Pap Test Adherence Research Articles

Abstract A146: Racial/ethnic differences in the relationship between human papillomavirus vaccination status and up-to-date Papanicolaou tests

Abstract Background: Human papillomavirus (HPV) vaccination and routine Papanicolaou (Pap) testing can prevent morbidity and mortality associated with cervical cancer (CC). Research suggests women who have initiated and completed the HPV vaccine are more likely to have an up-to-date Pap test than women who are unvaccinated against HPV. Limited research has focused on whether the association between HPV vaccination and Pap testing varies based on the number of HPV vaccine doses received across racial/ethnic groups. Methods: We conducted a cross-sectional analysis of 2018 – 2022 Behavioral Risk Factor Surveillance System data to investigate the relationship between HPV vaccination status and having an up-to-date Pap test by race/ethnicity. Based on the Advisory Committee on Immunization Practices’ (ACIP) guidelines, women who received 0 doses of the HPV vaccine were unvaccinated, women who received 1 or 2 doses initiated the vaccine series, and women who received 3 doses completed the HPV vaccine series. Based on the United States Preventive Services Task Force guidelines, women were considered to have an up-to-date Pap test if they reported having one within the past 3 years. We used weighted multivariable logistic regression models to examine the association. Results: Most women (n = 14,615) were unvaccinated (82.9%) and had an up-to- date Pap test (75.5%). Non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (11.8%), followed by non-Hispanic Other (NHO) women (11.2%), non- Hispanic Black (NHB) women (8.6%), and Hispanic women (8.3%). NHW women also had the highest rate of up-to-date Pap test (78.8%). NHB women had the second highest rate (77.6%), followed by Hispanic women (67.8%), and NHO women (66.4%). In adjusted analyses, NHO women were 34% less likely to have an up-to-date Pap test than NHW women (OR, 0.66; 95% CI: 0.51-0.86). Compared to unvaccinated women, those who completed and initiated the HPV vaccine series were more likely to have an up-to-date Pap test (initiated: OR: 1.40, 95% CI: 1.04-1.87; completed: OR:1.77, 95% CI: 1.35-2.34). NHB and NHO women who initiated the HPV vaccine series were more likely to have an up-to-date Pap test (NHB: OR: 3.37, 95% CI: 1.65-6.85; NHO: OR: 3.21, 95% CI: 1.73-5.95). NHW women who completed the HPV vaccine series were more likely to have an up-to-date Pap test (OR: 2.19, 95% CI: 1.55-3.08). Conclusion: NHB and NHO women who initiated the HPV vaccine series were three times as likely to have an up-to-date Pap test; NHW women who have completed the HPV vaccine series were twice as likely to receive an up-to-date Pap test. Women who do not receive Pap tests or the HPV vaccine miss important CC prevention opportunities. Thus, relevant stakeholders should aim to improve HPV vaccination rates; doing so could potentially enhance Pap test adherence simultaneously. This may be especially important for NHB and NHO women as they have lower rates of Pap test adherence and HPV vaccine series completion. Citation Format: Elinita Pollard, Meng-Han Tsai, Minjee Lee, Alice W. Lee, Mary A. Gerend. Racial/ethnic differences in the relationship between human papillomavirus vaccination status and up-to-date Papanicolaou tests [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A146.

Predictors of non-adherence to cervical cancer screening among immigrant women in Ontario, Canada

Cervical cancer is one of the most common types of cancer among women and is largely preventable with regular screening using Papanicolau (Pap) tests. In Canada, all provinces have regular screening programs, although with slightly differing recommendations. Previous research has found that immigrant women, who are a large proportion of the Canadian population, are at higher risk of being under-screened, or non-adherent to the recommended screening frequency.Using data from the 2017 Canadian Community Health Survey, this study examined: (1) the extent to which immigration status and time since immigration are associated with Pap test adherence in Ontario, and (2) predictors of Pap test adherence for immigrants and Canadian born populations in Ontario, Canada’s most populous province, with a focus on the role of racial or ethnic identity among immigrants. Estimates of 3-year test adherence were 71.3 % (95 %CI: 66.9–75.7) among immigrant women and 75.4 % (95 %CI: 73.1–77.1) among non-immigrant women. Recent immigrants (6–10 years in Canada) had lower adherence (63.5 %, 95 %CI: 48.0–80.0). Logistic regression models found that immigrant women had lower adherence than Canadian-born women, controlling for age, household income, education, and having a primary care physician. Subgroup analysis found that South Asian immigrant women were least likely to be adherent.These results support targeted programming to increase screening adherence among recent immigrants and raise concerns regarding potential barriers to screening. Data that allow better disaggregation of racial and ethnic identities are important for better understanding the potential implications of these patterns for racial inequities in health.

Validity of a questionnaire on self-efficacy for Pap test adherence screening

Self-efficacy has been related to different health preventive behaviors, included adherence to the Papanicolaou test-also called Pap smear or Pap test. The aim of this study is to test construct and criterion validity and reliability of a questionnaire on self-efficacy and the Pap test in Chilean women. This study was carried out on a sample of 969 women of ages from 25 to 64, who are users of the public health care system in Santiago, Chile. The validity of the Self-Efficacy Scale for the Pap Smear Screening Participation (SES-PSSP) questionnaire was done by confirmatory factor analysis, external criteria by t-test, and reliability by Cronbach's alpha. Three models were tested, obtaining a questionnaire with 20 items and 2 dimensions. The criteria validity was confirmed by adherence to the Pap test. The final questionnaire has a reliability of 0.95, measured by Cronbach´s alpha. A valid and reliable questionnaire to measure self-efficacy in relation to the Pap test is a relevant contribution in cervical cancer prevention, especially related to interventions focused on increasing adherence.

Never Screened: Understanding Breast Cancer Nonadherence in Puerto Rico.

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants (N = 300; aged ≥40 years old) enrolled in the intervention trial Cultivando la Salud, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.

Sức Khỏe là Hạnh Phúc (Health is Happiness): promoting mammography and pap test adherence among Vietnamese nail salon workers

ABSTRACT Vietnamese nail salon workers have low cancer screening rates and confront multiple socioeconomic disparities as immigrants to the US. The Sức Khỏe là Hạnh Phúc (Vietnamese for “Health is Happiness”) program was adapted to the cultural and work needs of this population and implemented at nail salons to increase cancer screening adherence. A total of 186 study participants were recruited from 59 nail salons in a neighborhood with mostly Asian population. After being pretested, workers were enrolled in a cancer education session delivered by Vietnamese lay health workers. Non-adherent cases were offered navigation to cancer screening services to a local federally qualified health center. Participants completed a posttest survey five months, on average. At posttest, navigated non-adherent participants were more likely to report a recent Pap test compared to cases not navigated (83.8% vs. 50.0%), an effect not observed for mammography uptake (77.3% vs. 71.4%). Time in the US, marital status, insurance status, having a primary care provider and/or a gynecologist were significantly associated with cancer screening adherence. Low rates of adherence to cancer screening among Vietnamese nail salons workers can be improved by community based programs addressing cultural and work-related barriers confronted by this population.

Psychometric Testing of Papanicolaou Testing Barriers and Self-efficacy Scales Among Black Women.

Black women face cervical cancer disparities with higher rates of morbidity and mortality compared with White women. Identifying predictors of Papanicolaou (Pap) testing is a first step to decrease morbidity and mortality from cervical cancer, with barriers and self-efficacy being constructs that should be related to Pap testing adherence. Although barriers and self-efficacy scales have been developed, they have not been validated in Black women for Pap testing. The purpose of this study was to modify and psychometrically test barriers and self-efficacy to Pap testing in a Black population. Data were collected from a minority health fair. Internal consistency reliability testing was conducted using item analysis and Cronbach's α. Construct validity was assessed by exploratory factor analysis and logistic regression. Papanicolaou testing adherence was regressed on each scale (barriers and self-efficacy) while controlling for antecedents. Data demonstrated 2 reliable scales: (1) barriers (Cronbach's α = .79), item-total correlation = 0.479 to 0.628; and (2) self-efficacy (Cronbach's α = .85), item-total correlation = 0.560 to 0.697. Exploratory factor analysis supported 2 unidimensional scales. The regression models supported a relationship between each scale and Pap testing adherence. The data suggested barriers and self-efficacy scales were reliable and valid among Black women. Barriers and self-efficacy could be tailored in future interventions to increase Pap testing adherence. Nurses could use responses to these scales for framing discussions about Pap testing.

HPV Self-sampling in Indigenous Communities: A Scoping Review.

Indigenous women have higher rates of cervical cancer and cervical cancer mortality compared to non-Indigenous women, as well as unique challenges to accessing screening services. Human papillomavirus (HPV) self-sampling has been demonstrated as an effective measure to reach under-screened women. A scoping review identified 19 sources matching selection criteria through a systematic search of PubMed and Scopus completed in May 2018. Analysis revealed that this is a limited field of research; albeit one that has undergone growth in the last 7years. HPV self-sampling is identified as easy, convenient, comfortable and private and is often preferred over Papanicolaou (Pap) testing. Despite largely positive experiences, several studies indicated that some women lacked confidence in their ability to adequately self-sample. HPV self-sampling may be an effective intervention where Pap testing adherence is low but should include supporting resources and community input so as to best tailor implementations to each community.

Predictors of Cervical Cancer Screening Among Infrequently Screened Women Completing Human Papillomavirus Self-Collection: My Body My Test-1.

Background: Approximately one-half of cervical cancer cases in the United States occur in underscreened or never-screened women. We examined predictors to completing Papanicolaou (Pap) testing and whether a positive human papillomavirus (HPV) self-collection result affects Pap testing adherence among underscreened women. Materials and Methods: Low-income women aged 30-65 years who reported no Pap testing in ≥4 years were recruited in North Carolina. Knowledge, attitudes, and barriers regarding cervical cancer and Pap testing were assessed by telephone questionnaires. We mailed self-collection kits for HPV testing and provided information regarding where to obtain affordable Pap testing. Participants received $45 for completing all activities. We used multivariable logistic regression to assess the predictors of longer reported time since last Pap (≥10 vs. 4-9 years) and of completion of Pap testing following study enrollment (follow-up Pap). Results: Participants (n = 230) were primarily black (55%), uninsured (64%), and with ≤high school education (59%). Cost and finding an affordable clinic were the most commonly reported barriers to screening. White women and those with ≤high school education reported longer intervals since last Pap test. Half of the participants reported completing a follow-up Pap test (55%). Women with a positive HPV self-collection were five times more likely to report completing a follow-up Pap test than those with negative self-collection (odds ratio = 5.1, 95% confidence interval 1.4-25.7). Conclusions: Improving awareness of resources for affordable screening could increase cervical cancer screening in underserved women. Home-based HPV self-collection represents an opportunity to re-engage infrequently screened women into preventive screening services.

A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women

Objective: Chronic diseases have become dominant in the global health landscape. Despite remarkable advances in basic science, pharmacology, surgery, and technology, progress in lifestyle improvements, now considered essential, has been disappointing. Patient adherence to medications and other instructions play the greatest role in individual outcome shortfalls. Classically medicine has approached management using a high-risk model, targeting clinical manifestations of disease with progressively intensive therapies, in contrast with population-based models. In an effort to identify effectiveness among the many models available, the “pathways model” is reevaluated. Methods: Relying upon secondary data from prior studies in which Papanicolaou (Pap) test utilization was successfully improved, a “pathway model” is qualitatively reexamined in which characteristics of patients, providers, and the health system—as impacted by culture, beliefs, values, and habits—are acknowledged and incorporated by community resources into treatment plans. In so doing, health disparities are also addressed. Observations: The culturally inclusive pathways model using immersion community-based participation was successful in modifying behaviors when applied to a high-risk population in great need of improving Pap test adherence. Conclusions: In populations characterized by recognized cultural barriers contributing to low adherence, the pathways model may improve chronic disease outcomes. This model emphasizes a high degree of immersion within a culture and community as vehicles to improve patient behavior and address inequities. Central features are concordant with current concepts in guidelines, scientific statements, manuals, and advisories concerning the conduct of community-based research and social determinants of health. The pathways model deserves consideration for use in other chronic illnesses, such as cardiometabolic disease.

Chronic comorbidities and cervical cancer screening and adherence among US-born and foreign-born women

Whereas chronic conditions and foreign-birth have an inverse relationship with cervical cancer screening, the combined effect of these factors on screening is unknown. This study examined the associations between chronic comorbidities and Pap screening recommendations and adherence, and whether these associations vary between foreign- and US-born women. In 2017, data from 2013 and 2015 National Health Interview Survey on women aged 21-65years (N = 20,080) were analyzed. Bivariate associations between chronic comorbidities (hypertension, diabetes, and obesity) and cervical cancer screening recommendation and adherence (screened in the last 3years) were examined using Chi-square analysis. Multivariate binary logistic regression was used to examine the association between foreign-born status and participant Pap test adherence, adjusting for physician Pap test recommendation and chronic comorbidities. Obesity, hypertension, and diabetes were positively associated with Pap screening recommendation. Hypertension and diabetes were negatively associated with screening adherence. Pap screening recommendation (60% vs. 57%, p < 0.05) and adherence (85% vs. 78%, p < 0.001) were higher among foreign-born than US-born women. After adjusting for chronic conditions, foreign-born women had significantly lower odds of receiving Pap tests compared with US-born women (OR 0.8, 95% CI 0.6-0.9). In stratified analysis, only obesity was associated with Pap testing among US-born and foreign-born women. Among foreign-born women, the association between obesity and Pap testing was attenuated after controlling for years lived in the US and citizenship. Public health intervention efforts must improve regular access to preventive care and encourage Pap screening among women diagnosed with chronic conditions. Future research should further identify additional factors driving the cervical cancer screening practices of both US- and foreign-born women with and without chronic conditions.

Cervical Cancer Attitudes and Prevention in Rural Nicaragua [20M

INTRODUCTION: In Nicaragua, cervical cancer is the leading cause of cancer-related deaths, with an estimated 18.43 deaths per 100,000 females in 2011. Prevention of cervical cancer is largely dependent on Pap testing; however, access is difficult in many Latin American countries due to limited health education and socioeconomic and cultural barriers. The objective of this study was to evaluate the epidemiology and perceptions regarding cervical cancer prevention and awareness in a rural Hispanic community. METHODS: Investigators evaluated a rural Nicaraguan community’s perceptions of HPV, Pap tests, and cervical cancer, measured through survey (n=40). A chart review was performed at the main local clinic, which addresses the majority of women’s health needs for the population, in order to gauge baseline community Pap test adherence and cervical cancer rates (n=564). RESULTS: Preliminary survey data found that 82% of women had previous knowledge of HPV, but basic questions about the disease were answered incorrectly greater than 50% of the time. Baseline chart review data indicated that 88.3% of eligible women had no Pap test data on file, and of those that did, 3% had an abnormal result possibly indicative of malignancy. CONCLUSION: The collected data indicates a significant deficit in both knowledge regarding cervical cancer and complete screening coverage in this community. Based on these findings, increased community health promotion would be valuable to educate women in prevention strategies and encourage greater Pap testing rates.

Development of mobile technologies for the prevention of cervical cancer in Santiago, Chile study protocol: a randomized controlled trial

BackgroundIn Chile, more than 500 women die every year from cervical cancer, and a majority of Chilean women are not up-to-date with their Papanicolau (Pap) test. Mobile health has great potential in many health areas, particularly in health promotion and prevention. There are no randomized controlled trials in Latin America assessing its use in cervical cancer screening. The ‘Development of Mobile Technologies for the Prevention of Cervical Cancer in Santiago, Chile’ study aims to determine the efficacy of a text-message intervention on Pap test adherence among Chilean women in the metropolitan region of Santiago.Methods/designThis study is a parallel randomized-controlled trial of 400 Chilean women aged 25–64 who are non-adherent with current recommendations for Pap test screening. Participants will be randomly assigned to (1) a control arm (usual care) or (2) an intervention arm, where text and voice messages containing information and encouragement to undergo screening will be sent to the women. The primary endpoint is completion of a Pap test within 6 months of baseline assessment, as determined by medical record review at community-based clinics. Medical record reviewers will be blinded to randomization arms. The secondary endpoint is an evaluation of the implementation and usability of the text message intervention as a strategy to improve screening adherence.DiscussionThis intervention using mobile technology intends to raise cervical cancer screening adherence and compliance among a Chilean population of low and middle-low socioeconomic status. If successful, this strategy may reduce the incidence of cervical cancer.Trial registrationClinicaltrials.gov NCT02376023 Registered 2/17/2015.First participant enrolled Feb 22nd 2016.

A longitudinal assessment of adherence to breast and cervical cancer screening recommendations among women with and without intellectual disability.

Each year in the United States, about 4000 deaths are attributed to cervical cancer, and over 40,000 deaths are attributed to breast cancer (U.S. Cancer Statistics Working Group, 2015). The purpose of this study was to identify predictors of full, partial, and no screening for breast and cervical cancer among women with and without intellectual disability (ID) who are within the age group for screening recommended by the U.S. Preventive Service Task Force (USPSTF), while accounting for changes in recommendations over the study period. Women with ID and an age matched comparison group of women without ID were identified using merged South Carolina Medicaid and Medicare files from 2000 to 2010. The sample consisted of 9406 and 16,806 women for mammography screening and Papanicolaou (Pap) testing adherence, respectively. We estimated multinomial logistic regression models and determined that women with ID were significantly less likely than women without ID to be fully adherent compared to no screening with mammography recommendations (adjusted odds ratio [AOR]: 0.63, 95% confidence interval [CI] 0.55-0.72), and Pap testing recommendations (AOR: 0.17, 95% CI 0.16-0.19). For the 70% of women with ID for whom we had residential information, those who lived in a group home, medical facility, or supervised community living setting were more likely to be fully adherent with both preventive services than those living alone or with family members. For both outcomes, women residing in a supervised nonmedical community living setting had the highest odds of full adherence, adjusting for other covariates.

Comparative effectiveness of two outreach strategies for cervical cancer screening

ObjectiveTest-specific reminder letters can improve cancer screening adherence. Little is known about the effectiveness of a reminder system that targets the whole person by including multiple screening recommendations per letter. MethodsWe compared the effectiveness of a Pap-specific reminder letter sent 27months after a woman's last Pap, to a reminder letter that included up to seven preventive service recommendations sent before a woman's birthday (“birthday letter”) on Pap smear adherence from a natural experiment occurring in routine clinical care. Participants included 82,016 women from Washington State who received 72,615 Pap-specific letters between 2003 and 2007 and 100,218 birthday letters between 2009 and 2012. We defined adherence as having a Pap test within a six month window around the Pap test due date. Using logistic regression, we calculated adjusted odds ratios (OR) for adherence with 95% confidence intervals (CI) following the birthday letter with 1–2 recommendations, 3–5 recommendations, and 6–7 recommendations compared to the Pap-specific letter. All analyses were stratified by whether a woman was up-to-date or overdue for screening at the time she received a letter. ResultsAdjusted ORs showed reduced adherence following the birthday letter compared with the Pap-specific letter for up-to-date women whether the letter had 1–2 recommendations (OR=0.37, 95%CI=0.36–0.39), 3–5 recommendations (OR=0.44, 95%CI=0.42–0.45), or 6–7 recommendations (OR=0.36, 95%CI=0.32–0.40). We noted no difference in Pap-test adherence between letter types for overdue women. ConclusionsIn conclusion, for women regularly adherent to screening, an annual birthday letter containing reminders for multiple preventive services was less effective at promoting cervical cancer screening compared with a Pap-specific letter.

Pap Test Adherence, Cervical Cancer Perceptions, and HPV Knowledge Among HIV-Infected Women in a Community Health Setting

The Health Belief Model (HBM) has been widely used as a framework to explain health behaviors in diverse populations, but little HBM research has focused on HIV-infected women and their increased risks for cervical cancer. We used Champion's Health Belief Model and Self-Efficacy scales to assess relationships between Pap test adherence and constructs of the HBM among 300 HIV-infected women. In addition, we assessed the relationship between HPV and cervical cancer knowledge and key HBM concepts. Participants reported low levels of knowledge regarding risk for cervical cancer and HPV. They perceived lower personal risk for cervical cancer. Women with higher perceived self-efficacy and lower perceived barrier scores reported better Pap test adherence. Findings indicate that HIV-infected women are not aware of the risk for cervical cancer and may not take preventive actions. Further research is needed to identify the full range of factors that impact adherence to cervical cancer screening.

A Community‐Based Participatory Research Approach to Understanding Pap Testing Adherence Among Vietnamese American Immigrants

To explore factors potentially influencing Pap testing practices among Vietnamese American immigrant women (VIW, foreign-born) and describe their awareness of cervical cancer screening resources in their community. Descriptive study guided by the ecological model and community-based participatory research principles. Portland, Oregon, metropolitan area. Vietnamese American immigrant women (211) who were age 21 and older. We used descriptive statistics and logistic regression analyses to analyze a self-administered questionnaire that was pretested and translated using a team approach. Approximately 74% of VIW who completed the survey reported at least one Pap test, and 69% reported Pap testing history adherent to national guidelines. The factor most strongly associated with Pap testing receipt was suggestion from a friend, followed by longer residency in the United States, lower perceived common barriers, and lower perceived cultural barriers, for example, lack of family support and use of Eastern/Asian medicine. The factor most strongly associated with guideline adherence was having health insurance, followed by a recommendation from a physician or nurse practitioner. Only 11% of VIW knew where to obtain a free or low-cost Pap tests. Nurses can influence rates of Pap testing among VIW by providing health education through outreach programs targeted at lay health workers and their social networks, identifying at-risk patients such as recently immigrated women, reducing perceived common and cultural barriers to Pap testing, and helping women seek alternative payment options if they lack health insurance. Primary health care providers should be reminded of their essential role in increasing Pap testing adherence.

Factors Influencing Cervical Cancer Screening in Women Infected With HIV: A Review of the Literature

The purpose of this article is to review and compare factors that influence cervical cancer screening behavior in HIV-infected women and uninfected women. The research literature revealed that age, ethnicity/race, tobacco use, weight, education, economic issues, and risky behaviors such as substance abuse were factors that influenced cervical cancer screening among all women. HIV viral load and CD4+ T lymphocyte count were serologic factors that affected cervical cancer screening in HIV-infected women. Clinicians can use this information to identify patients at risk for poor Pap test adherence. Future interventions to reduce potential barriers for cervical cancer screening are needed in HIV-infected women.

Age-Related Differences in Health Beliefs Regarding Cervical Cancer Screening Among Korean American Women

Cervical cancer screening rates among older Korean American (KA) women are much lower than the rates for younger KA women, even though the overall cancer screening rates in the population continue to have one of the lowest Papanicolaou (Pap) test adherence rates compared with non-Hispanic White women. Variables based on the Health Belief Model related to cervical cancer screening were compared by age group among KA women. A telephone survey was conducted with 189 KA women living in the midwestern United States. Perceived barriers to having a Pap test predicted the outcome variable of having had Pap tests in the preceding 3 years in older KA women who were 65 or older, but not in younger women who were between 40 and 64 years old. Having physical examinations without symptoms in the preceding 2 years predicted the outcome variable in both age groups. Intervention strategies for all KA women should focus on encouraging them to receive routine physical examinations. In addition, attempts should be made to reduce perception of barriers in older KA women to improve their cervical cancer screening behaviors.

Cervical Cancer Screening Among Immigrant Hispanics: An Analysis by Country of Origin

As the largest and most diverse ethnic minority population in the U.S., it is important to examine differences in and correlates of Pap test adherence among Hispanics by country of origin. The data for these analyses are baseline responses from a Randomized Controlled Trial. Bivariate and multivariable logistic regression models were conducted among Hispanic immigrant women who identified as Mexican, Puerto Rican, Dominican, or Central/South American (n=1,305). There were significant differences in Pap test adherence: Dominicans (81.6%), Mexicans (77.5%), Central/South Americans (71.2%), and Puerto Ricans (69.3%). In multivariable analyses, there were different correlates of Pap test adherence for each country of origin. For example, marriage status (P=.0001) and younger age (P=.006) were positively associated with adherence among Mexican women. This research provides insight into the variability that exists among Hispanics and can help improve understanding of important determinants that may influence Pap test screening among diverse Hispanics.

Risk Factors for Nonadherence with Pap Testing in HIV-Infected Women

HIV-infected women are at increased risk for cervical cancer; thus, adherence with Papanicolaou (Pap) testing is of particular importance. The objective of this study was to identify risk factors for inadequate Pap testing in a diverse cohort of HIV-infected women at a large urban safety net HIV clinic. This retrospective cohort study assessed HIV-infected women aged 18?60 years in care between October 1, 2003, and March 31, 2008, for risk factors for inadequate Pap testing. Unadjusted odds ratios (OR) with confidence intervals (CI) and multivariate analyses with generalized estimating equations for correlated data were calculated. Of 549 women, 293 (53.4%) had a Pap test during each follow-up period. Women who were older, white or Hispanic race/ethnicity, U.S. born, unemployed, drug users, and those with advanced HIV had increased odds of no Pap testing in unadjusted analyses. In multivariate analyses, U.S.-born women who were white or unemployed or had a baseline CD4 count <200 cells/mm(3) had increased odds of no Pap testing (OR 2.0, 95% CI 1.3-3.1; OR 2.3, CI 1.0-5.0; OR 1.7, CI 1.0-2.9, respectively). For non-U.S.-born women, age ?50 years (OR 3.9, CI 1.7-9.0), non-English-speaking status (OR 1.6, CI 1.0-2.4), and drug use (OR 5.8, CI 2.5-13.9) were associated with no Pap testing. U.S.-born status and low CD4 count were associated with increased odds of inadequate Pap testing. Further study is needed to identify interventions to improve Pap testing adherence in this high-risk group.