Healthy behaviors among women in the United States and Ontario: The effect on use of preventive care

Objectives. This study examined how several healthy behaviors among women in Ontario and the United States explained (1) the use of preventive health services, (2) differences in use between socioeconomic groups, and (3) differences in use between the two health systems. Methods. 1990 data on women from the Ontario Health Survey (n = 22 985) and the US National Health Interview Survey (n = 19 092) were analyzed. A woman who avoided smoking and obesity, used seatbelts, and regularly engaged in aerobic exercise was defined as having a healthy lifestyle. Women were considered screened if they reported a mammogram or a breast exam within the previous year or a Pap smear within 2 years. Results. A healthy lifestyle was more common in the United States than Canada among more highly educated groups (odds ratio [OR] 1.40; 95% confidence interval [CI] = 1.22, 1.60 for college educated) but less common in the United States for those with less than a high school education (OR = 0.52; 95% CI = 0.40, 0.67). Each additional unhealthy behavior decreased the odds of having undergone a mammogram in the previous year by 20%. However, adjusting for the number of unhealthy behaviors did not substantially change the relationship between socioeconomic status and use of preventive services. Conclusions. The number of healthy behaviors is an important measure of demand for preventive health services. This measure varies across country and socioeconomic group.