1. Low Rates of Cancer Screening in Rural Kentucky 141 st APHA Annual Meeting ∙ November 2013 Richard Crosby Robin Vanderpool Bin Huang This presentation is supported by Cooperative Agreement Number 1U48DP001932-01 from the Centers for Disease Control and Prevention (CDC). The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC.

2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Richard Crosby Dr. Crosby served as a paid consultant to Merck Pharmaceuticals

3. UK Rural Cancer Prevention Center The Rural Cancer Prevention Center (RCPC) is a planned collaboration of community members, public health professionals, and researchers designed to reduce health disparities associated with cervical, breast, and colorectal cancer among residents of the Kentucky River Health District in Appalachian Kentucky.

4. UK Rural Cancer Prevention Center

5. Pap Smear Screening Rates in KY 2002-2010, by Metro Status

6. Pap Smear Screening Rates in KY 2002-2010, by Appalachian Status

7. Logistic Models: Modeling Probability of Having Pap Screening while Controlling for Year and Metro/AP Status

8. Sigmoidoscopy & Colonoscopy Rates in KY 2002-2010, by Metro Status

9. Sigmoidoscopy & Colonoscopy Rates in KY 2002-2010, by Appalachian Status

10. Logistic Models: Modeling Probability of Having Sigmoidoscopy/Colonoscopy while Controlling for Year and Metro/AP Status

11. Mammography Screening Rates in KY 2002-2010, by Metro Status

12. Mammography Screening Rates in KY 2002-2010, by Appalachian Status

13. Logistic Models: Modeling Probability of Having Mammography while Controlling for Year and Metro/AP Status

14. Blood Stool Test Rates in KY 2002- 2010, by Metro Status

15. ORs between Blood Stool Test and Metro status by Year (Metro vs Non- Metro)

16. Blood Stool Test Rates in KY 2002- 2010, by Appalachian Status

17. ORs between Blood Stool Test and AP Status by Year (Non-AP vs AP)

18. Correlation between Pap Screening and Demographic - Modeling Probability of having Pap screening within the past three years VariablesOdds Ratio95% CIp-value Year0.930.900.95<0.0001 Age0.990.980.99<0.0001 Education <0.0001 Reference = Less than HS HS or GED2.131.712.67 Education beyond HS1.511.201.89 Income <0.0001 Reference = less than $15,000 $15,000-$24,9991.320.981.77 $25,000-$34,9991.431.012.02 $35,000-$49,9991.901.362.67 $50,000+3.322.404.60 Unknown1.120.811.53 AP Status (Non AP vs AP)1.201.031.410.0222

19. Correlation between Sigmoidoscopy/Colonoscopy and Demographic - Modeling Probability of Ever Having Sigmoidoscopy/Colonoscopy VariablesOdds Ratio95% CIp-value Year1.101.091.12<0.0001 Age1.041.031.04<0.0001 Sex (Male vs. Female)0.810.740.88 Education <0.0001 Reference = Less than HS HS or GED1.791.582.03 Education beyond HS1.351.201.52 Income <0.0001 Reference = less than $15,0001.171.021.35 $15,000-$24,9991.331.131.56 $25,000-$34,9991.471.241.73 $35,000-$49,9991.991.712.32 $50,000+1.241.081.43 Unknown1.231.131.34 Metro Status (Metro vs Non Metro)1.231.131.34<0.0001

20. Correlation between Mammography and Demographic - Modeling Probability of having Mammography within the past two years VariablesOdds Ratio95% CIp-value Year1.00.91.0<0.0001 Education <0.0001 Reference = Less than HS HS or GED1.81.62.1 Education beyond HS1.41.31.7 Income <0.0001 Reference = less than $15,000 $15,000-$24,9991.10.91.3 $25,000-$34,9991.81.42.2 $35,000-$49,9991.81.42.3 $50,000+2.92.33.6 Unknown1.41.21.7 AP Status (Non AP vs AP)1.31.21.5<0.0001

21. Correlation between blood stool test and demographic - Modeling Probability of having blood stool test within the past two years VariablesOdds Ratio95% CIp-value Year0.880.860.90<.0001 Age1.02 1.03<.0001 Education <.0001 Reference = Less than HS HS or GED1.421.211.67 Education beyond HS1.221.051.42 Income 0.003 Reference = less than $15,000 $15,000-$24,9991.301.081.55 $25,000-$34,9991.331.091.63 $35,000-$49,9991.381.131.69 $50,000+1.100.911.33 Unknown1.010.851.19 Metro Status (Metro vs Non Metro)1.141.031.260.011

22. Thank you! Richard.Crosby@uky.edu Questions?