Factors associated with cervical cancer screening behavior among Vietnamese women

The purpose of this study was to gather information on the prevalence of pap smear testing among Vietnamese women and to identify predictive factors that influence women to engage in early cervical cancer detection behavior. One hundred and forty-one (141) Vietnamese women ages 18 years and older and living in Western Massachusetts were surveyed by telephone. The overall socioeconomic status of these women was low. Survey results showed that among these women, the use of pap tests was lower than for the U.S. female population in general. Approximately one-half of the respondents reported having had a pap smear. Bivariate and multivariate methods, including logistic regression, were used to analyze the differences between users and nonusers. Bivariate analysis revealed that age, marital status, number of children, religion, regular physician care, and income were significantly related to a prior pap smear experience. The multivariate model for pap test included: age, income, length of residence in the U.S., and marital status. Compared to women who had never had a pap test, women who had were older, married, had higher incomes, and lived in the U.S. longer. It was concluded that this model is useful for screening cancer behavior in Vietnamese women 18 years and older and living in Western Massachusetts, but, in general, should not be used as a cancer screening tool in other populations, at least until similar assessments have been done for these populations.     

Social and psychological correlates of unprotected anal intercourse among Hispanic-American women: implications for STI/HIV prevention

Heterosexual anal intercourse is associated with increased risk for HIV and other sexually transmitted infections. Research on the social and psychological risk factors associated with heterosexual unprotected anal intercourse among Hispanic women in the USA is limited. We examined demographic, mental health, relationship power, sexual self-efficacy, self-esteem, acculturation and HIV knowledge as correlates of unprotected anal intercourse among 514 HIV-negative Hispanic women, 18 to 59 years of age, residing in one urban county in southern Florida. In both unadjusted and adjusted results, the likelihood of engaging in unprotected anal intercourse was associated with food insecurity in the past 30 days (adjusted odds ratio [AOR] = 1.57, 95% confidence interval [CI] 1.03, 2.40) and more interpersonal power attributed to the male partner (AOR = 1.63, 95%CI 1.08, 2.45). Not significant, yet of possible importance, were ever having engaged in exchange sex (AOR = 1.96, 95%CI = 0.97, 3.98) and lower HIV knowledge (AOR = 0.80, 95%CI = 0.63, 1.01). Interventions aimed at reducing heterosexual unprotected anal intercourse risk for HIV infection among Hispanic women may benefit by addressing socioeconomic and interpersonal issues, and assessing HIV knowledge and comprehension.     

Cancer screening among the overweight and obese in Canada

BACKGROUND: Despite increased cancer incidence and mortality among overweight and obese men and women, U.S. studies have reported the reduced use of cancer screening among these subjects. We sought to analyze the relationship between overweight/obesity and cancer screening practices using population-based Canadian data. METHODS: Responses from adults surveyed in the Canadian Community Health Survey 2003 who provided complete information regarding variables of interest were analyzed. Cancer screening modalities included Pap smear testing, mammography, and fecal occult blood testing, and were based on contemporary recommendations of the Canadian Task Force for Preventive Health. The association between overweight/obesity and cancer screening was explored using logistic regression after adjusting for demographic and socioeconomic factors, health habits, healthcare access, and obesity-related comorbidity. The analysis was conducted in 2007. RESULTS: Compared to normal-weight controls, overweight and obese women were significantly less likely to have undergone cervical cancer screening. In the fully adjusted model, increasing obesity was associated with decreasing odds of Pap smear testing, with overweight, Class-I, -II, and -III obesity having 95% ORs of 0.87 (0.81, 0.94); 0.79 (0.72, 0.88); 0.62 (0.54, 0.71); and 0.61 (0.53, 0.72), respectively. The prevalence of biennial breast and colorectal cancer screenings was largely unaffected by weight in the adjusted analyses. CONCLUSIONS: Overweight and obesity are associated with markedly lower utilization of cervical cancer screening, despite increased disease risks. This association is independent of sociodemographic factors, comorbidity, and healthcare access. This is consistent with findings in U.S. populations, and suggests that patient and provider factors serve as greater barriers to screening than do healthcare system factors.     

Correlates of Cervical Cancer Screening Adherence Among Women in the U.S.: Findings from HINTS 2013–2014

Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21–65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years. Correlates of guideline adherent cervical cancer screening included socio-demographic and health-related characteristics and HPV/cervical cancer-related beliefs and knowledge items. Multivariable logistic regression analyses were used to estimate prevalence of guideline adherent screening. An estimated 81.3% of women aged 21–65 years reported being screened for cervical cancer within the last 3 years. Controlling for sociodemographic and health-related characteristics and survey year, women aged 46–65 years were less likely to be guideline adherent than those aged 21–30 years (aPR?=?0.89; 95% CI 0.82–0.97). The adjusted prevalence of adherence was significantly higher among married/partnered than among not married women (aPR?=?1.13; 95% CI 1.05–1.22), and those with one to three medical visits (aPR?=?1.30; 95% CI 1.14–1.48), and four or more visits in the past year (aPR?=?1.26; 95% CI 1.09–1.45) compared to those with no medical visits. Differences in unadjusted prevalence of guideline adherent screening depending on women’s beliefs and knowledge about HPV and cervical cancer were not significant in adjusted analyses. Lack of interaction with a healthcare provider, being not married/partnered and increasing age continue to be risk factors of foregoing guideline adherent cervical cancer screening.     

Cervical cancer screening beliefs among young Hispanic women

OBJECTIVES: This study examined beliefs, attitudes, and personal characteristics that correlated with self-reported cervical cancer screening history among Hispanic women aged 18 to 25 years old in El Paso, TX, a large metropolitan area on the U.S.-Mexico border. METHODS: Data were collected through a cross-sectional, face-to-face survey. The study questionnaire was based primarily on the Health Belief Model, and included scales that measured perceived susceptibility and seriousness of cervical cancer, and perceived benefits and barriers to Pap test screening. The study questionnaire also included measures of acculturation, Pap test history, pregnancy and sexual history, use of birth control, type of medical insurance, and educational attainment. RESULTS: Sixty-nine percent reported ever having had a Pap test and 56% reported having had a test in the past year. Eighty percent reported that they were sexually active, and of these, 63% reported using birth control. Respondents understood the seriousness of cervical cancer, their susceptibility to cervical cancer, and the benefits of Pap testing; however, only 61% agreed that most young women whom they know have Pap tests. Greater acculturation and the belief that most young unmarried women have Pap tests were positively associated with ever having screening. The perception that the test would be painful and not knowing where to go for the test were negatively associated with ever having a Pap test. CONCLUSIONS: This study found suboptimal rates of screening for cervical cancer in a sample of young Hispanic women residing along the U.S.-Mexico border. Although women may understand the seriousness of cervical cancer and the benefits of screening, perceptions about Pap tests may pose barriers to undergoing screening. Efforts to increase screening also may need to focus specifically on women who are least acculturated, as they also were least likely to have had prior Pap tests.     

Predictors of Never Being Screened for Cervical Cancer by Metropolitan Area

Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21–65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported “fair or poor” general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.     

Coverage and focus of a cervical cancer prevention program in southern Brazil.

OBJECTIVE: To determine the coverage and focus of cervical cancer screening (Pap smears) in a population-based sample in Brazil. METHODS: Cross-sectional cluster survey covering 1730 women aged 20 years or older with a history of sexual activity. Information was collected on social, demographic and behavioral variables, knowledge of and use of the Pap test. RESULTS: Of women aged 25-59 years, who are the target population of the national cervical cancer screening program, 78.7% had had at least one Pap test in their lifetime, and 68.8% had had a Pap test in the last 3 years. Statistics for focus of the program showed that of the 637 women who reported having a Pap test in the last year, only 20.6% actually required one. The remainder were either outside the age range or had had another test less than 30 months previously. Prevalence of not having been tested in the previous 3 years was highest among black (41.7%) and low-income women (64.3%), and among those at greatest risk for cervical cancer (62.3% for women with three or more risk factors). Focus was inversely related to socioeconomic status. CONCLUSION: Coverage rates were similar to those reported in other national studies, but this is the first report to examine the focus of the national program. We show that 8 of every 10 Pap tests were not necessary. Coverage levels remain unacceptably low among women of low socioeconomic status and those at greatest risk for cervical cancer.     

Factors Influencing Breast Cancer Screening in Low-Income African Americans in Tennessee

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 334) were selected from the Meharry CNP community survey database. There were several predictors of breast cancer screening such as marital status and having health insurance (P < .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and not having enough information about screenings (P < .05). Educational interventions aimed at improving breast cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.     

Breast and Cervical Cancer Screening Disparities Associated with Disability Severity

BackgroundPrior research has noted disparities between women with and without disabilities in receipt of timely screening for breast and cervical cancer. Some studies suggest greater disparities for women with more severe disabilities, but the research to date has yielded inconsistent findings. Our purpose was to further examine differences in receipt of breast and cervical cancer screening in relation to severity of disability.MethodsWe analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses examined whether Pap smears and mammograms had been received within the recommended timeframe according to U.S. Preventive Services Task Force Guidelines. We compared four groups of women aged 18 to 64 years, categorized by presence and complexity of disability: 1) No limitations, 2) basic action difficulties only, 3) complex activity limitations only, and 4) both basic and complex activity limitations.FindingsWomen both with and without disabilities fell short of Healthy People 2020 goals for breast and cervical cancer screening. Overall, women with disabilities were less likely to be up to date with both mammograms and Pap tests. The magnitude of disparities was greater for women with complex limitations. Disparities in Pap testing, but not mammography, remained significant when controlling for demographic, geographic, and socioeconomic factors.ConclusionsWomen with more complex or severe disability were less likely to be up to date with breast and cervical cancer screenings. Targeted efforts are needed to reduce barriers to breast and cervical cancer screening for women with significant disabilities, especially those who also experience other socioecological disadvantages.     

Cervical Cancer Screening Among Homeless Women of New York City Shelters

Introduction Homeless persons have minimal opportunities to complete recommended cancer screening. The rates and predictors of cervical cancer screening are understudied among homeless women in the US. Methods We enrolled 297 homeless women 21–65 years old residing in 6 major New York City shelters from 2012 to 2014. We used a validated national survey to determine the proportion and predictors of cervical cancer screening using cytology (Pap test). Results Mean age was 44.72 (±11.96) years. Majority was Black, heterosexual, single, with high school or lower education; 50.9 % were smokers and 41.7 % were homeless more than a year. Despite a 76.5 % proportion of self-reported Pap test within the past 3 years, 65 % of women assumed their Pap test results were normal or did not get proper follow up after abnormal results. Forty-five-point-nine percent of women did not know about frequency of Pap test or causes of cervical cancer. Lower proportion of up-to-date Pap test was associated with lack of knowledge of recommended Pap test frequency (p < 0.01) and relationship between HPV and an abnormal Pap test (p < 0.01). Conclusions Self-reported Pap testing in homeless women was similar to a national sample. However, the majority of women surveyed were not aware of their results, received limited if any follow up and had significant education gaps about cervical cancer screening. We recommend improved counseling and patient education, patient navigators to close screening loops, and consideration of alternative test-and-treat modalities to improve effective screening.     

Socioeconomic factors, immigration status, and cancer screening among Mexican American women aged 75 and older

To explore the association between socioeconomic factors and acculturation with cancer screening methods, we analyzed data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, on 1,272 women aged 75 and older residing in the United States in 2004-2005. We found that lower Pap smear or mammography uses were associated with older age, lower education, and having public health insurance compared with private. Other factors associated with mammography use were depressive symptoms, cognition, and functional limitations. In sum, socioeconomic factors and health insurance coverage, but not acculturation, determine cancer screening utilization in very old Mexican American women.     

Socioeconomic Factors,Immigration Status,and Cancer Screening Among Mexican American Women Aged 75 and Older

To explore the association between socioeconomic factors and acculturation with cancer screening methods, we analyzed data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, on 1,272 women aged 75 and older residing in the United States in 2004–2005. We found that lower Pap smear or mammography uses were associated with older age, lower education, and having public health insurance compared with private. Other factors associated with mammography use were depressive symptoms, cognition, and functional limitations. In sum, socioeconomic factors and health insurance coverage, but not acculturation, determine cancer screening utilization in very old Mexican American women.     

Differences in Cervical Cancer Screening Between African-American Versus African-Born Black Women in the United States

Although the incidence of cervical cancer has been declining steadily since the Pap smear became standard of care in the U.S., many African immigrants are unfamiliar with this screening test and its potential benefits. Using data from the CDC’s National Health Interview Surveys, we identified respondents who were black women living in the United States, distinguishing U.S.-born (n = 620) and African-born (n = 36). We constructed a measure of current Pap status and used multivariate logistic regression models to compare Pap status between the two groups. Controlling for income, age, education, health insurance, and marital status, African American women were over 3 times more likely to have reported a current Pap smear than African-born women [Adjusted OR = 3.37, 95 % CI = (1.89, 5.96)]. Being an African-born woman was the strongest predictor of current Pap status. Distinguishing immigrant status in an analysis of cervical cancer screening rates for black women indicated much lower Pap smear rates for African-born women, compared with African-American women. More research on the impact of education and culturally specific care is needed to address the disparity in Pap smear rates for African-born black women.     

Factors associated with women's failure to submit to Pap smears: a population-based study in Campinas, São Paulo, Brazil

This study analyzes the prevalence of non-submittal to Pap smears according to socioeconomic, demographic, and health-related behavioral variables in women 40 years or older in Campinas, S?o Paulo State. This was a cross-sectional population-based study with a sample of 290 women. Based on multivariate analysis, factors associated with not having Pap smears were: age (40-59 years), race/ethnicity (black or mixed-race), and schooling (< 4 years). The following reasons were cited for not having Pap smears: considered unnecessary (43.5%), embarrassment (28.1%), and barriers related to health services (13.7%). The Unified National Health System performed 43.2% of the reported Pap smears. Health services should promote more equitable access to the health care system and improve the quality of care for women, since Pap smears are an effective tool against cervical cancer. The study confirmed that women's failure to obtain Pap smears is associated with social and racial inequality, placing these women at increased risk of cervical cancer.     

Prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and factors associated with non-participation in screening

The objective of the study was to determine the self-reported prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and to analyze factors associated with non-participation in screening. A population-based cross-sectional study with a sample of 772 women 18 to 69 years of age and living in Rio Branco was conducted in 2007 and 2008. Data were analyzed with Stata 10.0, and prevalence rates were estimated with Poisson multivariate regression (95%CI). 85.3% of women reported at least one cervical cancer screening test in the previous three years. The majority of women (72.8%) were screened in the Brazilian Unified National Health System. After adjusting for selected variables, statistically significant prevalence rates for absence of screening were found in women 18-24 and 60-69 years of age, single, and with low income and low schooling. The prevalence rates were consistent with findings from other studies, highlighting the need for greater intervention in the group of women most vulnerable to cervical cancer incidence and mortality.     

Women's Behaviors Toward Mammogram and Pap Test: Opportunities to Increase Cervical Cancer Screening Participation Rates among Older Women

Objectives

Screening rates for cervical cancer remain moderate among women over 50 years of age. Because cervical and breast screening interventions can be linked, evaluating screening factors relating to both is important. This study evaluates factors associated with breast and cervical screening participation in women aged 52 to 69.

Attitude to cervical cancer screening of women residing in two regions of northern Tunisia

The objective of this survey to describe knowledge, attitudes and behaviours of women residing in two regions of the North of Tunisia, towards cervical cancer screening methods. 936 women residing to the Ariana (urbanized region) and 993 women residing to Zaghouan (region to farming predominance) were included; they were chosen according to the method of quotas while taking like criteria's, the of area residence (urban or rural), age and the level of education. Every woman should have answered to a questionnaire. Data collected were related to women perception of the severity of the cervical cancer, of their vulnerability for this cancer, of screening efficiency and the recourse of women to this service. The recourse to the cervical cancer screening was significantly more frequent in Ariana (24,6% vs. 13,8% p <0,001); the half of women is optimistic towards the therapeutic progress recorded in Tunisia in the domain of cancer. A better organization of cervical cancer screening including the individual invitations of women and a better sensitization and implication of physicians of the first line in the two sectors public and private, are indispensable to improve the frequency of recourse to cervical cancer screening.     

Compliance rates and predictors of cancer screening recommendations among Appalachian women

High rates of morbidity and mortality in the Appalachian region of the country warrant examination of the preventive care behavior of its residents. This study determined compliance rates for breast and cervical cancer screening recommendations for women residing in Appalachian states and identified predictors of such compliance using the Behavioral Risk Factor Surveillance System data (1995-97). Healthy People 2000 goals were used as benchmarks for progress. Appalachian women have made good progress toward goals pertaining to breast and cervical cancer screening. Compliance with other preventive services, having insurance coverage, residing in urban areas, better self-reported health, and higher education were independently associated with increased odds of compliance with annual-screening recommendations. Risk factors of obesity and smoking were associated with decreased odds of compliance. Findings should be useful to health care providers, policy makers, and researchers in their efforts to educate, encourage, and promote preventive care behavior among residents of Appalachia.