metropolitan areas throughout the United States, merged with community data from various existing sources to construct this model (e.g. US Census, Area Resource File). By focusing on specific pathways of the constructed multilevel model, the findings of this novel study will serve as the basis for future cancer control research grant applications. Such applications will focus on the evaluation of specific hypotheses using population-based surveys and in-depth data collection methods not available by using existing data sources.