Recommended use of clinical preventive services (CPS) reduces morbidity and mortality from numerous health conditions. Despite this, many individuals choose to forego these life saving procedures. CPS differ from other prevention behaviors in that they are administered by health care professionals, are invasive, and are associated with risks. Invasive risky procedures create barriers to the use of CPS. Extant research notes that economic and social conditions affect health care utilization rates, but little research examines these factors in relation to CPS utilization. This gap persists despite systemic concern that macro level conditions (e.g. economic downturns) affect health and health care use. Our proposed study examines how economic conditions and social capital affect the use of CPS. For this, we have developed the following specific aims 1) assess how economic changes affect the use of CPS;2) examine how social capital affect the use of CPS;and 3) determine the relationship between economic conditions, social capital, and CPS embedded within individuals, counties, and states. Using the Behavioral Risk Factor Surveillance System (BRFSS), we will examine the following CPS utilization outcomes for each specific aim: vaccinations (influenza and human papilloma (HPV)) and health screenings (prostate cancer, colorectal cancer, cervical cancer, and breast cancer). The BRFSS is a nationally representative dataset that includes information on CPS utilization. We will use the General Social Survey and previous research to construct state and county level measures of social capital. We will obtain economic and demographic data from the Department of Census. Cross-sections of data will be pooled across years 1990-2011 (as available) and linked with state and county identifiers. Our core estimation will rely on fixed effects analyses and multileve modeling. These methods are appropriate because they address time invariant state level heterogeneity and allow nesting of individuals within groups. Our study is responsive to two of AHRQ's research goals: 1) achieving efficiency in health care delivery and 2) assuring that consumers use information to make informed choices. Findings will assist in developing health care policies that are sensitive to the economic and social context, and empower individuals to overcome their reluctance to use CPS.

Public Health Relevance

Clinical Preventive Services (CPS), such as vaccinations and health care screenings, are critical strategies to reduce morbidity and mortality rates;however, many individuals choose to forego these services. Linking data from multiple sources and using advanced statistical techniques, our study 1) assesses how economic conditions affect CPS use;2) examines how social capital affects CPS use;and 3) uses multilevel modeling to understand the relationships between economic conditions, social capital, and CPS embedded within individuals, counties, and states. Our study will yield important information on how economic and social context shapes CPS utilization behavior.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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University of Miami Coral Gables
Social Sciences
Schools of Arts and Sciences
Coral Gables
United States
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