This study will examine the effects of socio-ecological factors on population-based cancer screening behaviors, specifically for breast, cervix, colorectal and prostate cancers. """"""""Socio-ecological"""""""" factors are community-level social and other environmental characteristics that may influence individuals' utilization of cancer screening. Most importantly, this investigation focuses on identifying which socio-ecological conditions contribute to racial and ethnic differences in cancer screening.
The specific aims of this study are (1) to gather and link data at the individual-level, zip code-level and county-level that are relevant to cancer screening access and utilization; (2) with these data, to construct a multivariate multilevel model that predicts cancer screening utilization; and (3) use this multivariate multilevel model framework to measure racial and ethnic differentials in access and utilization of cancer screening tests by interacting individual race/ethnicity variables with selected socio-ecological variables. In this study, I will examine three domains of socio-ecological factors to assess their impact on individuals' utilization of cancer screening: (1) social resources, (2) health services, and (3) health insurance markets. In this multilevel framework, level I is measured at the individual level; it includes the dependent variable (receipt of a cancer screening test) and all associated individual-level characteristics such as sociodemographic information, health status and health insurance. Levels 2 and 3 reflect socio-ecological factors: level 2 consists of aggregate measures of social resources at the zip code-level, for example the proportion of households below poverty level, the percent of non-citizens, and the proportion of households with children; and level 3 includes county-level or county-group-level characteristics for health services and health insurance markets, for example, the percent of minority primary care physicians, the percent of oncologists and the per capita number of community health clinics. The study will use individual-level data from the California Health Interview Survey (CHIS) and socio-ecological variables drawn from a variety of sources. Combining these managed care, competition variables, with social resources and health services capacity provides a comprehensive evaluation of the health system's mediating effect on promoting cancer screening behavior of minority communities. This study complements and advances the knowledge on individual determinants of cancer screening disparities among racial and ethnic groups. And, in analyzing a comprehensive data set with multiple-levels of information, I can target needed policy changes in social and health market conditions in neighborhoods and in counties to reduce disparities in cancer screening.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Academic/Teacher Award (ATA) (K07)
Project #
5K07CA100097-02
Application #
6945635
Study Section
Subcommittee G - Education (NCI)
Program Officer
Gorelic, Lester S
Project Start
2004-09-01
Project End
2009-08-31
Budget Start
2005-09-01
Budget End
2006-08-31
Support Year
2
Fiscal Year
2005
Total Cost
$127,170
Indirect Cost
Name
University of California Los Angeles
Department
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Ko, Michelle; Ponce, Ninez A (2013) Community residential segregation and the local supply of federally qualified health centers. Health Serv Res 48:253-70
Viruell-Fuentes, Edna A; Ponce, Ninez A; Alegría, Margarita (2012) Neighborhood context and hypertension outcomes among Latinos in Chicago. J Immigr Minor Health 14:959-67
Ponce, Ninez A; Tsui, Jennifer; Knight, Sara J et al. (2012) Disparities in cancer screening in individuals with a family history of breast or colorectal cancer. Cancer 118:1656-63
Cordasco, Kristina M; Ponce, Ninez A; Gatchell, Melissa S et al. (2011) English language proficiency and geographical proximity to a safety net clinic as a predictor of health care access. J Immigr Minor Health 13:260-7
Gee, Gilbert C; Ponce, Ninez (2010) Associations between racial discrimination, limited English proficiency, and health-related quality of life among 6 Asian ethnic groups in California. Am J Public Health 100:888-95
Afable-Munsuz, Aimee; Ponce, Ninez A; Rodriguez, Michael et al. (2010) Immigrant generation and physical activity among Mexican, Chinese & Filipino adults in the U.S. Soc Sci Med 70:1997-2005
Cummings, Janet R; Ponce, Ninez A; Mays, Vickie M (2010) Comparing racial/ethnic differences in mental health service use among high-need subpopulations across clinical and school-based settings. J Adolesc Health 46:603-6
Ponce, Ninez A; Cochran, Susan D; Mays, Vickie M et al. (2008) Health coverage of low-income citizen and noncitizen wage earners: sources and disparities. J Immigr Minor Health 10:167-76
Kagawa-Singer, Marjorie; Pourat, Nadereh; Breen, Nancy et al. (2007) Breast and cervical cancer screening rates of subgroups of Asian American women in California. Med Care Res Rev 64:706-30
Ponce, Ninez A; Chawla, Neetu; Babey, Susan H et al. (2006) Is there a language divide in pap test use? Med Care 44:998-1004

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