Using the Rural-Urban Continuum to Assess Women's Reproductive Health Care Utilization Across the Life Course

Open Access
- Author:
- Ely, Danielle Mamie
- Graduate Program:
- Rural Sociology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- October 04, 2016
- Committee Members:
- Shannon Marie Monnat, Dissertation Advisor/Co-Advisor
Shannon Marie Monnat, Committee Chair/Co-Chair
Leif Jensen, Committee Member
Carolyn Elizabeth Sachs, Committee Member
Patricia Y Miranda, Outside Member - Keywords:
- Mammogram
Pap test
HPV vaccination
Rural-Urban Continuum
Health Disparities
Women's Health
Reproductive Health - Abstract:
- Rural women are less likely than their urban peers to have access to and to utilize cancer screenings related to reproductive health care. This trend has been apparent to health researchers for decades. Using a five-category metropolitan status variable, I examine rural-urban continuum differences in women’s receipt of the Human Papillomavirus Virus (HPV) vaccine, papanicolaou tests, and mammograms. Guided by Andersen's Behavioral Model for Health Services Use (1995), this dissertation assesses the importance of individual- and contextual- level enabling factors in contributing to rural/urban continuum differences in women's utilization of reproductive health care. This research aims to 1) Describe rural-urban continuum difference in mammogram and cervical cancer screening utilization and HPV vaccination among adult women in the U.S.; 2) Identify the individual and contextual factors that contribute to rural-urban continuum differences in these outcomes; and 3) Determine whether metropolitan status moderates associations between these enabling factors and service utilization. I conduct analyses on two reproductive health screenings (papanicolaou test and mammograms) and HPV vaccination. I use recommendations from the American Cancer Society, the U.S. Preventative Services Task Force, and the U.S. Centers for Disease Control and Prevention to assess receipt of these services in the recommended time frame. Several important findings emerge. Women in metropolitan counties are more likely than those in nonmetropolitan counties to have received recent pap tests and mammograms, with the lowest screening rates among women in the smallest rural areas. Metropolitan status is not associated with HPV vaccination among adult women. Women’s individual-level enabling factors, including household income, educational attainment, health insurance status, access to a personal physician, and medical cost barriers contribute to these rural/urban differences in salient ways. This dissertation advances the extant literature by identifying the importance of moving past the rural/urban dichotomy to understand differences cancer screening receipt and by identifying which enabling factors are the most important predictors of screening and vaccine receipt along the rural-urban continuum. These findings inform implications for practice, policy, and research toward improving rural women’s receipt of cancer screening recommendations.