Using Secondary Data Analysis to Investigate Source of Care & Cervical Cancer Screening Participation

Article excerpt


The National Health Interview Survey (NHIS) is considered the primary reference for establishing the level of health and examining health practices of the U.S. population. Secondary analyses of large datasets such as the NHIS are rarely found in the nursing literature despite the accessibility and size of these datasets. Secondary data analysis using logistic regression, the Wald, and R2 statistic provides descriptive results that can be the basis for hypothesis-driven research. Using the 2000 NHIS and the 2000 Topical Module on Cancer, this study examines selected variables from the 150+ variables that can be extracted from the NHIS, to quantify characteristics of women that engage in cervical cancer screening based on having a usual source of care. The strongest predictors of having a Pap smear in the last year for the NHIS sample included employment in the last year and having insurance. Health care policy implications related to cervical cancer screening and recommendations for future studies are reported.

Key Words: Secondary data analysis, National Health Interview Survey, Cervical cancer, Source of care

Technology has increased access to large samples and expanded opportunities for analysis of national datasets. The National Center for Health Statistics (NCHS) provides researchers data on vital events as well as information on health status, lifestyle, the onset and diagnosis of illness and disability, and the use of healthcare (Vahey, Corser, & Brennan, 2001). The National Health Interview Survey (NHIS) provides users with reports of disease specific statistics on a national level, supplemented on occasion with detailed statistics on topics as broad as cancer. Challenges exist, however, in accessing the data and interpreting the resulting query.

Cervical Cancer Facts

Cervical cancer is the third most common reproductive cancer in the U.S. and the most common worldwide (American Cancer Society (ACS), 2006; Gynecologic Cancer Foundation (GCF), 2005). Use of the Pap smear as a screening tool continues to be the most effective method available for early detection of cervical cancer (ACS, 2006; GCF, 2005). Although cervical cancer incidence and mortality have declined substantially in the past several decades, participation in screening continues to be a major health concern. The principle risk factor for invasive disease is failure to receive routine screening. Improving access to screening would enhance early detection and lower mortality from cervical cancer.

Using the NHIS, a secondary data analysis was conducted to investigate participation based on provider or usual source of care for cervical cancer screening and to investigate cervical cancer screening differences from a national perspective. The purpose of this study was to examine factors that influence access to cervical cancer screening by quantifying the characteristics of women that engage in screening based on their selected provider and place for screening.

The National Health Interview Survey (NHIS) Dataset

Social scientists frequently use data collected by other investigators or organizations for research purposes. Secondary data analysis refers to using previously collected data for reasons other than the original purpose (Frankfort-Nachmias & Nachimias, 1996). Political scientists and social historians rely almost exclusively on secondary data. This study uses secondary data collected in 2000 by the NCHS, for the NHIS, which was released in 2002 (NCHS, 2002). The NCHS has relied on the NHIS as the prime reference on the health of Americans for decades. Use and selection of a secondary dataset should be guided by a) implicit purpose or bias of the data source, b) database characteristics, c) usability, d) access rights and costs, e) quality, and f) ethics (Vahey et al., 2001). Selection of the NHIS for this study will be discussed using these criteria.

Purpose of the data source. …