Skip Navigation Links
Centers for Disease Control and Prevention
 CDC Home Search Health Topics A-Z

Preventing Chronic Disease: Public Health Research, Practice and Policy

View Current Issue
Issue Archive
Archivo de números en español








Emerging Infectious Diseases Journal
MMWR


 Home 

Volume 2: No. 3, July 2005

ORIGINAL RESEARCH
Are Older Adults Up-to-Date With Cancer Screening and Vaccinations?


TABLE OF CONTENTS


Translation available Este elemento en español
  Cet article est en français
  此項為中文
  此项为中文
Print this article Print this article
E-mail this article E-mail this article:



Send feedback to editors Send feedback to editors
Download this article as a PDF Download this article as a PDF (595K)

You will need Adobe Acrobat Reader to view PDF files.


Navigate This Article
Abstract
Introduction
Methods
Results
Discussion
Acknowledgments
Author Information
References
Tables
Appendices


Douglas Shenson, MD, MPH, MS, Julie Bolen, PhD, MPH, Mary Adams, MPH, Laura Seeff, MD, Donald Blackman, PhD

Suggested citation for this article: Shenson D, Bolen J, Adams M, Seeff L, Blackman D. Are older adults up-to-date with cancer screening and vaccinations? Prev Chronic Dis [serial online] 2005 Jul [date cited]. Available from: URL: http://www.cdc.gov/pcd/issues/2005/
jul/05_0021.htm
.

PEER REVIEWED

Abstract

Introduction
Public health organizations in the United States emphasize the importance of providing routine screening for breast cancer, cervical cancer, and colorectal cancer, as well as vaccinations against influenza and pneumococcal disease among older adults. We report a composite measure of adults aged 50 years and older who receive recommended cancer screening services and vaccinations.

Methods
We analyzed state data from the 2002 Behavioral Risk Factor Surveillance System, which included 105,860 respondents aged 50 and older. We created a composite measure that included colonoscopy or sigmoidoscopy within 10 years or a fecal occult blood test in the past year, an influenza vaccination in the past year, a Papanicolaou test within 3 years for women with an intact cervix, a mammogram, and for adults aged 65 and older, a pneumonia vaccination during their lifetime. We performed separate analyses for four age and sex groups: men aged 50 to 64, women aged 50 to 64, men aged 65 and older, and women aged 65 and older.

Results
The percentage of each age and sex group that was up-to-date according to our composite measure ranged from 21.1% of women aged 50 to 64 (four tests) to 39.6% of men aged 65 and older (three tests). For each group, results varied by income, education, race/ethnicity, insurance status, and whether the respondent had a personal physician.

Conclusion
These results suggest the need to improve the delivery of cancer screenings and vaccinations among adults aged 50 and older. We propose continued efforts to measure use of clinical preventive services.

Back to top

Introduction

Healthy People 2010 is a national initiative that has set specific health and health care objectives (1). These performance targets include the delivery of adult clinical preventive services such as cancer screening and vaccinations. Studies of the effectiveness of these services have been reviewed by the U.S. Preventive Services Task Force (USPSTF) (2), and recommendations for providing the services have been developed by the Guide to Community Preventive Services (3). Both efforts emphasize the importance of providing routine screening for breast cancer, cervical cancer, and colorectal cancer as well as vaccinations against influenza and pneumococcal disease.  

The delivery rates of cancer screenings and adult vaccinations have typically been measured separately through population-based surveys, including the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS). Although this approach is well suited for assessing progress toward Healthy People 2010 objectives, it does not measure the extent to which individuals receive the full complement of recommended clinical preventive services.

There is currently no index that combines data on the use of all recommended clinical preventive services among adults. In this article, we present a composite measure of cancer screening services and vaccinations obtained by adults aged 50 years and older as a first step toward assessing overall clinical preventive service delivery. We chose to begin our assessment by combining these two sets of interventions because they are universally recommended and data on their use in all 50 states and the District of Columbia are available through the 2002 BRFSS. Composite indices have long been used for the surveillance of childhood vaccinations (4).

Our approach aims to provide a more meaningful and practical measure of the state of clinical preventive service delivery. Such a comprehensive measure could also enhance the ability of health departments and community groups to assess disparities in delivering preventive services, to better gauge progress toward measurable objectives, and to identify best practices for achieving prevention goals.

Back to top

Methods

Data

We used data from the 2002 BRFSS; the BRFSS is an ongoing state-based telephone survey of randomly selected adults and is coordinated by the Centers for Disease Control and Prevention (CDC). The survey collects data from noninstitutionalized adults aged 18 and older on health practices that are related to the leading causes of death and disability (5). We limited our analysis to data from adults aged 50 and older, including 105,860 respondents in 49 states and the District of Columbia. Illinois data are not reported because approximately half of the female respondents in that state were not asked questions about breast and cervical cancer screening. All results are based on weighted data that account for different probabilities of selection and are adjusted to the total adult population in each state by age and sex or age, race, and sex.

Measures

We analyzed responses to the BRFSS core questions on the use of clinical preventive services recommended by the USPSTF for adults aged 50 and older: colorectal cancer screening, mammography, Papanicolaou (Pap) test, and influenza and pneumococcal vaccinations (Table 1). These questions were asked in all states and territories that participated in the 2002 BRFSS survey. All measures of preventive health services were dichotomized as yes or no based on receipt of the service according to schedules recommended by the USPSTF. The USPSTF recommends influenza vaccination for adults aged 50 and older (6); other agencies support this recommendation (7). We used a 10-year interval for endoscopy (colonoscopy or sigmoidoscopy) because the BRFSS question did not distinguish between the two interventions. The USPSTF does not recommend intervals for the use of sigmoidoscopy or colonoscopy; other national guidelines recommend a 5-year interval for sigmoidoscopy and a 10-year interval for colonoscopy (8-10). For all services, people who had never had the test or had the tests outside the designated schedule were included in the group who answered no. Our analysis excluded respondents with missing values except for respondents missing one colorectal cancer screening value. Because colorectal cancer screening recommendations involve receiving either endoscopy or fecal occult blood testing (FOBT), we did not exclude respondents with missing values for one test if they had the other test within the recommended interval.

From the separate measures for cancer screenings and vaccinations, we created a variable to measure whether a person had received all of these clinical preventive services as recommended by the USPSTF. Because the recommendations vary by age and sex, this measure, which we call being up-to-date, was determined separately for four age and sex groups. For men aged 50 to 64, the up-to-date measure included men who met the recommendation for colon cancer screening and influenza vaccination (two services). For women aged 50 to 64, the up-to-date measure included women who met the recommendations for colon cancer screening, breast cancer screening, cervical cancer screening, and influenza vaccination (four services). The up-to-date measure includes women with a hysterectomy among those who met recommendations for cervical cancer screening. Because a Pap test is not normally recommended for these women, it would be incorrect to classify them as not being up-to-date on cervical cancer screening. For adults aged 65 and older, the up-to-date measure included the cancer screening tests for their sex, plus an influenza vaccination and a pneumococcal vaccination (three services for men and five services for women). The number of tests required for being up-to-date was two for men aged 50 to 64, three for men aged 65 and older, four for women aged 50 to 64, and five for women aged 65 and older (colorectal, breast, and cervical cancer screening in addition to influenza and pneumonia vaccinations).

From responses to several questions on race and ethnicity that permitted respondents to indicate more than one race, we created five groups: white (limited to non-Hispanic whites), black (limited to non-Hispanic blacks), Hispanic of any race, Asian or Pacific Islander, and American Indian or Alaska Native. Level of education was recoded from multiple responses into four categories: less than high school, high school graduate or general equivalency diploma (GED), some college, and college graduate. Health insurance status was determined by the response to a single question and coded yes or no. Data on household income were coded into four groups: less than $25,000, $25,000 to $49,999, $50,000 to $74,999, and $75,000 and above. Respondents were asked if they had a personal physician; those with one or more were coded as yes. Health status was dichotomized into 1) fair or poor or 2) good, very good, or excellent.

Statistical analysis

Stata, Version 8.0 (StataCorp, College Station, Tex), was used in all statistical analyses to account for the complex sample design of the BRFSS. Most analyses were performed on subpopulations representing four age and sex groups: men aged 50 to 64, women aged 50 to 64, men aged 65 and older, and women aged 65 and older. Pearson's chi-square tests were used to compare the percentage of adults who were up-to-date on the recommended services for their age and sex group by demographic characteristics. For mapping purposes, we divided state results into quartiles and then combined the middle two quartiles.

Back to top

Results

The median state response rate for the 2002 BRFSS was 58.3% (range 42.2%–82.6%) (11). Results for the individual preventive health services for each of the age and sex groups are presented in Appendix Tables A–D. All other results are for being up-to-date on cancer screening and vaccinations as defined above.

We combined data for 49 states and the District of Columbia to examine the percentage of adults who were up-to-date among demographic and risk-factor subgroups (Table 2). Black, Hispanic, and Asian older adults were significantly less likely than whites to be up-to-date in at least two of the four age and sex groups. On the other hand, although they did not reach statistical significance, rates for American Indians were consistently close to rates for whites in three of the four groups.

Among both men and women in all age groups, having more education was strongly related to being up-to-date. Respondents with less than a high school education were much less likely to be up-to-date (range 12.4%–29.5%) than those with a college degree (range 25.4%–43.8%). Similarly, higher income was associated with being up-to-date on cancer screening and vaccinations. Adults with health insurance were about twice as likely to almost three times as likely to be up-to-date as adults with no insurance. The same was true for adults with a personal physician compared with those without one. Overall, people who reported fair or poor health were more likely to be up-to-date than those who reported good, very good, or excellent health.

State-specific prevalence estimates for each of the age and sex groups were divided into quartiles and mapped (Figure 1). States in the western and southeastern United States were among those with the lowest percentage of men aged 50 to 64 who were up-to-date on cancer screening and vaccinations (California, Idaho, Nevada, Utah, and Wyoming in the West; Arkansas, Florida, Georgia, Louisiana, and Mississippi in the Southeast). There was a similar but less pronounced pattern for women aged 50 to 64 (Idaho, Nevada, and Wyoming in the West; Arkansas, Florida, Georgia, Louisiana, and Mississippi in the Southeast). The percentage of men and women aged 65 and older who were up-to-date was low in Indiana, Louisiana, Mississippi, Nebraska, and Texas. Arizona, California, Minnesota, North Dakota, Connecticut, Rhode Island, Wisconsin, Massachusetts, and Maine had higher percentages of people aged 65 and older who were up-to-date than most of the other states. Minnesota had the highest percentage of up-to-date adults in each of the four age and sex groups.

Maps of the United States

Figure 1. Prevalence estimates of adults aged ≥50 years who were up-to-date for cancer screening and vaccinations by age group, sex, and state, Behavioral Risk Factor Surveillance System (BRFSS), 2002. Data from 49 states and the District of Columbia. Results were divided into quartiles, and the middle two quartiles were combined. Illinois data are not included because the state used a split sample for some preventive service questions. [A text description of these maps is also available.]

The percentage of each age and sex group that was up-to-date is presented by state in Table 3. The state medians for the percentage of respondents who were up-to-date were consistently less than 40% (with a range of 22.1% for women aged 50 to 64 to 38.2% for men aged 65 and older) (Figure 2). Median state values were similar to results for all adults reported in Table 2.

Bar graph

Figure 2. Median and range of state-specific results for percentage of adults aged ≥50 years who were up-to-date for cancer screening and immunizations, Behavioral Risk Factor Surveillance System (BRFSS), 2002. Data from 49 states and the District of Columbia. Illinois data are not included because the state used a split sample for some preventive service questions. [A text description of this graph is also available.]

Table 4 shows the percentage of adults who had zero, one, two, three, four, or five cancer screenings or vaccinations. Most adults had one or more preventive services, with the percentage of adults who received none of the services ranging from 3.6% for women aged 65 and older to 38.3% for men aged 50 to 64. Thus, the results indicated that at least 61.7% of older men and more than 95% of older women have had some contact with the health care system within the past few years.

Back to top

Discussion

This analysis of state BRFSS data indicates that among the four age and sex groups, the state medians for adults who are up-to-date with recommended cancer screenings and vaccinations range from 22.1% (women aged 50 to 64) to 38.2% (men aged 65 and older). Although the delivery rates of individual clinical preventive services may be relatively high — cervical cancer screening, for example, is at a national median of 81.0% — overall levels of protection provided by cancer screenings and vaccinations are low.

This study did not include data on cholesterol screening or tetanus–diphtheria vaccination, or data on clinical preventive services that are also recommended according to a specific schedule. Other excluded measures included screening for abnormalities of blood pressure, height, weight, obesity, vision, and hearing; chemoprevention for cardiovascular disease (aspirin); and counseling on calcium intake, folic acid, tobacco cessation, drug and alcohol use, sexually transmitted diseases, human immunodeficiency virus (HIV), nutrition, physical activity, sun exposure, oral health, injury prevention, and polypharmacy.

In addition to low absolute levels, the data indicate important differences among states. For each of the four age and sex groups, Minnesota consistently had the highest up-to-date percentages. Several factors may explain why this state has done so well in preventive service delivery: a high proportion of the population is enrolled in managed care; the state has a low uninsurance rate; and state-sponsored outreach promotes colorectal cancer screening and adult vaccinations. Additional research is necessary to fully explore the reasons for success in Minnesota. Many of the lowest measurements were found in the southeastern and south-central United States; these states have low rates of health insurance among adults (12).

Each of the four age and sex groups has its own set of recommended clinical preventive services. Figure 2 illustrates that men and women within each of the two age groups have similar proportions that are up-to-date, despite the fact that more tests are required of women. When compared with women in the same age group, men are much more likely to have had none of the recommended services. The reasons for these differences are not clear from the data and require further analysis.

There were significant differences in being up-to-date among racial and ethnic categories. Based on consistency across age and sex groups, it appears that blacks, Hispanics, and Asians may be less likely than whites to be up-to-date for cancer screenings and adult vaccinations. There may be higher rates of screening among American Indians because many American Indians receive health care through the Indian Health Service, which emphasizes preventive health practices. Further investigation of these racial and ethnic disparities is warranted.

Not only are reasons for racial and ethnic disparities not clear from the data but these disparities also are confounded by disparities in being up-to-date according to educational, socioeconomic, and insurance status. Respondents who have a college degree are 1.5 to 2 times more likely to be up-to-date than respondents who do not have a high school degree. Receipt of clinical preventive services is also consistently associated with higher income level for each of the four age and sex groups. Large differences exist between people who have medical insurance and people who do not. People with health insurance or personal physicians have approximately two to three times the rate of clinical preventive service delivery as people without either of them. According to the U.S. Census, 11.1% of whites, 19.6% of blacks, 18.8% of Asians, and 32.7% of Hispanics lacked insurance in 2003 (13). These findings are consistent with those of other studies that have found significant disparities in the delivery of cancer screening (14-16) and adult vaccinations (17,18) when measured by race/ethnic group, education, and income.

More than 95% of adults aged 65 and older have health insurance through Medicare, which pays for cancer screening and vaccinations (19). Nonetheless, fewer than 40% of this age group are up-to-date on all of the recommended cancer screening and vaccinations. Having health insurance (and a personal physician) — although necessary — is not in itself sufficient for achieving high levels of being up-to-date with cancer screenings and vaccinations.

Our results suggest that most respondents have received at least one cancer screening or vaccination. Therefore, most adults aged 50 and older have had some contact with the health care system within the past few years, but they do not receive the preventive services recommended for their age and sex group. At the same time, the analysis indicates that up-to-date rates are not low because adults lack only a single service.

This work builds on the analysis of others (20). The BRFSS has followed state rates for clinical preventive service delivery for more than 20 years, and a recent study has provided a comprehensive overview of trends (21). Combined measurements of mammography, clinical breast exam, and Pap testing have been made using data from the 1990 NHIS of Health Promotion and Disease Prevention (22). A methodology for building a prevention index has also been developed using electronic medical records. This index can serve as a combined quality assessment measure and be compared with consensus measures or with selected Health Plan Employer Data and Information Set (HEDIS) scores for health management organizations (23).

This study has a number of limitations. First, the BRFSS relies on self-reported data. Depending on the measure, self-reports can result in overestimates or underestimates compared with other data sources, such as health care records. Unfamiliarity with medical terms and telescoping (24) (recalling events more recently than they actually occurred) can affect the validity of self-reported clinical preventive services and probably result in overestimates (20,25). A review article by Nelson et al rates the validity of self-reports for mammography, Pap test, colorectal cancer screening, and pneumococcal vaccination as moderate and the validity for influenza vaccination as high (26). Second, households without telephones, which are more likely to have adults with low socioeconomic status, were excluded from the survey. This omission may have resulted in an overestimation of delivery rates (27). Third, the survey excludes people who rely only on cellular telephones for their telephone service. Finally, the BRFSS questions limited our ability to adequately determine compliance with Pap test recommendations for women aged 65 and older. The USPSTF recommends against routine screening for cervical cancer for women in this age group if they have had sufficient recent Pap tests with no abnormal results and are not otherwise at increased risk for cervical cancer (28). Without Pap test histories, we could not ascertain which of these older women might not need further Pap testing, and thus we were unable to determine how this anomaly in the recommendations might have affected our estimates of being up-to-date on the Pap test among women aged 65 and older. 

The results of this study suggest several potential next steps. From a surveillance perspective, we recommend that state-based surveys such as the BRFSS consider periodically collecting in the same year information about clinical preventive services with specific schedules (i.e., the services analyzed in this study as well as cholesterol screening and tetanus–diphtheria vaccination). In this way, a more complete measure of delivered adult clinical preventive services recommended by age and sex can be calculated. One of the strengths of a composite measure of clinical preventive services is that it emphasizes the overall protection of individuals by combining measurements across disease categories. We also recommend that surveys such as the BRFSS examine the feasibility and implications of routinely reporting a composite measure such as the one suggested by this study.  

The building blocks of composite measures will change as recommendations for individual interventions evolve. For example, colorectal cancer screening guidelines for Healthy People 2010 objectives have not yet been updated to match USPSTF recommendations. (Healthy People 2010 objectives for Pap test, mammography, and adult vaccinations are consistent with USPSTF recommendations for women aged 50 and older.)

The results of this study also suggest that the delivery of clinical preventive services in physicians’ offices needs continued attention. Among respondents who indicated having a personal physician, the group with the highest proportion of up-to-date was men aged 65 and older at only 41.5%; the group with the lowest proportion was women aged 50 to 64 at 22.8%. Despite important initiatives designed to improve the provision of clinical preventive services in physicians’ offices, such as the Agency for Healthcare Research and Quality’s Put Prevention Into Practice (PPIP) (29), more work is necessary to enhance chart-flagging systems and improve reminder protocols aimed at patients. Physicians have begun to systematically consider various approaches to addressing multiple behavioral risk factors in primary care (30), and we hope that this commitment can be extended to providing multiple clinical preventive services.

From a public health standpoint, new kinds of programs are needed to address the shortfall identified by this study. Access to each of the recommended clinical preventive services can be facilitated inside and outside of the clinical setting. New initiatives must focus on populations, not patient panels. A community-wide strategy has been developed by the Sickness Prevention Achieved through Regional Collaboration (SPARC) program in Connecticut, Massachusetts, and New York, and has achieved promising results (31,32) by expanding delivery at clinical sites and creating new points of access in nonclinical settings. A similar approach has been taken by New York State’s Healthy Women Partnerships, which facilitates the delivery of multiple cancer screenings for underserved populations. Community-wide assurance of clinical preventive services has been a priority for the Group Health Cooperative, a nonprofit health care system based in Seattle, Wash, which covers a large proportion of its region’s residents (33).

Additional analytic work is necessary. An examination of data from states that collect information on cholesterol screening and tetanus–diphtheria vaccinations will yield a more complete — and perhaps lower — composite measure of up-to-date use of recommended services. A multivariable regression analysis will provide a fuller understanding of factors that are most strongly and independently associated with failure to be up-to-date, and a longitudinal analysis of trends in the composite measure will yield useful information for targeting state preventive health efforts.

This study reports low composite rates of adult clinical preventive service delivery based on 2002 BRFSS data for adults aged 50 and older and highlights significant disparities among groups. We must redouble our efforts to develop more effective approaches to delivering these basic adult clinical preventive services.

Back to top

Acknowledgments

The authors thank Michael Alderman, MD, and David Nelson, MD, MPH, for their review of earlier drafts of this article.

Back to top

Author Information

Corresponding Author: Douglas Shenson, MD, MPH, MS, 76 Prince St, Newton, MA 02465. The author is affiliated with Sickness Prevention Achieved through Regional Collaboration (SPARC), Lakeville, Conn. Telephone: 617-796-7966. E-mail: dshenson@sparc-health.org.

Author Affiliations: Julie Bolen, PhD, MPH, Laura Seeff, MD, Donald Blackman, PhD, Centers for Disease Control and Prevention, Atlanta, Ga; Mary Adams, MPH, On Target Health Data LLC, Hartford, Conn.

Back to top

References

  1. U.S. Department of Health and Human Services. Healthy People 2010: understanding and improving health. 2nd ed. Washington (DC): U.S. Government Printing Office; 2000 Nov.
  2. U.S. Department of Health and Human Services. Guide to clinical preventive services. U.S. Preventive Services Task Force. 3rd ed. Washington (DC): U.S. Government Printing Office; 2004 Apr.
  3. Zaza S, Briss PA, Harris KW, editors. The guide to community preventive services: what works to promote health? Task Force on Community Preventive Services. New York (NY): Oxford University Press; 2005.
  4. Barker L, Santoli J, McCauley M. National, state, and urban area vaccination coverage among children aged 19-35 months — U.S. 2003. MMWR 2004;53(29):658-61. 
  5. Bolen JC, Rhodes L, Powell‑Griner E, Bland SD, Holtzman D. State‑specific prevalence of selected health behaviors, by race and ethnicity — Behavioral Risk Factor Surveillance System 1997. MMWR CDC Surveill Summ 2000;49(2):1-60.
  6. Clinical Preventive Services for Normal-Risk Adults Recommended by the U.S. Preventive Services Task Force. Put Prevention into Practice. Agency for Healthcare Research and Quality. Rockville (MD);2004 Jan. Available from: URL: http://www.ahrq.gov/ppip/adulttm.htm.
  7. Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(RR-3):1-38.
  8. Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137(2):132-41.
  9. Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastrointestinal Consortium Panel. Gastroenterology 2003;124(2):544–60.
  10. Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T, Rothenberger D, et al. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. CA Cancer J Clin 2001;51(1):38-75.
  11. Centers for Disease Control and Prevention. 2002 Behavioral Risk Factor Surveillance System summary data quality report. Atlanta (GA): Centers for Disease Control and Prevention. Available from: URL: http://www.cdc.gov/brfss/technical_infodata/pdf/ 2002SummaryDataQualityReport.pdf.
  12. Mills RJ, Bhandari S. Health insurance coverage in the United States, 2002. Current Population Reports, P60-223. Washington (DC): U.S. Census Bureau; 2003. p.1-24.
  13. DeNavas-Walt C, Proctor BD, Mills RJ. Income, poverty, and health insurance coverage in the United States, 2003. Current Population Reports, P60-226. Washington (DC): U.S. Census Bureau; 2004.
  14. Bradley CJ, Given CW, Roberts C. Health care disparities and cervical cancer. Am J Public Health 2004;94(12):2098-103.
  15. Peek ME, Han JH. Disparities in screening mammography. Current status, interventions and implications. J Gen Intern Med 2004;19(2):184-94.
  16. Shapiro JA, Seeff LC, Nadel MR. Colorectal cancer-screening tests and associated health behaviors. Am J Prev Med 2001;21(2):132-7.
  17. Centers for Disease Control and Prevention. Racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons aged ≥65 — United States, 1989-2001. MMWR 2003;52(40):958-62.
  18. Bonito AJ, Lenfestey NF, Eicheldinger C, Iannacchione VG, Campbell L. Disparities in immunizations among elderly Medicare beneficiaries, 2000-2002. Am J Prev Med 2004;27(2):153-60.
  19. U.S. Department of Health and Human Services. The guide to medicare prevention services: for physicians, providers, suppliers, and other health care professionals. Center for Medicare and Medicaid Services. CMS-10110. Washington (DC): U.S. Government Printing Office: 2004 Aug.
  20. Nelson DE, Bland S, Powell-Griner E, Klein R, Wells HE, Hogelin G, et al. State trends in health risk factors and receipt of clinical preventive services among U.S. adults during the 1990s. JAMA 2002;287(20):2659-67.
  21. Okoro CA, Strine TW, Young SL, Balluz LS, Mokdad AH. Access to health care among older adults and receipt of preventive services. Behavioral Risk Factor Surveillance System (BRFSS), 2002. Prev Med 2005;40(3):337-43.
  22. Pearlman DN, Rakowski W, Ehrich B. Mammography, clinical breast exam, and pap testing: correlates of combined screening. Am J Prev Med 1996;12(1):52-64.
  23. Vogt TM, Aickin M, Ahmed F, Schmidt M. The Prevention Index: using technology to improve quality assessment. Health Serv Res 2004;39(3):511-30.
  24. Sudman SN, Bradburn NM. Effects of time and memory factors on response in surveys. J Am Stat Assoc 1973;68:805-15.
  25. Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ. The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. Am J Prev Med 1999;17(3):211-29.
  26. Nelson DE, Holtzman D, Bolen J, Mack KA, Stanwyck CA. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Soz Praventivmed 2001;46 (Suppl 1) p. S3-42.
  27. Thornberry OT, Massey JT. Trends in the United States telephone coverage across time and subgroup. In: Groves RM, Biemer PP, Lyberg LR, Massey JT, Nichols WL, editors. Telephone survey methodology. New York (NY): John Wiley & Sons; 1988. p. 25-49.
  28. Smith RA, Cokkinides V, von Eschenbach AC, Levin B, Cohen C, Runowicz CD, et al. American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin 2002;52(1):8-22. 
  29. Agency for Healthcare Research and Quality. About PPIP: Put Prevention Into Practice, 2000. Rockville (MD): Agency for Healthcare Research and Quality; 2000. Available from: URL: http://www.ahrq.gov/ppip/ppipabou.htm.
  30. Pronk NP, Peek CJ, Goldstein MG. Addressing multiple behavioral risk factors in primary care. Am J Prev Med 2004;27(2S):1-110.
  31. Shenson D, Cassarino L, DiMartino D, Marantz P, Bolen J, Good B, et al. Improving access to mammography through community-based influenza clinics: a quasi-experimental study. Am J Prev Med 2001;20(2):97-102.
  32. Shenson D, Quinley J, DiMartino D, Stumpf P, Caldwell M, Lee T. Pneumococcal immunizations at flu clinics: the impact of community-wide outreach. J Community Health 2001;26(3):191-01.
  33. Thompson RS, Taplin SH, McAfee TA, Mandelson MT, Smith AE. Primary and secondary prevention services in clinical practice. Twenty years’ experience in development, implementation, and evaluation. JAMA 1995; 273(14):1130-5.

Back to top

 



Tables

Return to your place in the textTable 1. Clinical Preventive Services Recommended for Adults Aged 50 Years and Older by the United States Preventive Services Task Force (USPSTF), 2004a
Measure Definition Age Groups for Which Services Are Recommended Men 50-64 Women 50-64 Men ≥65 Women ≥65
Influenza vaccination Received in past 12 months Men and women ≥50 X X X X
Pneumococcal vaccination Ever received Men and women ≥65     X X
Mammogram Received in past 2 years Women ≥40   X   X
Pap test Received in past 3 years Women ≥18 with intact cervix   X   X
Colorectal cancer screeningb Received FOBT in past 12 months or endoscopy in past 10 years Men and women ≥50 X X X X
Cholesterol screeningc Every 5 years Men ≥35; women ≥45 X X X X
Tetanus– diphtheria vaccinationc Every 10 years Men and women ≥18 years X X X X

aEmpty cells indicate that the service does not apply to the demographic category.
bIncludes receiving fecal occult blood test (FOBT) or endoscopy (sigmoidoscopy or colonoscopy) within recommended time frames.
cThese services are recommended by the USPSTF, but data were not collected by all states in the Behavioral Risk Factor Surveillance System (BRFSS), 2002, and were not analyzed as part of this study.

Return to your place in the textTable 2. Respondents Aged 50 Years and Older Who Are Up-To-Date for Cancer Screening and Adult Immunization by Age and Sex Group and Demographic Characteristics, Behavioral Risk Factor Surveillance System (BRFSS), 2002a
   Men 50-64b
% (95% CI)
Women 50-64c
% (95% CI)
Men ≥65d
% (95% CI)
Women ≥65e
% (95% CI)
All Adults ≥50
% (95% CI)
Race/ethnicity
White (non-Hispanic) 22.7 (21.8-23.7) 22.2 (21.4-23.0) 41.7 (40.3-43.0) 34.6 (33.6-35.6) 29.2 (28.7-29.7)
Black (non-Hispanic) 18.6 (15.2-22.6) 16.5 (14.1-19.3) 26.2 (20.9-32.3) 21.0 (17.4-25.2) 19.4 (17.7-21.3)
Hispanic (all races) 13.3 (9.8-17.8) 17.9 (14.3-22.1) 30.8 (22.0-41.2) 22.2 (15.2-31.3) 19.1 (16.4-22.2)
Asian or Pacific Islanderf 12.4 (7.8-19.0) 20.1 (12.2-31.3) 25.7 (17.4-36.3) 21.1 (10.6-37.7) 17.6 (13.3-22.9)
American Indian or Alaska Nativef 25.4 (14.4-40.9) 17.7 (10.3-28.9) 41.0 (25.0-59.1) 28.2 (12.1-52.8) 26.6 (19.8-34.6)
P valueg <.001 .03 <.001 <.001 <.001
Education
<High school degree 12.4 (10.1-15.0) 15.5 (13.2-18.1) 29.5 (26.6-32.6) 22.7 (20.0-25.5) 20.4 (19.0-21.8)
High school degree or general equivalency diploma (GED) 18.8 (17.3-20.4) 18.5 (17.4-19.8) 38.5 (36.0-41.0) 30.5 (29.1-31.9) 25.5 (24.7-26.3)
Some college 22.0 (20.2-24.0) 21.9 (20.5-23.4) 43.8 (40.9-46.9) 38.4 (36.3-40.5) 29.4 (28.3-30.4)
College degree 25.4 (23.8-27.0) 25.4 (23.9-27.1) 43.8 (41.5-46.1) 38.9 (36.3-41.5) 30.9 (29.9-31.8)
P valueg <.001 <.001 <.001 <.001 <.001
Annual income,$h
<25,000 16.9 (15.0-19.1) 16.4 (15.0-17.8) 35.1 (32.7-37.5) 27.2 (25.8-28.7) 24.2 (23.3-25.1)
25,000-49,999 19.4 (17.8-21.1) 21.1 (19.7-22.6) 42.4 (40.0-44.7) 37.2 (35.1-39.4) 28.9 (27.9-29.8)
50,000-74,999 21.7 (19.7-23.8) 22.0 (20.2-23.9) 43.1 (39.2-47.2) 40.5 (35.3-45.9) 26.9 (25.6-28.3)
≥75,000 25.6 (23.8-27.5) 25.3 (23.4-27.4) 42.4 (38.4-46.4) 43.5 (38.1-49.1) 28.6 (27.4-30.0)
P valueg <.001 <.001 <.001 <.001 <.001
Insured
Yes 23.3 (22.3-24.3) 23.1 (22.3-24.0) 40.1 (38.7-41.4) 32.8 (31.8-33.8) 28.9 (28.4-29.4)
No 7.9 (6.6-9.5) 7.8 (6.4-9.5) 19.1 (13.9-25.6) 16.5 (11.5-23.3) 9.0 (8.0-10.2)
P value <.001 <.001 <.001 <.001 <.001
Personal physician
Yes 24.0 (22.9-25.0) 22.8 (21.9-23.6) 41.5 (40.1-42.9) 33.8 (32.8-34.9) 29.3 (28.8-29.8)
No 8.0 (6.7-9.6) 6.6 (5.0-8.5) 20.7 (16.8-25.2) 12.2 (9.7-15.1) 10.1 (9.1-11.3)
P value <.001 <.001 <.001 <.001 <.001
Health status
Fair or poor 26.2 (24.0-28.6) 22.0 (20.3-23.8) 41.5 (39.0-44.1) 31.6 (29.6-33.6) 30.0 (28.9-31.1)
Good, very good, or excellent 20.4 (19.4-21.4) 20.9 (20.0-21.8) 38.9 (37.3-40.4) 32.9 (31.7-34.1) 26.5 (25.9-27.0)
P value <.001 .27 .08 .29 .001
Total 21.4 (20.5-22.3) 21.1 (20.3-21.9) 39.6 (38.2-40.9) 32.4 (31.4-33.4) 27.3 (26.8-27.8)
No. BRFSS respondents aged ≥50 (%) 23,568 (22.3) 33,389 (31.5) 17,187 (16.2) 31,716 (30.0) 105,860
No. BRFSS respondents aged ≥50 with missing data other than annual income (%)h 609 (2.6) 982 (2.9) 1,327 (7.7) 2,779 (8.8) 5,697 (5.4)
No. BRFSS respondents aged ≥50 with complete data (except annual income)h 22,959 32,407 15,860 28,937 100,163

aN = 100,163; includes complete sets of data from 49 states and the District of Columbia. Illinois data are not included because the state used a split sample for some preventive services questions. CI indicates confidence interval.
bMen aged 50–64 were up-to-date for preventive services if they met screening recommendations for colorectal cancer and had an influenza vaccination in the past year.
cWomen aged 50–64 were up-to-date for preventive services if they met screening recommendations for breast cancer, cervical cancer, colorectal cancer, and had an influenza vaccination in the past year.
dMen aged ≥65 were up-to-date for preventive services if they met screening recommendations for colorectal cancer, had an influenza vaccination in the past year, and had ever had a pneumococcal vaccination.
eWomen aged ≥65 were up-to-date on preventive services if they met screening recommendations for breast cancer, cervical cancer, and colorectal cancer, had an influenza vaccination in the past year, and had ever had a pneumococcal vaccination.
fThese estimates are based on small numbers of respondents, resulting in wide confidence intervals and potentially unstable point estimates, and should be interpreted with caution.
gP values <.05 indicate that being up-to-date is associated with a demographic characteristic within an age and sex group based on Pearson's chi-square test but do not specify which groups are significantly different from each other.
hN = 82,769 for annual income; 17.4% (17,394/100,163) of otherwise complete questionnaires were missing data on annual income.

Return to your place in the textTable 3.  Percentage of Respondents Who Are Up-To-Date for Cancer Screening and Vaccinations, by State, Behavioral Risk Factor Surveillance System (BRFSS), 2002
Men 50-64a Women 50-64b Men ≥65c Women ≥65d
N % (95% CI)e N % (95% CI) N % (95% CI) N % (95% CI)
Alabama 265 20.1 (15.3-25.9) 486 22.0 (18.4-26.2) 206 34.7 (27.9-42.2) 482 29.8 (25.4-34.7)
Alaska 299 22.7 (16.3-30.6) 323 22.2 (15.7-30.3) 127 25.8 (16.3-38.4) 166 36.8 (25.6-49.7)
Arizona 326 24.4 (17.9-32.2) 512 22.9 (18.3-28.3) 331 48.8 (41.3-56.3) 527 38.0 (32.0-44.4)
Arkansas 380 19.3 (15.4-24.0) 598 16.4 (13.5-19.8) 321 38.2 (32.5-44.2) 600 27.2 (23.3-31.4)
California 385 18.0 (14.2-22.5) 531 21.0 (17.3-25.3) 277 45.7 (38.6-53.0) 472 38.1 (32.3-44.2)
Colorado 371 26.7 (21.2-33.1) 602 27.9 (24.1-32.0) 234 48.3 (41.2-55.4) 432 34.0 (28.7-39.7)
Connecticut 592 24.7 (20.6-29.3) 712 28.6 (24.6-32.9) 392 44.3 (38.5-50.3) 708 39.0 (34.7-43.5)
Delaware 373 30.4 (24.2-37.4) 552 27.7 (23.2-32.7) 348 38.8 (32.3-45.7) 575 37.4 (32.3-42.9)
District of Columbia 210 27.8 (21.1-35.6) 282 21.4 (16.4-27.4) 146 34.5 (25.8-44.4) 259 31.0 (24.6-38.3)
Florida 574 15.6 (12.7-19.0) 869 15.9 (13.3-18.8) 600 36.6 (32.4-41.1) 957 32.4 (29.0-36.0)
Georgia 430 15.5 (11.9-19.9) 714 18.3 (15.1-22.0) 290 33.0 (27.1-39.5) 598 28.1 (23.8-32.8)
Hawaii 661 20.7 (16.6-25.6) 798 21.2 (17.6-25.3) 485 33.8 (28.5-39.6) 764 34.1 (29.6-38.8)
Idaho 505 19.7 (15.8-24.3) 646 17.6 (14.4-21.2) 388 34.2 (28.9-39.8) 688 29.5 (25.4-34.0)
Illinoisf --- --- --- --- --- --- --- ---
Indiana 508 23.7 (19.8-28.1) 830 17.3 (14.7-20.3) 388 33.3 (28.3-38.8) 710 23.2 (19.8-27.0)
Iowa 337 24.2 (19.4-29.8) 517 24.9 (20.8-29.4) 291 42.0 (35.7-48.6) 630 34.3 (29.8-39.1)
Kansas 455 20.6 (16.8-25.0) 612 23.4 (19.9-27.4) 307 43.2 (37.0-49.5) 586 28.5 (24.3-33.0)
Kentucky 605 22.3 (17.7-27.8) 1097 20.0 (16.6-23.8) 506 36.3 (30.6-42.4) 1315 26.8 (23.2-30.8)
Louisiana 419 13.9 (10.3-18.3) 744 14.7 (12.2-17.6) 334 31.0 (25.7-36.9) 692 23.0 (19.7-26.7)
Maine 251 23.9 (18.6-30.1) 362 29.7 (24.7-35.1) 161 50.1 (41.5-58.6) 318 37.8 (31.9-44.0)
Maryland 424 26.1 (21.6-31.1) 635 23.7 (19.9-27.8) 289 46.4 (38.8-54.2) 478 33.6 (28.2-39.4)
Massachusetts 662 23.2 (19.6-27.3) 883 24.9 (21.6-28.4) 499 43.8 (38.5-49.2) 908 37.4 (33.3-41.6)
Michigan 607 19.0 (15.6-22.9) 855 22.4 (19.2-25.9) 435 43.4 (37.8-49.1) 740 33.2 (29.0-37.6)
Minnesota 479 31.4 (27.0-36.0) 590 31.5 (27.5-35.9) 305 53.9 (47.7-60.0) 640 46.3 (41.9-50.8)
Mississippi 373 19.7 (15.5-24.8) 607 15.8 (13.0-19.0) 248 28.9 (23.1-35.5) 647 27.4 (23.5-31.7)
Missouri 445 25.3 (20.0-31.6) 685 21.3 (17.3-25.8) 381 31.1 (25.4-37.5) 761 29.4 (24.9-34.3)
Montana 486 21.1 (15.9-27.4) 556 21.1 (17.0-25.7) 311 35.7 (28.9-43.2) 537 39.7 (34.1-45.6)
Nebraska 356 25.4 (20.8-30.7) 539 23.6 (19.8-27.9) 393 32.4 (27.4-37.7) 754 26.7 (23.0-30.7)
Nevada 400 16.9 (12.1-23.0) 366 11.8 (8.6-16.1) 266 32.9 (25.3-41.5) 337 34.2 (27.5-41.6)
New Hampshire 538 26.2 (22.1-30.6) 692 23.3 (20.0-26.9) 331 39.8 (34.0-45.8) 562 34.2 (29.9-38.9)
New Jersey 612 24.8 (18.1-32.9) 813 15.2 (10.5-21.5) 491 39.9 (31.6-48.9) 813 33.3 (26.8-40.4)
New Mexico 502 20.0 (16.3-24.3) 709 16.8 (13.8-20.2) 410 38.6 (33.2-44.3) 625 26.7 (22.4-31.6)
New York 399 23.2 (18.7-28.3) 575 23.6 (19.8-27.8) 289 43.3 (36.7-50.2) 532 28.0 (23.8-32.5)
North Carolina 618 22.9 (18.3-28.3) 948 25.3 (21.5-29.6) 485 40.4 (33.4-47.7) 944 34.0 (29.5-38.7)
North Dakota 325 18.7 (14.6-23.6) 375 25.9 (21.4-31.0) 206 46.5 (39.1-54.2) 439 37.7 (32.3-43.4)
Ohio 398 17.8 (13.9-22.4) 548 20.2 (16.7-24.3) 262 34.1 (27.6-41.3) 513 29.5 (24.7-34.9)
Oklahoma 709 23.1 (19.5-27.0) 1024 18.6 (16.2-21.3) 605 38.2 (34.0-42.6) 1083 25.7 (22.8-28.8)
Oregon 328 20.2 (15.8-25.3) 467 21.3 (17.6-25.6) 213 34.5 (27.7-41.9) 408 39.1 (33.8-44.7)
Pennsylvania 1351 22.6 (19.9-25.6) 1818 19.5 (17.3-22.0) 999 40.2(36.4-44.2) 1985 32.6 (29.9-35.5)
Rhode Island 330 25.1 (20.3-30.5) 500 25.7 (21.7-30.1) 273 48.4 (41.9-55.0) 477 37.9 (33.1-43.1)
South Carolina 460 19.9 (15.8-24.7) 666 22.6 (18.7-27.0) 319 42.6 (35.8-49.7) 583 36.1 (31.0-41.5)
South Dakota 462 23.7 (19.8-27.9) 634 22.7 (19.2-26.7) 415 35.2 (30.1-40.6) 775 26.5 (23.3-30.1)
Tennessee 302 28.7 (23.4-34.6) 462 23.3 (19.4-27.7) 249 38.1 (31.5-45.2) 423 30.3 (25.5-35.6)
Texas 489 20.6 (16.9-24.8) 772 19.4 (16.5-22.6) 359 31.9 (26.7-37.5) 672 27.1 (23.2-31.4)
Utah 409 17.2 (13.1-22.3) 449 22.8 (18.0-28.5) 285 41.9 (35.1-48.9) 403 27.8 (22.2-34.1)
Vermont 477 25.6 (21.6-30.1) 570 24.6 (21.0-28.6) 312 49.9 (43.8-56.1) 509 35.0 (30.4-39.9)
Virginia 422 25.9 (20.3-32.3) 606 21.4 (17.3-26.1) 292 33.9 (26.8-41.9) 513 32.5 (27.7-37.8)
Washington 478 23.5 (19.2-28.4) 679 24.5 (20.8-28.6) 324 36.5 (30.7-42.7) 597 36.4 (31.6-41.6)
West Virginia 336 21.7 (17.4-26.8) 504 17.1 (13.8-21.0) 276 35.7 (29.7-42.1) 570 24.4 (20.6-28.6)
Wisconsin 427 23.8 (19.5-28.7) 576 23.1 (19.4-27.3) 282 45.4 (38.6-52.4) 565 38.7 (33.9-43.6)
Wyoming 409 19.3 (15.5-23.9) 517 16.3 (13.2-20.0) 251 33.1 (27.0-39.8) 444 30.0 (25.5-34.9)
 
Lowest   13.9   11.8   25.8   23.0 
Highest   31.4   31.5   53.9   46.3
Mediang   22.8   22.1   38.2   32.9

aMen aged 50–64 were up-to-date for preventive services if they met screening recommendations for colorectal cancer and had an influenza vaccination in the past year.
bWomen aged 50–64 were up-to-date for preventive services if they met screening recommendations for breast cancer, cervical cancer, colorectal cancer, and had an influenza vaccination in the past year.
cMen aged ≥65 were up-to-date for preventive services if they met screening recommendations for colorectal cancer, had an influenza vaccination in the past year, and had ever had a pneumococcal vaccination.
dWomen aged ≥65 were up-to-date for preventive services if they met screening recommendations for breast cancer, cervical cancer, and colorectal cancer, had an influenza vaccination in the past year, and had ever had a pneumococcal vaccination. 
eCI indicates confidence interval.
fIllinois data are not included because the state used a split sample for some preventive services questions.
gMedian represents the median value among the 49 states and the District of Columbia.

Return to your place in the textTable 4. Number of Preventive Services Received by Age and Sex Group, Behavioral Risk Factor Surveillance System (BRFSS), 2002a
  No. Preventive Services Received
0 1 2 3 4 5
Men aged 50-64b 38.3 40.3 21.4 NAc NA NA
Men aged ≥65d 12.6 20.5 27.3 39.6 NA NA
Women aged 50-64e 4.7 9.0 28.2 37.0 21.1 NA
Women aged ≥65f 3.6 5.5 11.9 19.5 27.1 32.4

aAll values represent percentages. Includes data from 49 states and the District of Columbia. Illinois data are not included because the state used a split sample for some preventive services questions.
bMen aged 50–64 were up-to-date for preventive services if they received two services (described in Table 1).
cNA indicates not applicable.
dMen aged ≥65 were up-to-date for preventive services if they received three services (described in Table 1).
eWomen aged 50–64 were up-to-date for preventive services if they received four services (described in Table 1).
fWomen aged ≥65 were up-to-date for preventive services if they received five services (described in Table 1).

Back to top

 



Appendices

Return to your place in the textAppendix Table A. Prevalence of Receipt of Preventive Services for Men Aged 50–64 Years, Behavioral Risk Factor Surveillance System (BRFSS), 2002

    Colon Cancer Screeninga Influenza vaccinationb Up-to-Datec
N % (95% CI)d % (95% CI) % (95% CI)
Alabama 273 46.5 (40.0-53.1) 35.3 (29.4-41.7) 20.1 (15.3-25.9)
Alaska 308 49.9 (41.5-58.3) 37.0 (29.4-45.3) 22.7 (16.3-30.6)
Arizona 330 49.0 (40.0-58.1) 31.8 (24.6-39.9) 24.4 (17.9-32.2)
Arkansas 390 38.1 (33.0-43.5) 37.3 (32.2-42.6) 19.3 (15.4-24.0)
California 393 43.7 (37.9-49.6) 31.1 (26.1-36.6) 18.0 (14.2-22.5)
Colorado 384 48.1 (42.0-54.2) 44.2 (38.3-50.3) 26.7 (21.2-33.1)
Connecticut 617 56.1 (51.0-61.1) 35.6 (31.0-40.4) 24.7 (20.6-29.3)
Delaware 376 58.2 (51.2-64.9) 45.7 (38.8-52.7) 30.4 (24.2-37.4)
District of Columbia 215 59.8 (51.5-67.7) 34.4 (27.3-42.4) 27.8 (21.1-35.6)
Florida 592 47.9 (43.0-52.7) 26.5 (22.6-30.7) 15.6 (12.7-19.0)
Georgia 445 45.1 (39.6-50.7) 30.8 (25.9-36.2) 15.5 (11.9-19.9)
Hawaii 675 41.4 (36.2-46.7) 34.4 (29.3-39.9) 20.7 (16.6-25.6)
Idaho 519 44.7 (39.8-49.8) 33.3 (28.7-38.3) 19.7 (15.8-24.3)
Illinoise --- --- ---- --- --- ---- ----
Indiana 518 45.2 (40.4-50.0) 40.8 (36.3-45.6) 23.7 (19.8-28.1)
Iowa 340 45.0 (39.1-51.0) 44.8 (39.0-50.7) 24.2 (19.4-29.8)
Kansas 466 48.8 (43.8-53.7) 35.2 (30.6-40.1) 20.6 (16.8-25.0)
Kentucky 642 46.0 (40.4-51.6) 38.5 (33.2-44.1) 22.3 (17.7-27.8)
Louisiana 437 42.6 (37.2-48.2) 26.6 (22.1-31.6) 13.9 (10.3-18.3)
Maine 257 53.1 (46.2-59.8) 36.7 (30.5-43.4) 23.9 (18.6-30.1)
Maryland 437 56.9 (51.0-62.5) 38.4 (33.1-43.9) 26.1 (21.6-31.1)
Massachusetts 693 59.2 (54.7-63.6) 35.8 (31.6-40.2) 23.2 (19.6-27.3)
Michigan 616 52.0 (47.1-56.8) 29.1 (25.1-33.5) 19.0 (15.6-22.9)
Minnesota 482 60.7 (55.9-65.2) 42.7 (38.0-47.5) 31.4 (27.0-36.0)
Mississippi 394 39.7 (34.4-45.3) 36.3 (31.2-41.7) 19.7 (15.5-24.8)
Missouri 451 52.5 (46.1-58.8) 38.8 (32.7-45.3) 25.3 (20.0-31.6)
Montana 502 38.9 (32.9-45.2) 40.7 (34.8-46.9) 21.1 (15.9-27.4)
Nebraska 365 46.7 (41.0-52.4) 40.7 (35.3-46.4) 25.4 (20.8-30.7)
Nevada 410 41.7 (34.6-49.1) 27.1 (21.3-33.8) 16.9 (12.1-23.0)
New Hampshire 553 56.5 (51.8-61.1) 37.5 (33.0-42.1) 26.2 (22.1-30.6)
New Jersey 631 50.4 (42.3-58.6) 38.0 (30.4-46.3) 24.8 (18.1-32.9)
New Mexico 513 42.7 (37.8-47.8) 37.8 (33.1-42.8) 20.0 (16.3-24.3)
New York 417 54.0 (48.0-59.9) 35.7 (30.3-41.5) 23.2 (18.7-28.3)
North Carolina 631 49.6 (43.9-55.3) 37.7 (32.3-43.3) 22.9 (18.3-28.3)
North Dakota 333 35.4 (30.2-41.1) 32.8 (27.7-38.3) 18.7 (14.6-23.6)
Ohio 414 47.6 (41.8-53.5) 29.3 (24.5-34.7) 17.8 (13.9-22.4)
Oklahoma 718 36.2 (32.3-40.4) 46.5 (42.3-50.7) 23.1 (19.5-27.0)
Oregon 336 47.3 (41.3-53.3) 35.4 (29.9-41.3) 20.2 (15.8-25.3)
Pennsylvania 1388 47.1 (43.7-50.5) 37.3 (34.1-40.6) 22.6 (19.9-25.6)
Rhode Island 335 53.8 (47.7-59.8) 39.4 (33.7-45.3) 25.1 (20.3-30.5)
South Carolina 471 45.2 (39.4-51.2) 34.5 (29.2-40.2) 19.9 (15.8-24.7)
South Dakota 469 36.6 (32.0-41.5) 48.1 (43.0-53.2) 23.7 (19.8-27.9)
Tennessee 306 50.5 (44.0-57.0) 42.0 (35.9-48.4) 28.7 (23.4-34.6)
Texas 494 41.5 (36.7-46.5) 33.2 (28.4-38.5) 20.6 (16.9-24.8)
Utah 413 40.0 (34.0-46.4) 32.8 (27.3-38.9) 17.2 (13.1-22.3)
Vermont 488 58.0 (53.1-62.7) 35.2 (30.7-39.9) 25.6 (21.6-30.1)
Virginia 441 52.6 (45.8-59.4) 41.4 (34.7-48.4) 25.9 (20.3-32.3)
Washington 494 51.4 (45.7-57.1) 37.5 (32.4-43.0) 23.5 (19.2-28.4)
West Virginia 340 42.0 (36.4-47.7) 37.4 (32.0-43.1) 21.7 (17.4-26.8)
Wisconsin 441 55.1 (49.6-60.4) 36.0 (31.0-41.2) 23.8 (19.5-28.7)
Wyoming 415 34.5 (29.5-40.0) 41.1 (35.2-47.3) 19.3 (15.5-23.9)
 
Lowest   34.5   26.5   13.9  
Highest   60.7   48.1   31.4  
Medianf   47.4   36.9   22.8  

aMet colorectal cancer screening recommendation (had either fecal occult blood testing [FOBT] in the past year or endoscopy [colonoscopy or sigmoidoscopy] within the past 10 years).
bMet immunization recommendation for influenza vaccination (influenza vaccination in the past year).
cMet recommendations for colorectal cancer screening and immunization.
dCI indicates confidence interval.
eIllinois data are not included because the state used a split sample for some preventive services questions.
fMedian represents the median value among the 49 states and the District of Columbia.

Return to your place in the textAppendix Table B. Prevalence of Receipt of Preventive Services for Women Aged 50–64 Years, Behavioral Risk Factor Surveillance System (BRFSS), 2002

    Breast Cancer Screeninga Cervical Cancer Screeningb Colon Cancer Screeningc Influenza Vaccinationd Up-to-Datee
N % (95% CI)f % (95% CI) % (95% CI) % (95% CI) % (95% CI)
Alabama 499 80.1 (75.9-83.7) 87.1 (81.8-91.0) 48.3 (43.5-53.2) 39.1 (34.6-43.8) 22.0 (18.4-26.2)
Alaska 334 84.7 (77.6-89.8) 88.9 (78.9-94.5) 52.9 (43.4-62.1) 38.1 (29.7-47.3) 22.2 (15.7-30.3)
Arizona 516 81.4 (76.6-85.4) 87.2 (80.8-91.6) 47.3 (40.9-53.7) 41.0 (35.1-47.3) 22.9 (18.3-28.3)
Arkansas 624 69.7 (65.3-73.7) 75.3 (68.9-80.7) 38.0 (33.7-42.5) 40.5 (36.3-44.9) 16.4 (13.5-19.8)
California 542 83.0 (78.6-86.7) 85.4 (79.9-89.6) 47.7 (42.6-52.9) 36.7 (31.9-41.6) 21.0 (17.3-25.3)
Colorado 615 81.2 (77.4-84.4) 89.7 (85.9-92.6) 51.7 (47.2-56.1) 46.3 (41.9-50.7) 27.9 (24.1-32.0)
Connecticut 743 87.2 (83.6-90.1) 91.6 (88.4-94.0) 59.1 (54.5-63.5) 44.2 (39.8-48.8) 28.6 (24.6-32.9)
Delaware 586 90.7 (87.6-93.1) 94.3 (91.4-96.3) 57.7 (52.3-62.9) 42.5 (37.2-47.8) 27.7 (23.2-32.7)
District of Columbia 292 86.0 (80.7-90.0) 93.7 (88.5-96.7) 58.0 (50.9-64.7) 35.7 (29.3-42.5) 21.4 (16.4-27.4)
Florida 897 79.3 (75.7-82.5) 89.9 (86.1-92.7) 46.8 (42.8-50.7) 28.0 (24.6-31.6) 15.9 (13.3-18.8)
Georgia 737 80.7 (76.7-84.1) 89.7 (85.9-92.5) 51.4 (47.1-55.7) 34.3 (30.3-38.5) 18.3 (15.1-22.0)
Hawaii 819 74.4 (70.1-78.3) 83.2 (78.7-86.9) 42.9 (38.3-47.5) 38.9 (34.5-43.5) 21.2 (17.6-25.3)
Idaho 662 72.0 (68.0-75.7) 83.1 (78.1-87.1) 39.2 (34.9-43.6) 38.0 (33.9-42.3) 17.6 (14.4-21.2)
Illinoisg --- --- --- --- --- ---- --- --- --- --- ----
Indiana 851 79.7 (76.5-82.6) 85.0 (81.2-88.2) 40.6 (36.9-44.5) 40.5 (36.8-44.2) 17.3 (14.7-20.3)
Iowa 526 83.3 (79.3-86.6) 88.3 (83.6-91.7) 49.1 (44.2-53.9) 45.4 (40.6-50.3) 24.9 (20.8-29.4)
Kansas 623 81.6 (78.1-84.6) 88.0 (83.6-91.4) 44.6 (40.4-48.9) 47.3 (43.0-51.6) 23.4 (19.9-27.4)
Kentucky 1170 79.8 (76.4-82.8) 84.9 (80.9-88.2) 47.3 (43.0-51.6) 38.6 (34.6-42.8) 20.0 (16.6-23.8)
Louisiana 765 80.2 (76.9-83.1) 86.7 (82.2-90.2) 39.7 (35.9-43.6) 30.8 (27.4-34.5) 14.7 (12.2-17.6)
Maine 374 86.5 (82.3-89.8) 94.5 (90.8-96.8) 53.4 (47.7-58.9) 50.0 (44.4-55.5) 29.7 (24.7-35.1)
Maryland 654 88.2 (85.0-90.9) 91.9 (86.7-95.2) 55.6 (50.7-60.3) 41.1 (36.5-45.8) 23.7 (19.9-27.8)
Massachusetts 923 88.9 (86.1-91.1) 88.7 (85.3-91.3) 53.2 (49.1-57.3) 42.5 (38.5-46.5) 24.9 (21.6-28.4)
Michigan 870 82.9 (78.4-86.6) 88.3 (84.2-91.4) 54.1 (49.6-58.6) 35.0 (31.1-39.0) 22.4 (19.2-25.9)
Minnesota 599 86.3 (82.9-89.1) 91.4 (88.1-93.8) 58.8 (54.3-63.0) 45.2 (40.8-49.6) 31.5 (27.5-35.9)
Mississippi 637 73.1 (69.0-76.8) 83.8 (77.9-88.4) 38.6 (34.5-42.8) 34.7 (30.9-38.8) 15.8 (13.0-19.0)
Missouri 698 78.9 (74.7-82.6) 83.2 (77.7-87.6) 42.9 (38.0-47.9) 42.3 (37.5-47.3) 21.3 (17.3-25.8)
Montana 570 78.3 (74.0-82.0) 85.2 (80.3-89.0) 46.6 (41.2-52.0) 44.5 (39.3-49.8) 21.1 (17.0-25.7)
Nebraska 551 79.2 (75.1-82.7) 88.4 (84.3-91.5) 43.0 (38.5-47.6) 47.8 (43.3-52.4) 23.6 (19.8-27.9)
Nevada 378 78.7 (72.3-83.9) 89.8 (82.9-94.1) 40.8 (34.1-47.8) 31.2 (25.4-37.6) 11.8 (8.6-16.1)
New Hampshire 703 84.2 (80.9-87.0) 89.1 (85.6-91.9) 49.7 (45.6-53.8) 39.3 (35.4-43.4) 23.3 (20.0-26.9)
New Jersey 847 82.2 (76.6-86.7) 85.4 (78.9-90.1) 44.5 (37.4-51.9) 32.8 (26.5-39.7) 15.2 (10.5-21.5)
New Mexico 728 77.9 (74.2-81.2) 85.2 (81.0-88.6) 37.0 (33.0-41.2) 38.1 (34.1-42.3) 16.8 (13.8-20.2)
New York 600 86.2 (82.8-89.0) 91.0 (87.6-93.6) 50.7 (45.9-55.5) 39.1 (34.6-43.8) 23.6 (19.8-27.8)
North Carolina 978 85.3 (81.5-88.3) 91.8 (87.2-94.9) 57.4 (52.6-62.0) 41.4 (36.9-46.1) 25.3 (21.5-29.6)
North Dakota 387 81.8 (77.3-85.5) 85.4 (80.3-89.3) 45.5 (40.1-51.0) 47.1 (41.7-52.5) 25.9 (21.4-31.0)
Ohio 570 81.5 (77.7-84.8) 86.4 (81.7-90.0) 48.4 (43.7-53.1) 38.0 (33.6-42.7) 20.2 (16.7-24.3)
Oklahoma 1045 74.2 (71.1-77.1) 84.0 (80.3-87.2) 37.4 (34.1-40.7) 43.2 (39.8-46.6) 18.6 (16.2-21.3)
Oregon 478 79.8 (75.4-83.6) 86.9 (82.0-90.5) 45.6 (40.6-50.5) 39.7 (35.0-44.7) 21.3 (17.6-25.6)
Pennsylvania 1875 80.9 (78.4-83.2) 86.3 (83.5-88.6) 43.9 (40.9-46.9) 39.2 (36.4-42.1) 19.5 (17.3-22.0)
Rhode Island 515 90.7 (87.6-93.1) 92.6 (88.9-95.1) 55.3 (50.4-60.1) 43.3 (38.6-48.1) 25.7 (21.7-30.1)
South Carolina 688 79.0 (74.8-82.6) 85.3 (80.1-89.3) 47.5 (42.8-52.3) 39.9 (35.4-44.6) 22.6 (18.7-27.0)
South Dakota 642 83.2 (79.8-86.0) 89.9 (86.5-92.5) 42.2 (38.0-46.5) 49.8 (45.6-54.0) 22.7 (19.2-26.7)
Tennessee 474 78.6 (74.1-82.5) 83.1 (77.3-87.6) 49.3 (44.3-54.3) 43.9 (39.1-48.9) 23.3 (19.4-27.7)
Texas 799 77.9 (74.5-81.0) 85.2 (81.0-88.6) 42.6 (38.6-46.7) 42.0 (38.0-46.1) 19.4 (16.5-22.6)
Utah 456 79.0 (74.0-83.2) 85.6 (78.9-90.4) 41.5 (35.7-47.6) 47.1 (41.2-53.1) 22.8 (18.0-28.5)
Vermont 592 83.4 (79.7-86.6) 89.1 (85.5-91.9) 53.4 (49.0-57.8) 39.1 (35.0-43.4) 24.6 (21.0-28.6)
Virginia 633 78.2 (72.9-82.6) 87.1 (81.6-91.1) 45.1 (39.8-50.6) 38.4 (33.5-43.7) 21.4 (17.3-26.1)
Washington 694 80.4 (76.5-83.7) 91.0 (87.5-93.6) 55.4 (50.9-59.9) 40.1 (35.8-44.5) 24.5 (20.8-28.6)
West Virginia 512 81.6 (77.6-85.0) 86.6 (81.9-90.2) 36.6 (32.1-41.3) 40.0 (35.4-44.7) 17.1 (13.8-21.0)
Wisconsin 590 84.3 (80.6-87.4) 88.2 (84.1-91.4) 51.7 (46.9-56.3) 40.2 (35.7-44.8) 23.1 (19.4-27.3)
Wyoming 528 74.8 (70.6-78.6) 85.6 (80.9-89.4) 33.9 (29.7-38.4) 40.5 (36.1-45.1) 16.3 (13.2-20.0)
 
Lowest   69.7   75.3   33.9   28.0   11.8  
Highest   90.7   94.5   59.1   50.0   31.5  
Medianh   81.0   87.1   47.3   40.1   22.1  

aMet breast cancer screening recommendations (mammogram in past 2 years).
bMet cervical cancer screening recommendations (Pap test in the past 3 years, unless the respondent had a hysterectomy and a Pap test was not needed).
cMet colorectal cancer screening recommendations (either fecal occult blood testing [FOBT] in the past year or endoscopy [colonoscopy or sigmoidoscopy] within the past 10 years).
dMet recommendation for influenza vaccination (influenza vaccination in the past year).
eUp-to-date on preventive services: met screening recommendations for breast cancer, cervical cancer (or if the respondent had a hysterectomy and cervical cancer screening was not recommended), colorectal cancer, and vaccination.
fCI indicates confidence interval.
gIllinois data are not included because the state used a split sample for some preventive services questions.
hMedian represents the median value among the 49 states and the District of Columbia.

Return to your place in the textAppendix Table C. Prevalence of Receipt of Preventive Services for Men Aged 65 Years and Older, Behavioral Risk Factor Surveillance System (BRFSS), 2002

    Colon Cancer Screeninga Influenza Vaccinationb Pneumococcal Vaccinationc Up-to-Dated
N % (95% CI)e % (95% CI) % (95% CI) % (95% CI)
Alabama 206 59.6 (52.1-66.7) 64.6 (57.3-71.3) 57.5 (50.0-64.6) 34.7 (27.9-42.2)
Alaska 127 72.9 (61.4-82.0) 63.5 (49.3-75.7) 47.5 (33.9-61.5) 25.8 (16.3-38.4)
Arizona 331 77.5 (71.2-82.8) 72.2 (65.2-78.3) 64.8 (57.6-71.4) 48.8 (41.3-56.3)
Arkansas 321 57.1 (51.1-63.0) 70.2 (64.5-75.4) 58.2 (52.3-63.9) 38.2 (32.5-44.2)
California 277 73.0 (65.9-79.1) 69.8 (63.3-75.7) 59.9 (52.8-66.6) 45.7 (38.6-53.0)
Colorado 234 68.7 (61.9-74.9) 76.7 (70.2-82.2) 66.4 (59.5-72.8) 48.3 (41.2-55.4)
Connecticut 392 74.6 (69.1-79.5) 70.9 (65.4-75.8) 59.8 (54.0-65.4) 44.3 (38.5-50.3)
Delaware 348 73.1 (66.3-79.0) 70.8 (63.0-77.6) 58.3 (50.7-65.5) 38.8 (32.3-45.7)
District of Columbia 146 78.0 (68.4-85.3) 63.9 (54.2-72.6) 43.4 (34.0-53.4) 34.5 (25.8-44.4)
Florida 600 66.5 (61.9-70.8) 60.5 (56.0-64.8) 57.8 (53.3-62.2) 36.6 (32.4-41.1)
Georgia 290 64.9 (58.0-71.2) 60.3 (53.7-66.6) 56.5 (49.5-63.2) 33.0 (27.1-39.5)
Hawaii 485 49.3 (43.6-55.0) 74.1 (68.9-78.7) 53.3 (47.6-59.0) 33.8 (28.5-39.6)
Idaho 388 54.6 (48.9-60.2) 65.4 (59.9-70.6) 56.2 (50.5-61.7) 34.2 (28.9-39.8)
Illinoisf --- --- --- --- --- --- --- --- ---
Indiana 388 53.5 (47.9-58.9) 68.0 (62.7-72.9) 61.4 (55.9-66.6) 33.3 (28.3-38.8)
Iowa 291 63.2 (56.7-69.2) 73.4 (67.3-78.7) 65.2 (58.6-71.2) 42.0 (35.7-48.6)
Kansas 307 64.5 (58.3-70.3) 72.6 (66.7-77.7) 64.9 (58.4-70.8) 43.2 (37.0-49.5)
Kentucky 506 58.0 (52.1-63.7) 67.9 (62.5-72.8) 56.3 (50.3-62.0) 36.3 (30.6-42.4)
Louisiana 334 57.6 (51.4-63.5) 56.4 (50.4-62.2) 58.5 (52.5-64.2) 31.0 (25.7-36.9)
Maine 161 73.1 (64.6-80.2) 73.2 (65.0-80.1) 67.7 (59.3-75.2) 50.1 (41.5-58.6)
Maryland 289 76.8 (70.3-82.3) 69.7 (62.5-76.1) 59.7 (52.0-67.0) 46.4 (38.8-54.2)
Massachusetts 499 69.0 (63.9-73.7) 70.4 (65.4-75.0) 61.7 (56.4-66.7) 43.8 (38.5-49.2)
Michigan 435 72.1 (66.8-76.8) 66.4 (60.9-71.5) 60.8 (55.2-66.2) 43.4 (37.8-49.1)
Minnesota 305 80.5 (75.3-84.9) 74.2 (68.6-79.1) 67.8 (61.7-73.3) 53.9 (47.7-60.0)
Mississippi 248 55.2 (48.3-62.0) 61.2 (54.4-67.6) 56.2 (49.3-62.9) 28.9 (23.1-35.5)
Missouri 381 52.8 (46.2-59.3) 66.2 (59.7-72.2) 57.3 (50.6-63.6) 31.1 (25.4-37.5)
Montana 311 57.2 (49.8-64.3) 65.4 (58.3-71.9) 62.1 (55.0-68.8) 35.7 (28.9-43.2)
Nebraska 393 53.9 (48.3-59.4) 63.7 (58.2-68.8) 57.9 (52.4-63.2) 32.4 (27.4-37.7)
Nevada 266 60.6 (51.9-68.7) 55.8 (47.0-64.2) 61.7 (52.7-69.9) 32.9 (25.3-41.5)
New Hampshire 331 67.9 (61.9-73.4) 73.0 (67.5-77.8) 62.9 (57.1-68.3) 39.8 (34.0-45.8)
New Jersey 491 64.7 (56.3-72.3) 74.8 (67.2-81.1) 62.7 (53.9-70.8) 39.9 (31.6-48.9)
New Mexico 410 59.4 (53.8-64.7) 67.0 (61.5-72.0) 62.4 (56.9-67.6) 38.6 (33.2-44.3)
New York 289 70.6 (64.2-76.3) 65.7 (59.2-71.7) 64.6 (57.8-70.8) 43.3 (36.7-50.2)
North Carolina 485 61.0 (54.1-67.5) 69.4 (62.8-75.3) 62.6 (55.8-68.9) 40.4 (33.4-47.7)
North Dakota 206 63.8 (56.2-70.7) 78.4 (71.5-84.0) 74.0 (66.6-80.2) 46.5 (39.1-54.2)
Ohio 262 57.3 (50.1-64.1) 68.1 (61.3-74.2) 61.2 (53.9-67.9) 34.1 (27.6-41.3)
Oklahoma 605 54.6 (50.2-58.9) 75.2 (71.4-78.7) 65.4 (61.1-69.4) 38.2 (34.0-42.6)
Oregon 213 63.8 (56.5-70.6) 65.9 (58.9-72.3) 60.5 (53.2-67.4) 34.5 (27.7-41.9)
Pennsylvania 999 64.8 (60.9-68.4) 72.0 (68.5-75.2) 62.4 (58.5-66.1) 40.2 (36.4-44.2)
Rhode Island 273 76.0 (69.8-81.2) 74.4 (68.4-79.6) 62.2 (55.8-68.1) 48.4 (41.9-55.0)
South Carolina 319 64.8 (58.0-71.0) 68.0 (61.4-73.9) 64.4 (57.6-70.8) 42.6 (35.8-49.7)
South Dakota 415 60.0 (54.8-65.1) 74.0 (69.2-78.3) 55.4 (50.0-60.6) 35.2 (30.1-40.6)
Tennessee 249 59.3 (52.3-65.9) 70.2 (63.6-76.1) 59.6 (52.6-66.2) 38.1 (31.5-45.2)
Texas 359 61.0 (55.0-66.5) 58.7 (52.9-64.3) 52.8 (46.9-58.5) 31.9 (26.7-37.5)
Utah 285 57.0 (49.9-63.8) 73.3 (66.7-79.1) 66.3 (59.3-72.7) 41.9 (35.1-48.9)
Vermont 312 74.2 (68.5-79.1) 74.5 (69.1-79.2) 64.7 (58.7-70.2) 49.9 (43.8-56.1)
Virginia 292 64.1 (55.7-71.7) 66.3 (57.9-73.7) 57.9 (49.9-65.4) 33.9 (26.8-41.9)
Washington 324 62.3 (55.9-68.3) 59.4 (53.0-65.6) 58.0 (51.5-64.3) 36.5 (30.7-42.7)
West Virginia 276 57.9 (51.5-64.1) 67.4 (61.0-73.2) 61.3 (54.8-67.4) 35.7 (29.7-42.1)
Wisconsin 282 69.8 (63.3-75.6) 75.7 (69.8-80.8) 68.5 (61.8-74.5) 45.4 (38.6-52.4)
Wyoming 251 51.5 (44.6-58.3) 70.5 (63.5-76.6) 64.6 (57.4-71.1) 33.1 (27.0-39.8)
 
Lowest   49.3   55.8   43.4   25.8  
Highest   80.5   78.4   74.0   53.9  
Mediang   63.8   69.5   61.2   38.2  

aMet colorectal cancer screening recommendations (either fecal occult blood testing [FOBT] in the past year or endoscopy [colonoscopy or sigmoidoscopy] within the past 10 years).
bMet recommendation for influenza vaccination (influenza vaccination in the past year).
cMet recommendation for pneumonia vaccination (ever had pneumonia vaccination).
dUp-to-date on preventive services: met colorectal cancer screening recommendations and immunization recommendations.
eCI indicates confidence interval.
fIllinois data are not included because the state used a split sample for some preventive services questions.
gMedian represents the median value among the 49 states and the District of Columbia.

Return to your place in the textAppendix Table D. Prevalence of Receipt of Preventive Services for Women Aged 65 Years and Older, Behavioral Risk Factor Surveillance System (BRFSS), 2002

    Breast Cancer Screeninga Cervical Cancer Screeningb Colon Cancer Screeningc Influenza Vaccinationd Pneumococcal Vaccinatione Up-to-Datef
 N % (95% CI)g % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)
Alabama 482 80.1 (75.7-83.9) 77.1 (70.0-82.9) 54.3 (49.2-59.3) 64.9 (59.9-69.5) 59.1 (54.1-63.9) 29.8 (25.4-34.7)
Alaska 166 76.6 (64.3-85.6) 79.4 (64.6-89.1) 66.0 (55.3-75.4) 74.7 (64.9-82.5) 70.2 (59.1-79.4) 36.8 (25.6-49.7)
Arizona 527 81.0 (76.4-84.9) 83.7 (76.6-89.0) 60.4 (54.1-66.3) 67.8 (61.9-73.2) 70.4 (64.8-75.5) 38.0 (32.0-44.4)
Arkansas 600 68.4 (64.2-72.4) 64.3 (57.6-70.5) 50.8 (46.3-55.3) 68.2 (63.9-72.3) 59.1 (54.6-63.4) 27.2 (23.3-31.4)
California 472 80.7 (74.6-85.6) 82.3 (76.0-87.3) 59.2 (52.8-65.3) 72.8 (66.8-78.0) 71.3 (65.3-76.7) 38.1 (32.3-44.2)
Colorado 432 75.2 (70.2-79.7) 73.9 (67.4-79.4) 62.8 (55.8-69.2) 70.8 (63.7-77.0) 69.4 (62.3-75.7) 34.0 (28.7-39.7)
Connecticut 708 81.9 (78.3-85.0) 76.2 (71.0-80.7) 66.4 (62.1-70.5) 71.8 (67.7-75.6) 67.7 (63.3-71.7) 39.0 (34.7-43.5)
Delaware 575 83.3 (78.9-86.9) 74.8 (68.5-80.3) 65.8 (60.7-70.6) 72.0 (67.1-76.5) 68.4 (63.5-73.0) 37.4 (32.3-42.9)
District of Columbia 259 82.8 (76.0-87.9) 73.7 (64.8-81.0) 73.9 (66.7-80.0) 55.5 (48.0-62.6) 50.6 (43.2-58.0) 31.0 (24.6-38.3)
Florida 957 81.8 (78.7-84.5) 77.0 (72.6-80.9) 67.0 (63.5-70.4) 54.3 (50.6-57.9) 56.8 (53.0-60.4) 32.4 (29.0-36.0)
Georgia 598 77.5 (72.8-81.6) 70.3 (63.1-76.6) 58.3 (53.1-63.3) 58.6 (53.6-63.5) 57.8 (52.8-62.6) 28.1 (23.8-32.8)
Hawaii 764 72.4 (67.5-76.7) 71.3 (64.9-76.9) 55.4 (50.4-60.3) 73.7 (69.4-77.5) 64.5 (59.7-69.0) 34.1 (29.6-38.8)
Idaho 688 70.3 (66.2-74.1) 63.0 (56.5-69.1) 58.1 (53.7-62.5) 64.9 (60.5-69.0) 58.4 (54.0-62.7) 29.5 (25.4-34.0)
Illinoish --- --- --- --- --- --- --- --- --- --- --- --- ---
Indiana 710 72.9 (69.1-76.4) 70.9 (65.6-75.7) 55.0 (50.7-59.2) 65.3 (61.1-69.2) 61.0 (56.8-65.1) 23.2 (19.8-27.0)
Iowa 630 76.7 (72.7-80.2) 75.4 (69.6-80.3) 59.7 (54.8-64.4) 73.5 (69.3-77.3) 66.9 (62.2-71.2) 34.3 (29.8-39.1)
Kansas 586 80.1 (76.4-83.4) 77.6 (72.2-82.2) 56.9 (52.3-61.4) 66.0 (61.6-70.1) 60.2 (55.6-64.6) 28.5 (24.3-33.0)
Kentucky 1315 77.2 (74.0-80.2) 76.4 (71.5-80.7) 57.7 (53.8-61.5) 64.3 (60.7-67.8) 56.8 (53.1-60.5) 26.8 (23.2-30.8)
Louisiana 692 79.6 (75.9-82.9) 74.9 (68.3-80.4) 50.9 (46.5-55.2) 57.9 (53.6-62.0) 54.8 (50.5-59.0) 23.0 (19.7-26.7)
Maine 318 82.8 (77.8-86.8) 80.7 (73.6-86.3) 63.9 (57.8-69.6) 74.2 (68.6-79.1) 66.1 (60.1-71.7) 37.8 (31.9-44.0)
Maryland 478 77.6 (72.1-82.2) 76.4 (69.3-82.2) 68.4 (62.9-73.5) 63.2 (57.4-68.7) 66.0 (60.3-71.3) 33.6 (28.2-39.4)
Massachusetts 908 82.3 (79.0-85.1) 73.4 (68.8-77.6) 65.3 (61.4-69.1) 74.0 (70.3-77.4) 64.6 (60.6-68.3) 37.4 (33.3-41.6)
Michigan 740 79.4 (75.6-82.8) 75.3 (69.9-79.9) 65.1 (60.7-69.3) 68.6 (64.4-72.6) 64.3 (59.9-68.5) 33.2 (29.0-37.6)
Minnesota 640 81.3 (77.8-84.2) 81.5 (77.1-85.3) 74.6 (70.8-78.1) 78.3 (74.7-81.6) 72.2 (68.2-75.8) 46.3 (41.9-50.8)
Mississippi 647 69.5 (65.3-73.3) 61.2 (54.3-67.6) 56.4 (51.9-60.8) 64.2 (59.8-68.4) 60.7 (56.2-65.0) 27.4 (23.5-31.7)
Missouri 761 72.6 (68.0-76.8) 65.4 (58.9-71.3) 57.0 (51.9-62.0) 70.3 (65.3-74.8) 63.2 (58.0-68.1) 29.4 (24.9-34.3)
Montana 537 73.8 (68.5-78.4) 78.7 (71.8-84.3) 63.2 (57.6-68.4) 69.4 (64.0-74.4) 71.2 (65.7-76.1) 39.7 (34.1-45.6)
Nebraska 754 73.9 (70.3-77.1) 71.7 (66.6-76.2) 53.3 (49.2-57.3) 71.4 (67.7-74.9) 63.6 (59.7-67.3) 26.7 (23.0-30.7)
Nevada 337 76.9 (69.2-83.2) 66.7 (55.1-76.6) 60.3 (52.4-67.6) 64.3 (56.7-71.2) 67.7 (59.8-74.6) 34.2 (27.5-41.6)
New Hampshire 562 79.7 (75.5-83.4) 78.3 (72.7-83.0) 64.9 (60.2-69.3) 71.9 (67.6-75.8) 64.4 (59.9-68.7) 34.2 (29.9-38.9)
New Jersey 813 74.8 (69.0-79.9) 70.5 (62.7-77.3) 63.5 (56.9-69.7) 65.4 (58.8-71.4) 63.4 (56.7-69.7) 33.3 (26.8-40.4)
New Mexico 625 71.9 (67.6-75.9) 68.0 (61.7-73.7) 52.0 (47.1-56.8) 66.4 (61.7-70.7) 63.0 (58.4-67.3) 26.7 (22.4-31.6)
New York 532 77.7 (73.2-81.6) 72.4 (66.3-77.7) 62.9 (57.7-67.7) 63.9 (58.9-68.7) 61.1 (55.8-66.0) 28.0 (23.8-32.5)
North Carolina 944 81.1 (77.3-84.4) 79.5 (73.9-84.2) 59.8 (54.9-64.5) 67.3 (62.7-71.7) 63.2 (58.4-67.8) 34.0 (29.5-38.7)
North Dakota 439 78.7 (74.2-82.5) 78.8 (72.6-83.9) 64.1 (58.9-69.0) 70.7 (65.8-75.2) 71.5 (66.7-75.9) 37.7 (32.3-43.4)
Ohio 513 77.1 (72.6-81.1) 73.8 (66.8-79.8) 56.4 (50.3-62.3) 65.7 (59.5-71.4) 65.3 (59.0-71.0) 29.5 (24.7-34.9)
Oklahoma 1,083 68.4 (65.2-71.5) 64.9 (59.7-69.7) 50.9 (47.5-54.3) 70.9 (67.6-73.9) 65.6 (62.2-68.9) 25.7 (22.8-28.8)
Oregon 408 83.0 (78.7-86.5) 73.0 (65.7-79.1) 68.3 (63.1-73.1) 69.6 (64.6-74.2) 68.1 (63.0-72.9) 39.1 (33.8-44.7)
Pennsylvania 1,985 77.0 (74.6-79.3) 68.4 (64.7-71.9) 58.8 (56.0-61.6) 69.6 (66.9-72.1) 64.3 (61.5-67.0) 32.6 (29.9-35.5)
Rhode Island 477 85.8 (82.2-88.8) 74.7 (68.7-80.0) 66.2 (61.2-70.8) 73.2 (68.5-77.4) 71.1 (66.3-75.4) 37.9 (33.1-43.1)
South Carolina 583 80.5 (75.9-84.4) 87.5 (82.3-91.3) 64.1 (58.9-69.0) 70.3 (65.3-74.9) 65.1 (59.9-70.0) 36.1 (31.0-41.5)
South Dakota 775 76.5 (73.0-79.6) 71.8 (66.6-76.5) 54.5 (50.6-58.4) 74.3 (70.5-77.8) 57.6 (53.7-61.5) 26.5 (23.3-30.1)
Tennessee 423 74.3 (69.3-78.7) 71.2 (63.5-77.8) 58.6 (53.3-63.8) 72.6 (67.7-77.0) 62.6 (57.4-67.5) 30.3 (25.5-35.6)
Texas 672 70.6 (66.0-74.8) 70.2 (62.7-76.7) 56.9 (52.1-61.5) 62.6 (57.8-67.2) 59.8 (55.0-64.4) 27.1 (23.2-31.4)
Utah 403 70.8 (64.3-76.5) 61.5 (50.8-71.1) 57.6 (50.9-64.1) 69.3 (62.7-75.2) 63.9 (57.1-70.2) 27.8 (22.2-34.1)
Vermont 509 78.9 (74.9-82.5) 76.5 (71.2-81.1) 65.1 (60.4-69.5) 73.0 (68.6-77.0) 67.4 (62.7-71.7) 35.0 (30.4-39.9)
Virginia 513 76.7 (72.1-80.8) 79.7 (72.7-85.2) 59.5 (54.0-64.7) 64.6 (59.4-69.5) 62.8 (57.5-67.8) 32.5 (27.7-37.8)
Washington 597 76.8 (72.1-80.9) 76.2 (70.0-81.4) 68.8 (64.0-73.3) 69.2 (64.6-73.4) 66.5 (61.4-71.2) 36.4 (31.6-41.6)
West Virginia 570 69.3 (65.0-73.2) 67.5 (61.7-72.8) 48.5 (43.9-53.0) 64.7 (60.2-68.9) 61.1 (56.6-65.4) 24.4 (20.6-28.6)
Wisconsin 565 80.3 (76.3-83.7) 74.6 (68.6-79.7) 66.3 (61.4-70.8) 72.8 (68.3-76.8) 72.0 (67.5-76.0) 38.7 (33.9-43.6)
Wyoming 444 69.0 (64.1-73.5) 67.8 (60.8-74.1) 54.0 (49.0-59.0) 70.7 (66.0-75.1) 71.0 (66.2-75.3) 30.0 (25.5-34.9)
 
Lowest   68.4   61.2   48.5   54.3   50.6   23.0   
Highest   85.8   87.5   74.6   78.3   72.2   46.3  
Mediani   77.2   74.2   59.7   69.3   64.4   32.9  

aMet breast cancer screening recommendations (mammogram within 2 years).
bMet cervical cancer screening recommendations (Pap test in the past 3 years, unless the respondent had a hysterectomy and a Pap test was not needed).
cMet colorectal cancer screening recommendations (either fecal occult blood testing [FOBT] in the past year or endoscopy [colonoscopy or sigmoidoscopy] within the past 10 years).
dMet influenza recommendation (influenza vaccination in the past year).
eMet recommendation for pneumococcal vaccination (ever had pneumonia vaccination).
fUp-to-date on preventive services: met screening recommendations for breast cancer, cervical cancer (or if the respondent had a hysterectomy and cervical cancer screening was not recommended), colorectal cancer, and immunizations.
gCI indicates confidence interval.
hIllinois data are not included because the state used a split sample for some preventive services questions.
iMedian represents the median value among the 49 states and the District of Columbia.

Back to top

 



 



The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


 Home 

Privacy Policy | Accessibility

CDC Home | Search | Health Topics A-Z

This page last reviewed March 22, 2013

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
 HHS logoUnited States Department of
Health and Human Services