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PubMed1999

Pap smear screening among urban Southwestern American Indian women.

BACKGROUND: American Indian women have among the highest incidence and mortality rates of cervix cancer in the United States. The incidence of cancer of the cervix among American Indians is 19.5/100,000 versus 7.8/100,000 in U.S. whites, and comparison by geographic region/tribe indicates that the rate is four to six times higher in some tribes. Papanicolaou cytological testing (Pap smear) permits the detection of cervical lesions before they become cancerous, effectively reducing the incidence of cervical cancer by 75-90%. The American Cancer Society recommends a Pap smear every year beginning at age 18 years or when sexually active, and more frequent screening in high-risk populations. METHODS: A random household cross-sectional survey was conducted in Phoenix, Arizona, to assess cervical cancer screening rates among 519 adult urban American Indian women. Logistic regression was used to identify predictors of Pap smear use. RESULTS: Three-quarters (76.1%) of urban women American Indian surveyed received a Pap smear within the past 3 years, but only 49.5% received a Pap smear within the last year. Women over age 50 years were significantly less likely to have received a recent Pap smear in comparison to younger women. CONCLUSIONS: The results of this study indicate that limited access to health care and lack of knowledge about the procedure were important barriers to Pap smear use. Improving cervix cancer screening participation rates is an important step in reducing the disease burden in this high-risk population.

Adult↗
PubMed1998

Sexual practices among men attending an anonymous HIV testing site in Singapore.

This study was undertaken to provide an empirical basis for planning safer sex interventions in Singapore by examining the sexual practices of men attending an anonymous HIV testing site. All male clients attending the testing site from January, 1996 to January 1997 were asked to complete an anonymous questionnaire concerning oral and anal sex with men as well as vaginal, oral and anal sex with women within the past year. Questionnaires were obtained from 251 male clients, ranging in age from 17 to 70 years (mean = 30.3). Of these 50.6% reported sex with women only, 39% with men only, 7.2% with both men and women and 3.2% with no one. Condom use was moderately high for anal and vaginal sex but low for oral sex. A risk index based on the riskiness of specific activities showed that bisexuals were the most likely to engage in high risk behaviour whereas homosexuals were the least likely. One factor in the greater riskiness of bisexuals' behaviour appeared to be a higher frequency of unprotected sex with women. These findings provide a preliminary portrait of sexual risk-taking among men in Singapore and suggest the need for continued emphasis on consistent condom use for penetrative sex as well as appropriate precautions for oral sex. The results also suggest the need to develop targeted interventions for bisexuals, particularly with respect to unprotected sex with women.

Adolescent↗
PubMed2004

Cervical cancer screening among Latinas recently immigrated to the United States.

BACKGROUND: Little is known about the cancer screening practices of women whose behavior may place them at a high risk for cervical cancer. We explored factors that influence repeated Pap smear screening among recently immigrated Latinas working in bars also called cantinas. METHODS: Face-to-face interview were administered to 360 women working in 60 cantinas. Participants provided information about their cancer screening practices including the number of Pap smears completed in the 5 years before the interview. A theory-based model proposing that demographic characteristics, cancer screening barriers and facilitators, and psychosocial factors influence repeated Pap smear screening was tested with a hierarchical linear regression. RESULTS: Facilitators of cancer screening (recent visit to a physician and receiving a Pap smear in a clinic) and psychosocial variables (Pap smear beliefs, cancer screening intentions and lack of encouragement) were significantly associated with the total number reported Pap smears (adjusted R2 = 0.31, P < 0.0001). Cervical cancer risk behaviors were not significantly associated with repeated screening. CONCLUSIONS: While risk behaviors did not act as barriers, access to health care measures facilitated repeated Pap smear screening. Psychosocial factors hypothesized to function as antecedents of Pap smear screening appear instead to follow from repeated experience with the examination.

Emigration and Immigration↗
PubMedDate not supplied

Cervical cancer screening and the older woman: obstacles and opportunities.

PURPOSE: This article presents information on the incidence of cervical cancer among women aged 50 and older. Guidelines for screening for cervical cancer and recommendations on methods to overcome barriers to screening are discussed. OVERVIEW: Although the Papanicoloau smear has been used for more than 30 years, invasive carcinoma of the cervix claims the lives of 5,000 women in the United States annually. Older women comprise 25% of patients with carcinoma of the cervix but 40% of the deaths. A disproportionate number of these patients present with locally advanced invasive cancer of the cervix, which explains the poorer survival of these women. Women older than the age of 65 with early stage disease enjoy disease-free intervals comparable to that of younger women. Stage of disease and not age appears to be a major predictor of survival. CLINICAL IMPLICATIONS: There are marked differences in age with respect to the use of screening for cervical cancer. However, screening may have a significant impact on morbidity and mortality among older women. Educating patients of the importance of regular screening is paramount, but educating healthcare personnel is also an important component of reducing barriers to effective screening.

Adolescent↗
PubMedDate not supplied

Adherence to care plan in women with abnormal Papanicolaou smears: a review of barriers and interventions.

BACKGROUND: Cancer of the cervix is preventable. According to the Surveillance, Epidemiology, and End Results (SEER) Program, invasive cervical cancer incidence is 9.0 and cancer mortality rate is 2.8 per 100,000 persons. Effective prevention includes appropriate use of Papanicolaou smears and adherence to a care plan by the patient. This review will examine the extent of nonadherence, negative outcomes, barriers, and interventions for improved adherence to care. METHODS: Computer searches in MEDLINE for English language articles were conducted from 1968 to 1999 using the key words "colposcopy," "abnormal Papanicolaou smear," "patient compliance," "adherence to care," and "follow-up." RESULTS: Although there is 10% to 40% nonadherence in the studies reviewed, the definition of nonadherence is not standard. Considerable morbidity from cervical cancer was described among nonadherent women. The most common barriers to follow-up were lack of understanding of the purpose of colposcopy, fear of cancer, forgetting appointments, and lack of time, money, or childcare. Emotional consequences of abnormal Papanicolaou smears had considerable impact on follow-up visits. Focused intervention strategies targeted to the study population were most effective in improving adherence. CONCLUSIONS: Nonadherence results from the interplay of emotional, logistic, cultural, or socioeconomic factors. Among the most effective strategies to improve adherence are personalized reminders to patients by their primary physicians and case management dictated by the size, structure, and style of the practice.

Case Management↗
PubMed2002

Physician-related determinants of cervical cancer screening among Caribbean women in Toronto.

BACKGROUND: Minority women in Canada are less likely to be screened for cervical cancer than their counterparts in the general population, despite the fact that the proportion of these women who consult a general practitioner about their health each year is similar to minority women. This study examined the physician and practice characteristics associated with Pap testing and perceived barriers to Pap testing of family physicians serving the Caribbean community of Toronto. METHODS: A mail-back questionnaire was sent to Toronto family physicians practicing in neighborhoods with a high proportion of Caribbean Canadians. RESULTS: Although 79.7% of the 64 participating physicians reported that they were 'very likely" to include Pap testing during an annual check-up, nearly half did not believe that the majority of Caribbean patients were actually screened. The amount of time a physician spent on patient education was significantly associated with his/her likelihood of screening. Male physicians who reported a high proportion of Caribbean female patients in their practices were significantly less likely to screen for cervical cancer than those who saw fewer Caribbean patients. CONCLUSION: These findings suggest that an increased emphasis on patient education is important to increase screening practice and that physician gender may be of major importance to the Caribbean community.

Adult↗
PubMed1996

Behavioral intervention to increase condom use among high-risk female adolescents.

OBJECTIVE: To determine whether condom use among high-risk female adolescents could be increased by a behavioral intervention, with the use of infection with Chlamydia trachomatis as a biomarker of condom practices. DESIGN: Prospective, randomized, controlled intervention. SETTING: Urban family planning and sexually transmitted disease clinics. PARTICIPANTS: Two hundred nine female adolescents, aged 15 through 19 years, who were treated for C. trachomatis genitourinary infection, were randomly assigned to standard (control) or experimental (behavioral intervention) groups. One hundred twelve subjects returned for follow-up 5 to 7 months after enrollment and comprise the study subjects. MEASUREMENTS: Subjects completed a multiinstrument questionnaire measuring sexual behavior, condom practices, attitudes and beliefs, cognitive complexity, sociodemographics, and motivation at enrollment and follow-up. Endourethral and endocervical sites were sampled for C. trachomatis. RESULTS: Among the 112 subjects who returned for repeated examination, those who had received the experimental intervention reported increased use of condoms by their sexual partners for protection against sexually transmitted diseases (odds ratio = 2.4; p = 0.02) and for vaginal intercourse (odds ratio = 3.1; p = 0.005) at the 6-month follow-up. Multivariable logistic regression analysis controlling for condom use at enrollment demonstrated that the experimental intervention (odds ratio = 2.8; p = 0.03) and the higher cognitive complexity (odds ratio = 4.6; p = 0.02) independently contributed to greater condom use at follow-up. Despite greater use of condoms among the group who had received the intervention, use remained inconsistent and rates of reinfection with C. trachomatis were not significantly different (26% vs 17%; p = 0.3). CONCLUSION: Although a brief behavioral intervention among high-risk female adolescents can increase condom use by their sexual partners, incident infection does not appear to be reduced, because condom use remained inconsistent.

Adolescent↗
PubMedDate not supplied

History of sexually transmitted diseases infection, drug-sex behaviors, and the use of condoms among midwestern users of injection drugs and crack cocaine.

BACKGROUND AND OBJECTIVES: This study describes self-reported histories of sexually transmitted diseases (STD) with respect to gender and ethnicity and examines the factors that influence the use of condoms among heterosexual users of injection drugs and/or crack cocaine. STUDY DESIGN: A cross-sectional design was used to interview 1046 active users of illicit drugs living in Columbus and Dayton, Ohio. RESULTS: STD was common among 29% of the white men, 53.6% of the black men, 55.9% of the white women, and 64.7% of the black women self-reporting previous infection. Among women, stepwise logistic regression showed that cohabitating with a spouse or a sex partner (OR 0.28; 95% CI, 0.06 to 0.77) and exchanging sex for drugs (OR 0.31; 95% CI, 0.11 to 0.88) were associated negatively with always using a condom during vaginal sex in the previous month, whereas exchanging sex for money (OR 4.48; 95% CI, 1.88 to 10.95) was associated positively. Among men, cohabitating with a spouse or a sex partner (OR 0.13; 95% CI, 0.06 to 0.31), having had an STD (OR 0.53; 95% CI, 0.33 to 0.85), and currently using injection drugs (OR 0.52; 95% CI, 0.33 to 0.84) were associated negatively with condom use. CONCLUSIONS: Users of illicit drugs are at high risk for the acquisition and transmission of STD. More research is needed to understand better the sex practices of users of injection drugs and crack cocaine so that appropriate interventions can be developed.

Adult↗
PubMedDate not supplied

Periodic abstinence from Pap (PAP) smear study: women's perceptions of Pap smear screening.

BACKGROUND: The purpose of this study was to explore attitudes, beliefs, and perceived barriers to risk-based cervical cancer screening through focus group interviews of patients. METHODS: We conducted 8 focus group interviews of women using semistructured interviews. The investigators independently reviewed the focus group transcripts and identified the overall themes and themes unique to each question using an immersion and crystallization approach. RESULTS: Women are in agreement that cervical cancer screening is important and that women should get Pap smears regularly as an important way of protecting their health. They are not open to the idea of reducing the frequency of Papanicolaou (Pap) smears, however, because they perceive annual screening to be successful in reducing cervical cancer mortality. Additionally, they have concerns about test accuracy. Women are distrustful of the rationale for reducing the frequency of Pap smears. Women's previous bad experiences have reinforced their need for self-advocacy. CONCLUSION: Women are reluctant to engage in risk-based cervical cancer screening. In this environment, risk-based cervical cancer screening recommendations are likely to be met with resistance.

Adult↗
PubMed2004

[A study on regular cervical cancer screening behavior among middle-aged women].

PURPOSE: To identify the status of regular cervical cancer screening practices among middle-aged women, the associations between regular practice and research factors, and the predictive model and factors effecting such behavior was studied. METHOD: Two hundred women, aged 40 to 60, were selected by convenience in one urban area of Seoul. They were asked about their regular attendance for screening, knowledge of cancer and screening, health belief, health self-determination index and certain personal factors. RESULT: Approximately 54.5% of the women had periodic screening tests every 6 months to 2 years. Their knowledge of cervical cancer and health belief were at the medium level of each scale, but their health self-determination scores (HSDI) were low. Some influencing factors, and their cancer odds ratio were identified through univariate regression analysis. These variables were included in a predictive model, and this model proved to have enough fit and classification power (83.5%). In this model, the financial state, self-belief and self-determination scores were found to be significant. CONCLUSION: Middle-age women's intrinsic motivation for healthy behavior was found to be low in those who felt to be in a poor financial state, had higher perceived barriers, lower perceived benefits and a lower prevalence of undergoing regular screening test.

Adult↗
PubMed1984

The effect of chemical intravaginal contraceptives and Betadine on Ureaplasma urealyticum.

The purpose of this study was to find a barrier contraceptive agent capable of controlling infections and sexual transmission of Ureaplasma urealyticum from the female genital tract, especially to help reduce nongonococcal urethritis in males caused by this organism. Therefore, the in vitro antimicrobial activity of six intravaginal contraceptives and BetadineR against the eight serotypes of the organism was investigated. The results indicate that some of these contraceptives produce partial inhibition of the Ureaplasma at low dilutions, while BetadineR produces a ureaplasmacidal effect up to dilutions of 1:64. These effects appear not to be due primarily to the pH of these agents. Thus, some of these agents may have a potential role in controlling transmission of Ureaplasma urealyticum.

Contraceptive Agents, Female↗
PubMed2006

Assessing awareness and knowledge of breast and cervical cancer among Appalachian women.

INTRODUCTION: West Virginia is the only state that lies entirely within Appalachia. West Virginians tend to be poorer and more likely to lack health insurance than the general U.S. population. The purpose of this qualitative study was to 1) obtain an understanding of attitudes about breast and cervical cancer screening among women aged 25 to 64 years; 2) determine factors that motivate women to be screened for breast and cervical cancer; and 3) evaluate educational materials about breast and cervical cancer screening for use in this population. METHODS: The West Virginia Breast and Cervical Cancer Screening Program (WVBCCSP) is a comprehensive public health program, funded by the Centers for Disease Control and Prevention, dedicated to removing barriers to breast and cervical cancer screening and providing screenings to underserved women aged 25 to 64 years. The program partnered with RMS Strategies, Inc, to conduct six focus groups in three communities in West Virginia. Women were recruited by telephone based on program eligibility guidelines. RESULTS: Results indicated that women were concerned about health care costs and lack of health insurance. Cost, fear, and embarrassment were identified as the top barriers to breast and cervical cancer screening. Participants believed that community-based educational campaigns would increase screening and promote use of the WVBCCSP. CONCLUSION: Understanding why low-income Appalachian women do not get screened for breast and cervical cancer and determining motivational factors that encourage screening are important to increase screening rates among this population. Breast and cervical cancer efforts that use the words, knowledge, and suggestions of the women they serve are more likely to be effective and have a larger impact.

Adult↗
PubMed1995

A randomised controlled trial of strategies to prompt attendance for a Pap smear.

OBJECTIVE: To assess the comparative efficacy, by randomised controlled trial, of three interventions designed to encourage "at risk" women to have a Pap smear: an educational pamphlet; letters inviting attendance at a women's health clinic; and letters from physicians. METHODS: Subjects at risk for cervical cancer who had not been adequately screened were identified by a random community survey and randomly allocated to one of the intervention groups or a control group. Six months after intervention implementation, a follow up survey assessed subsequent screening attendance. Self report was validated by comparison with a national screening data base. RESULTS: A significantly greater proportion of women (36.9%) within the group receiving a physician letter reported screening at follow up than in any other group (P = 0.012). The variables most strongly predicting screening attendance were: age, perceived frequency of screening required, use of oral contraceptives, and allocation to receive the physician letter intervention. CONCLUSIONS: The relative efficacy of the GP letter in prompting screening attendance shows that this strategy is worthy of further investigation. There remains a need to examine the barriers to screening for older women, and to develop tailored strategies for this population.

Adolescent↗
PubMed1998

Differences in condom behaviors and beliefs among female drug users recruited from two cities.

This paper examines predictors of condom cognitions and condom use for vaginal sex within women's main and paying partnerships. The sample consisted of active injection drug and crack-using women recruited from two cities with disparate HIV rates. A total of 338 drug-using women who reported vaginal sex with a main and/or paying partner in the prior 30 days were recruited for this study. Recruitment site was a significant predictor for several of the variables examined, for both main and paying partners. Ethnicity and prior HIV test result were also significant predictors, but only for main sex partners. Findings support previous research and suggest that the factors which predict condom beliefs, intention, and behaviors are different for main versus paying partners. Interventions designed to increase condom use must recognize that cognitive factors associated with condom use may vary by partner type, ethnicity, and recruitment site, particularly when important contextual variables, such as local seroprevalence, vary.

Adult↗
PubMed2000

Asian American and Pacific Islander breast and cervical carcinoma screening rates and healthy people 2000 objectives.

BACKGROUND: Breast carcinoma is the number one cause of cancer-related mortality among Asian American and Pacific Islander (AAPI) women, and for certain subgroups cervical carcinoma is among the top three causes. Yet AAPI women have the lowest cancer screening and early detection rates of all ethnic groups. The practice of merging AAPI data hides significant variation among AAPI groups, and the groups at highest risk for late presentation of disease become invisible. To the authors' knowledge, this study is the first report of disaggregated national data for breast and cervical carcinoma screening in AAPI subpopulations. The authors used data from the National Health Interview Survey (NHIS 1993 and 1994) and evaluated major socioeconomic and access variables associated with screening practices. METHODS: Healthy People 2000 (HP2000) criteria were used to evaluate the most recent NHIS screening rates for AAPIs as one group and for six distinct subgroups compared with HP2000 criteria. The sample included 2756 non-Hispanic AAPI and 64,196 non-Hispanic white women age 18 years or older in the 1993 and 1994 NHIS. The effects of socioeconomic and access-to-care indicators on screening were explored. RESULTS: Breast and cervical carcinoma screening rates for AAPIs were below those for white women and well below national goals and guidelines. Lack of insurance, low income, and lack of a usual source of care had a significantly greater negative impact on AAPIs than on white women, indicating that AAPIs may be more vulnerable to structural barriers to cancer control efforts. CONCLUSIONS: AAPI women have very low rates of breast and cervical screening, which increases their chances of later stage disease presentation. To reach the Healthy People 2000 objectives, targeted efforts are needed to increase cancer screening among AAPI women overall and specific subgroups in particular.

Adult↗
PubMed2005

Hispanic acculturation and utilization of cervical cancer screening in the US.

BACKGROUND: Hispanic women have an incidence rate of invasive cervical cancer that is twice as high as that of non-Hispanic White women. Previous investigations have reported that Hispanics are less likely to utilize cancer screening services. Using data from the 2000 National Health Interview Survey, this study examined whether acculturation of Hispanic women was associated with cervical cancer screening. METHODS: The subjects included 2307 Hispanic women aged 21-70 who did not have a history of cervical cancer or a hysterectomy. Women were analyzed by acculturation level according to whether or not they ever had a Pap smear and had one in the previous year and previous 3 years. RESULTS: Acculturation levels tended to be inversely correlated with no Pap smear. Compared to lower acculturated women, women who were more acculturated were less likely to never had a Pap smear (OR = 0.86; 95% CI = 0.58-1.27 for moderate acculturated women and OR = 0.51; 95% CI = 0.29-0.89 for higher acculturated women). Similar results were found for having no Pap smear within the past 3 years (OR = 0.83; 95% CI = 0.61-1.13 for moderate acculturated women and OR = 0.73; 95% CI = 0.49-1.08 for higher acculturated women). CONCLUSION: The findings show that lower acculturation was associated with the under use of cervical cancer screening and suggest that these women might have barriers in accessing and utilizing Pap smears.

Acculturation↗
PubMed1999

Bridging cultures through the development of a cervical cancer screening video for Cambodian women in the United States.

BACKGROUND: Southeast Asian women have higher invasive cervical cancer rates than any other U.S. racial/ethnic population subgroup, and their levels of Pap testing do not even approach the year 2000 goals. Video is a particularly useful medium for cancer education in Cambodian refugee communities because of low literacy levels and high rates of VCR ownership. METHODS: The authors produced a motivational Pap-testing video for Cambodian American women. The 18-minute Khmer-language video is entitled "The Preservation of Traditions." Content, with respect to cervical cancer screening barriers and facilitators, was guided by intensive qualitative data collection. Barriers addressed were: beliefs that traditional postpartum practices protect against cervical disease, Cambodians do not get cervical cancer, and screening is unnecessary; fear of cancer as well as surgery; lack of understanding about preventive concepts and familiarity with the Pap test; concerns about embarrassment and pain; and problems with transportation and child care. Facilitators included the availability of female physicians and interpreters. A community coalition of Cambodian women and two community advisors participated in all aspects of the video development and production. Video techniques frequently used in American productions were adapted to the target audience. For example, cultural context was provided, use of biomedical terminology minimized, role modeling emphasized, and testimonial accounts avoided. CONCLUSION: The processes used to translate empirical evidence into meaningful educational messages, and to adapt American behavioral change techniques to Cambodian cultural norms, are generalizable to other less acculturated immigrant groups and cancer education topics.

Cambodia↗
PubMed2002

Oves contraceptive cap: short-term acceptability, aspects of use and user satisfaction.

OBJECTIVE: To assess the short-term acceptability, aspects of use and user satisfaction with the Oves cap. DESIGN, SETTING AND SUBJECTS: A multicentre observational study, commissioned by Veos Ltd, manufacturers of the Oves cap, was carried out by the UK Family Planning and Reproductive Health Research Network in collaboration with the Institute of Population Studies, University of Exeter, Exeter, UK. Women from ten Network centres and one collaborating centre were invited to participate. Following an assessment by vaginal examination women were fitted with the cap and taught self-fitting by a doctor. The women were asked to use the cap six times in 8 weeks. Participants were asked to complete four questionnaires on various aspects of cap use including Likert-type measures and open-ended questions on experiences with the cap. Doctors were asked to complete a first visit and follow-up questionnaires. Women were self-selected clients in the participating centres. Women aged 18 years and over, gynaecologically healthy, using hormonal contraception or sterilised were eligible for the study. Thirty-five women were enrolled and fitted with the cap; 20 chose to participate in the study. MAIN OUTCOME MEASURES: Ease of fitting and removal of the cap expressed in structured and open-ended questions by both cap users and doctors; satisfaction of women and partners with the cap, measured by desire to use the cap in the future and by premature withdrawal from the trial. RESULTS: Twenty women used the cap on a total of 84 occasions. Four women completed the trial of six uses. While most doctors did not have difficulty with fittings or removals, 10/20 Oves cap users reported some difficulty in fitting it over the cervix and 12 reported some difficulty removing it in the first three uses. Fewer women had difficulty in fitting in uses 4-6 but nearly half continued to have some difficulty with removals. CONCLUSIONS: Few women indicated that they would use the cap in the future. However, most women were satisfied with their current method of contraception. The study raises the question whether women using non-barrier methods of contraception and satisfied with their current method of contraception are the appropriate target recruits for a trial such as this, even in the absence of robust efficacy data.

Adult↗