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PubMed1995

Single-visit program for cervical cancer prevention in a high-risk population.

OBJECTIVE: To evaluate the feasibility of a single-visit cervical neoplasia screening and intervention program. METHODS: A sample of asymptomatic, nonpregnant, indigent, adult women who had not had a Papanicolaou smear for at least 2 years (N = 126) was recruited through Spanish-language media in Orange County, California. Women who volunteered underwent a free, single-visit program combining a health questionnaire, education, an immediately read Papanicolaou smear, loop electrosurgical excision of the transformation zone for those with dysplastic cytology, and an exit questionnaire gauging satisfaction and educational impact. Main outcome measures included the frequency of cervical cancer risk factors and barriers to health care, incidence of cervical neoplasia, feasibility, short-term educational impact, and acceptability of interventions. RESULTS: All 126 patients had at least one cervical cancer risk factor; 101 (80.2%) reported at least one barrier to health care. One hundred sixteen (92.1%) had a normal Papanicolaou smear, and three (2.4%) with a mildly atypical smear were referred for colposcopy. Seven (5.6%) patients had a dysplastic smear and underwent same-day loop electrosurgical excision of the transformation zone without complication, with histology revealing koilocytotic atypia (two patients), cervical intraepithelial neoplasia (CIN) I (two), CIN II (two), and CIN III (one). No case of invasive cervical carcinoma was identified. The mean time from performance of Papanicolaou smear to receipt of cytologic results was 2.2 hours, and the mean total visit time was 3.6 hours. Patients found the single-visit program to be both beneficial and satisfying. CONCLUSION: This single-visit program is feasible and may overcome barriers to the diagnosis and management of cervical neoplasia in patients at high risk.

Adult↗

PubMed2000

Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan.

BACKGROUND: Despite the widespread use of Papanicolaou (Pap) smear screening, substantial morbidity and mortality from cervical carcinoma continue in the U.S. Although access to screening is a major barrier to use of the Pap smear, invasive cervical carcinoma (ICC) still is observed in health plan members who have comprehensive preventive care coverage. METHODS: For all women diagnosed with ICC between 1988 and 1994 in a large prepaid health plan, the authors retrospectively reviewed the medical records for prediagnosis Pap smear history to identify antecedents to ICC. RESULTS: Of 642 women diagnosed as having ICC, 455 (71%) had been plan members for > or = 30 of the 36 months before diagnosis. Of these 455 women, 240 (53%) had no Pap smear during the 6-36 months prior to diagnosis (i.e., were nonadherent to screening), 127 (28%) had only "normal" Pap smear results, 42 (9%) had at least 1 abnormal Pap smear and were adequately followed, 17 (4%) had at least 1 abnormal result without adequate follow-up, and 29 (6%) were classified as "other." Compared with adherent women, more nonadherent women presented with later stage disease, were symptomatic at the time of diagnosis, were older, and were of a race/ethnicity other than non-Hispanic white. CONCLUSIONS: Nonadherence to screening recommendations was found to be the most important modifiable antecedent to ICC in this population. The rate of incidence of ICC could be reduced by interventions to increase screening in women who do not have Pap smears regularly and by the use of newer screening technologies to reduce the false-negative rate of Pap smears.

Adult↗

PubMed2001

Beliefs and behaviors about Pap and breast self-examination among Thai immigrant women in Brisbane, Australia.

Regular screening is an important preventive method in reducing morbidity and mortality from cervical and breast cancer. In 1998, a cross-sectional study was conducted in Brisbane, Australia, among 145 Thai immigrant women, to explore cultural and social factors related to their use of Pap smear tests and breast self-examination (BSE). The study aimed at describing women's beliefs and perceptions about the body, breast and cervical cancer, and their perceptions of the causes of the diseases. It explored the women's perception of the severity and the effects of both cancers on aspects of patients' lives, and their chance of developing both cancers. The Thai immigrant women explained the causes of breast and cervical cancer using both traditional beliefs and medical knowledge. They perceived that both cancers affect a patient's health and her daily activities. Some women believed that they would develop cervical cancer if their perineum or vulva was "dirty." Some believed that they would have breast cancer because they had a history of benign tumor or cyst of a breast. Forty-four percent of the women had biennial Pap smears in the past five years and only 25% conducted BSE monthly in the past two years. Information relating to perceived barriers to undertake regular cervical cancer and breast cancer screenings and other health beliefs can be applied by health care personnel to increase Thai immigrant women's preventive health behaviors.

Adolescent↗

PubMed1997

Condom use by Dutch men with commercial heterosexual contacts: determinants and considerations.

We report responses from 559 clients of female prostitutes, with a view to determining to what extent previously identified factors play a part in condom use. To increase the response rate to advertisements in daily and weekly newspapers, interviews were held by phone. This procedure had the advantage of ensuring the anonymity many clients demanded. Of those clients having vaginal or anal contact (91%), 14% had not always used condoms in the previous year. Compared with consistent condom users, these men were less highly educated, had twice as many commercial contacts, and had more contacts with "steady" prostitutes. They were either more emotionally motivated to visit prostitutes than were consistent condom users or exhibited a stronger need for sexual variation. They showed a more compulsive attitude toward visiting prostitutes, had a more negative attitude toward prostitution in general, evaluated condoms more negatively, had a higher personal efficacy to achieve unsafe contacts, and had a higher general risk assessment, commensurate with their behavior. Men with only safe contacts had either an intrinsic or an extrinsic motivation for condom use. Among extrinsically motivated men, their behavior change was more recent and had not yet taken root: They still envisioned unsafe commercial sex to be possible in the future. Education aimed at the small group of men practicing unsafe contacts will not easily and directly lead to behavior change. But these educational activities may support prostitutes to persist in (consistent) condom use, regardless of clients' pressure to do otherwise.

Adult↗

PubMed2004

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.

Adult↗

PubMed2004

Psychological and sociocultural perspectives on follow-up of abnormal Papanicolaou results.

OBJECTIVE: To understand women's motivation to attend follow-up of an abnormal Papanicolaou (Pap) test by applying a general theoretical framework for voluntary behavior. METHODS: Semistructured, face-to-face interviews were conducted among 120 low-income, African-American, Caucasian, or Hispanic outpatients, aged 25-50 years, who presented for routine gynecologic care. Interview questions assessed social, cognitive, environmental, and emotional factors surrounding follow-up for an abnormal Pap test. Content analysis was performed. RESULTS: The majority of women (74%) described their attitude toward returning for a follow-up visit as favorable. Overall, knowledge regarding the significance of an abnormal result was poor, and misconceptions were common. Perceived barriers, consequences, and social influences associated with attending follow-up were qualitatively different across the 3 racial/ethnic groups. For example, African-American and Hispanic women expressed embarrassment more frequently than Caucasian women and were less likely to anticipate obstacles to attending follow-up. Furthermore, African-American women were the least likely to be influenced by others' opinions and to perceive difficulty in adhering to follow-up recommendations. For nearly all women, adequate communication with their provider was a key component of anticipated adherence. CONCLUSION: Clinicians may exert a positive influence on adherence among patients who experience an abnormal Pap test by engaging patients in a dialogue that accommodates the patient's sociocultural environment, explores concerns regarding the partner's reaction, emphasizes the importance of follow-up, provides a clear understanding of the process and timeline surrounding follow-up recommendations, and encourages the patient to anticipate obstacles to adherence and assists with solutions.

Adult↗

PubMed2006

Women's perceptions and social barriers determine compliance to cervical screening: results from a population based study in India.

BACKGROUND: Success of cervical screening initiatives depends on high participation of the target population, which in turn is determined by the women's perceptions, health orientation and other socio-cultural issues. The present study identifies the immediate social and cultural barriers that prevent women to attend cervical screening facilities. METHODS: Women non-compliant to a community-based cervical screening program were identified. From them 500 were randomly selected for interview using a structured questionnaire that was designed on the basis of feedbacks received from several focused group discussions. Questionnaire listed 24 possible reasons for non-compliance. The women were asked to select the most pertinent reason(s) for her non-attendance or to reveal if they had any reason other than the listed ones. RESULTS: A total of 469 non-compliant women were interviewed. They had significantly lower literacy rate compared to the compliant women (OR=2.25; 95% CI: 1.23-4.13). Nearly half of the interviewed women responded that they themselves opted to stay away from the program. Most common reasons cited for non-attendance in this group were reluctance to go for medical test in the absence of any symptoms and apprehension to have a test that detects cancer. Second major group of responders comprised of women who were willing, yet could not attend due to various hurdles. Most common hurdles were inability to leave household chores, pre-occupation with family problems and lack of approval from husbands. CONCLUSIONS: Modification of health behavior through education and social empowerment of women are essential for a population based cervical screening program to succeed in India.

Adult↗

PubMed1999

A single-visit cervical carcinoma prevention program offered at an inner city church: A pilot project.

BACKGROUND: A single-visit cervical carcinoma prevention program was implemented, integrating screening, diagnosis, treatment, and health education in the familiar environment of the community church. METHODS: Nonpregnant women age 18 years or older, who had not received cervical carcinoma screening in the preceding year were eligible. Subjects provided information on personal demographics, health, and knowledge regarding cervical carcinoma prevention. Thereafter, cervical cytology was collected, processed, and interpreted on site. Participants attended small-group instruction on cervical carcinoma prevention. Screening results were given to each subject individually. Patients with abnormal cytology underwent immediate colposcopy with biopsies or loop electrosurgical excision procedure as indicated. Participant satisfaction and educational impact were evaluated. RESULTS: Ninety of the 98 participants reported that Spanish was their native language; 59 did not speak English. Fifty-four had had fewer than 6 years of education and 55 were unemployed. Seventy-eight did not have a regular physician or health insurance. Twenty-four either had never undergone cervical carcinoma screening or had let more than 5 years elapse since their previous examination. None of nine potential barriers assessed correlated with past compliance with cervical carcinoma screening. The mean time for processing and on-site interpretation of cervical cytology smears was 22.6 +/- 5.3 minutes. The median time patients spent in the program was 75 minutes. There was a significant improvement in the subjects' knowledge regarding cervical carcinoma prevention. All participants were highly satisfied. CONCLUSIONS: This parish-based, integrated, single-visit program for the prevention of cervical carcinoma was easily implemented and provided care to a substantial proportion of underserved patients.

Adult↗

PubMed1997

Factors influencing condom use among heterosexual users of injection drugs and crack cocaine.

OBJECTIVES: To study factors that influence the self-reported use of condoms among injection drug users and crack smokers. STUDY DESIGN: A cross-sectional design was used to collect data from drug-using heterosexual men (n = 247) and women (n = 107). RESULTS: Participants were largely African American (79.4%), male (69.8%), and unmarried (90.1%). The mean age for men was 39.9 years, 35.5 years for women. Drug user groups consisted of individuals who used both crack cocaine and injection drugs (40.1%), noninjecting crack smokers (33.1%), and non-crack-smoking injection drug users (26.8%). Daily injection drug or crack use was reported by 62.9% of the sample. One third of the sample reported recent vaginal sex with more than one partner. More than 70% of the participants frequently used drugs when having sex. Logistic regression showed that individuals who were high when having vaginal sex were less likely to use condoms than people who were not high (odds ratio [OR] 0.82; 95% confidence interval [CI], 0.68-0.99); individuals whose partners got high when having sex were more likely to report condom use (OR 1.20; 95% CI, 1.01-1.42); individuals were less likely to use condoms when having sex with a main partner (OR 0.40; 95% CI, 0.20-0.80); individuals who believed it was important to use condoms were more likely to use condoms (beta = 0.57, P < 0.00); and people who believed condoms reduced sexual pleasure were less likely to use condoms (beta = -0.53, P < 0.00). CONCLUSIONS: In addition to being sensitive to partner characteristics, sex risk-reduction interventions targeting users of injection drugs or crack must address the widespread use of psychoactive drugs that occurs immediately before and during sex because such use presents a significant impediment to the employment of safer-sex techniques that rely on condoms. Until such interventions are in place, access to drug abuse treatment is a critical dimension of human immunodeficiency virus and other sexually transmitted disease prevention.

Adult↗

PubMed1999

Predictors of compliance with recommended cervical cancer screening schedule: a population-based study.

BACKGROUND: The prevalence of routine cervical cancer screening and compliance with screening schedules are low compared to the Year 2000 objectives. Identifying predictors of routine screening and screening schedule compliance will help achieve these objectives. METHODS: We analyzed data from probability samples of 1,609 Missouri women responding to both the 1994 Behavioral Risk Factor Surveillance System (BRFSS) and the Missouri Enhanced Survey (ES). We generated prevalence odds ratios to identify predictors of non-compliance to cervical cancer screening guidelines. Also, among a sample of women reporting a reason for last Pap test, we estimated the relative odds of a screening v. diagnostic exam. RESULTS: In the combined probability sample, compliance with screening schedule was likely among women younger than 50 years of age and women who had either a recent mammography or a clinical breast exam. Being African-American, not experiencing a cost barrier when seeking medical care, having at least a high-school education and health coverage were each associated with an increased compliance with a screening schedule in the combined probability sample. Among women in the combined probability sample, whites, those who experienced no cost barrier to seeking medical care, the non-obese, and those who had a recent mammography were each more likely to have had a screening as opposed to a diagnostic exam. DISCUSSION: Cancer control and cardiovascular (CVD) prevention programs should consider jointly targeting those at high risk for cervical cancer and CVD because of aging and associated high-risk behavior such as non-compliance with cervical cancer screening, smoking, and obesity. Also, further research is needed to examine whether the increased compliance with cervical cancer screening guidelines among African American women may be in part due to higher occurrence of diagnostic Pap smears.

Adult↗

PubMed2026

Clinical Trial: Effectiveness and Safety of a Novel Anal Insert Device for Treatment of Faecal Incontinence.

BACKGROUND: Treatment options for medically-refractory faecal incontinence (FI)-including anorectal biofeedback, dextranomer injection, and sacral nerve stimulation-are limited and outcomes are often suboptimal. Anal or vaginal insert devices are infrequently used. AIMS: We evaluated the safety and effectiveness of a new anal insert device (StaySure) in patients with FI. METHODS: Patients with FI for ≥ 6 months and ≥ 4 moderate or large FI episodes during a 4-week baseline entered a 2-4 week fitting/run-in period to individualise device size (10 or 13 mm) followed by a 4-week treatment period. Outcomes included effectiveness, safety, and quality of life (QoL). The primary outcome was the proportion achieving a ≥ 50% reduction in FI frequency. RESULTS: Of 124 enrolled patients, 98, 71, and 61 progressed through the baseline, fitting/run-in, and treatment phases respectively, with few exclusions due to device intolerance. In the intent-to-treat cohort of 59 participants (93% women), mean (SD) number of days with FI declined from 13.2 (7.0) to 6.3 (6.9), and FI weekly episodes declined from 5.4 (6.9) to 2.1 (5.1) (69% reduction; p < 0.001) with similar results for both device sizes. The primary endpoint was achieved in 76.3% of participants; 54.2% achieved ≥ 75% reduction. The FIQoL overall score increased from a mean (SD) of 1.9 (0.6) to 2.3 (0.6) (p < 0.001), indicating improved QoL. Improvements in FI frequency, FIQoL exceeded minimal clinically important difference thresholds, confirming clear clinical benefit. No treatment-related serious adverse events were reported. CONCLUSIONS: The StaySure anal insert device is safe, well tolerated, and effective in reducing FI in patients with moderate to severe symptoms refractory to conservative therapies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03898778.

Adult↗

PubMed2001

Cervical cancer screening in ethnocultural groups: case studies in women-centered care.

INTRODUCTION: The purpose of this study was to identify and describe critical elements of women-centered care within the context of providing cervical screening to three ethnocultural groups in Canada: Asian, South Asian and First Nations. METHODS: Data for this collective case study included open-ended interviews with purposive samples of women and key informants from each target group. Following thematic analysis, cross-case analysis was completed by comparing and contrasting issues and contextual factors influencing women's and providers' experiences. RESULTS: Cervical screening services for each group were shaped by attention to ethnocultural values, women's desire for thorough explanations, and the importance of a comfortable setting. While participation rates varied across clinics, women were positive about their experiences in obtaining cervical screening. Some women's expectations that they could address a range of health concerns with female health providers at the clinics were stymied by structural barriers that prevented staff from addressing issues beyond those directly related to cervical screening. Cross-case analysis revealed three key elements of women-centered care: respectful and culturally appropriate interactions between women and health providers, the importance of providing acceptable alternatives for women, and the need for comprehensive health services. CONCLUSION: While the establishment of Pap test clinics for ethnocultural groups has the potential to enhance participation in cervical screening, changes in health policy and the structure of health services are required for existing programs to fully implement the elements of women-centered health care identified in this study. Other models of providing health care to women in ethnocultural groups, including the use of clinics staffed by nurse practitioners, should be evaluated.

Adult↗

PubMedDate not supplied

CAPRELA (Cancer Prevention for Latinas): findings of a pilot study in Winston-Salem, Forsyth County.

OBJECTIVE: To evaluate knowledge and attitudes that affect cervical and breast cancer screening among uninsured Hispanic women. STUDY DESIGN: Cross-sectional, descriptive study of uninsured Latino women in Forsyth County, North Carolina. DATA SOURCES/STUDY SETTING: A convenience sample of Hispanic women who immigrated to the United States within the last ten years, primarily from Mexico (N = 70). DATA COLLECTION METHODS: Two trained lay health advisors (promotoras) administered in-person, structured surveys to 70 women in the community. All interviews were conducted in Spanish. Additionally two focus groups were conducted in Spanish to elucidate cultural beliefs and barriers to cancer screening not otherwise captured in the standardized surveys. Quantitative data were analyzed using logistic regression analysis. Qualitative data were transcribed and analyzed using a multi-step framework approach to identify and validate themes. PRINCIPAL FINDINGS: Of 70 women, 42 (60%) reported a Pap smear within the last year; 26 (37%) reported two exams within the past three years. Among women aged 40 and older, 10 of 18 (56%) reported ever having a mammogram. Being married (OR = 4.05, CI 1.07-15.25) and having the same healthcare provider (OR 5.64, CI 1.04-30.56) predicted better Pap smear screening in multivariate analyses. Limited knowledge about breast cancer and needing an interpreter to communicate reduced the likelihood that women received a mammogram. Qualitative results indicated that women had poor prior experiences with Pap smears, held several misconceptions about cancer etiology and risk factors, and expressed distinct gender roles for Latina women and men that may affect healthcare utilization. CONCLUSIONS: Screening rates for cervical and breast cancer are low among uninsured Latina women. Therefore, community and clinic-based interventions are needed to improve underutilization of and satisfaction with cancer screening practices among uninsured Latina women.

Adult↗

PubMedDate not supplied

Depressive symptom burden as a barrier to screening for breast and cervical cancers.

BACKGROUND: Depression has been associated with lower cancer screening rates in some studies. We examined whether a higher depressive symptom burden presented a barrier to subsequent mammography and Papanicolaou (Pap) smear testing. METHODS: Study of Women's Health Across the Nation (SWAN) is a cohort study of 3302 community-dwelling women. At baseline, participants were 42-52 years old, had no surgical removal of the uterus or both ovaries, no current use of hormones that affect the ovaries, and at least one menses in the previous 3 months. SWAN data spanned 4 years. Repeated measures logistic models determined odds of mammography and of Pap screening in the year following depressive symptom burden, as determined by Center for Epidemiological Studies Depression score (CES-D). The models controlled for age, race/ethnicity, health insurance, medical history and use, smoking, obesity, and socioeconomic status. RESULTS: At baseline, 75.6% (2493 of 3297) had a low depressive symptom burden (CES-D score < 16, referent), 9.5% (312 of 3297) had a moderate burden (CES-D 16-20), and 14.9% (492/3297) had a high burden (CES-D > or = 21). Women with a high depressive symptom burden had, in the subsequent year, significantly lower odds of mammography (OR 0.84, 95% CI 0.73-0.97) but not Pap smear (OR 0.88, 95% CI 0.76-1.03). There was not a significant dose-response relationship between depressive symptom burden and screening. CONCLUSIONS: The presence of a high depressive symptom burden is a modest independent risk factor for lack of subsequent mammography. Ensuring that depressed patients receive regular cancer screening services is important.

Adult↗

PubMed1997

Getting a Pap smear: focus group responses of African American and Latina women.

PURPOSE/OBJECTIVES: To identify barriers and facilitating factors associated with Papanicolaou (Pap) smear use among African American and Latina women. DESIGN: Descriptive, exploratory. SAMPLE AND SETTING: Fifty-two African American and Latina women recruited from health and social service agencies. METHODS: Guided by the Theory of Planned Behavior, focus group interviewing and an open-ended questionnaire were used to identify cancer beliefs and salient behavioral beliefs, referents, and control beliefs about Pap smears. FINDINGS: False-negative results, financial burden, and the role of the physician were the most salient beliefs for African American women. For Latinas, embarrassment, use of a cold or unclean speculum, and discomfort were the most salient beliefs. Salient referents for African American and Latina women were physicians and male partners; access to Pap smear screening and financial assistance were their frequently held control beliefs. Beliefs regarding cancer fatalism were consistent with reports of national samples of African American and Latino adults. CONCLUSIONS: Cancer beliefs among African Americans and Latinas have not changed significantly in the past 10-15 years, despite increased national cancer education and screening advertisements. Moreover, as issues regarding Pap smear use remain the same, new concerns develop. Specifically, beliefs about speculums, perceptions of discomfort, perceptions of disapproval of physicians and male partners, fear as a motivator and inhibitor, and lack of information about cervical cancer and Pap smear screening present new concerns for these women. IMPLICATIONS FOR NURSING PRACTICE: The findings provided data needed to develop a questionnaire that will be used to test Pap smear screening intentions among African American and Latina women.

Adult↗

PubMed2005

[Analysis of behavioral stage in pap testing by using transtheoretical model].

OBJECTIVE: To evaluate the relationships among sociodemographic characteristics, health behaviors, levels of pros and cons and stages of change in Pap testing for uterine cervical cancer. METHODS: A questionnaire survey was performed on 560 randomly sampled people who were assigned to participate in a Pap testing program by the 'National Cancer Screening Project in 2003' between 25 September and 10 October in Gyeonggi, Korea. Data about the behaviors and intentions of Pap testing, sociodemographic characteristics, health behaviors, and levels of acknowledged benefit (pros) and barrier (cons) for Pap testing was collected. The stages of change were grouped according to behaviors and intentions of Pap testing as passive, active, and relapse. RESULTS: Logistic analysis between the passive and active groups showed that city dwellers, 'high' and 'middle' groups in terms of the individual's health belief, those who had undergone a health examination within the past 2 years, and those who had undergone hormone replacement therapy had a higher odds ratios to be in the active group. As the 'benefit' scores increased and the 'Unnecessity' scores decreased, the probabilities to be in the active group increased. According to the logistic analysis results between the active and relapse groups, those who were 60 years or older, members of the National Heath Insurance, and those who had not undergone a health examination within the past 2 years had a higher odds ratio to be in the relapse group. The 'Benefit' scores were not significant in this relationship. The probabilities of being in the relapse group increased as the 'Unnecessity' and 'Shamefulness' scores increased. CONCLUSIONS: In conclusion, health planners should inform women in the passive group of the benefits and necessity of Pap testing. It would be better to reduce the barriers to the active group of undergoing Pap smear. This study might be a useful guide for future planning of Pap testing program.

Adult↗

PubMedDate not supplied

Pap smear screening in a health maintenance organization: 1986-1990.

BACKGROUND: To assess Pap smear utilization and compliance with screening recommendations, a study was conducted in a large midwestern HMO where cost is not a barrier to care. The purpose of the study was to examine rates of screening by age, identify the proportion of abnormal cytologic findings, and determine screening incidence for women with a diagnosis of cervical cancer. METHOD: Computerized records on screening frequency over a 5-year interval were examined for 23,649 consecutively enrolled women ages 18-70. In addition, medical records were examined for patients with a cervical cancer diagnosis (n = 32). RESULTS: Eighty-five percent of the women had at least one Pap smear within the 5-year duration. Nearly half (47%) obtained four to five tests, 30% obtained two or three tests, and 14% were screened only once during the 5 years. Percentages were similar across all age groups. Cytopathology reports indicated 95% of tests as normal, 4% as low-grade squamous intraepithelial lesions (SIL), <1% as high-grade squamous intraepithelial lesions, and 0.02% as suspected malignancy. Younger women were more likely to evidence SIL; older women were somewhat more likely to have carcinoma. For women with a cancer diagnosis, 63% had not been screened the previous year and 34% had no screening recorded for the prior 3 years. Twenty-two percent had no record of screening within the past 5 years compared with 8.5% of the total group. CONCLUSIONS: In HMOs with prepayment, one would hypothesize that patients would obtain more regular preventive screening of all types, yet women at highest risk seemed less likely to obtain Pap smear screening. This group is not fully understood and probably represents the best opportunity to reduce morbidity, mortality, and expense from preventable cervical neoplasias.

Adolescent↗

PubMedDate not supplied

The impact of farm lifestyle and health characteristics: cervical cancer screening among southern farmwomen.

BACKGROUND: Rural residence, access to healthcare facilities, and multiple roles of farmwomen may pose barriers to cervical cancer screening among women living in southern farm states. OBJECTIVES: To compare the proportion of women failing to obtain cervical cancer screening in three Southern states to state-level Behavioral Risk Factor Surveillance System (BRFSS) data and to identify factors contributing to cervical cancer screening and detection behaviors. METHODS: A cross-sectional study design was used. Data were collected using several Farm Family Health and Injury Prevention surveys via telephone interviews in three southern states. Farmwomen (N = 2,324) from three states comprised the sample on Pap testing. Data were used from summary reports of the BRFSS for each state to compare the proportion of farmwomen >or=18 years of age who had failed to obtain a Pap test within the past 3 years to failure to obtain Pap tests statewide. Multiple logistic regression analyses were conducted to examine the predictors of failure to obtain early screening. RESULTS: Pap testing did not meet Healthy People 2010 target goal of 90%. Farm lifestyle predicting failure to obtain cervical cancer screening included having a house on the farm and engaging in no off-farm work and minimal involvement in farm tasks. The risk of failing to obtain Pap testing increased with age and decreased with education. The only health access variable contributing to failure to obtain Pap testing was women with no insurance. Positive preventive risk factors contributing to compliance with up-to-date status were previous mammogram and previous breast exam. Being married was a positive risk factor. DISCUSSION: Although the failure to obtain Pap testing in Texas was comparable to state BRFSS rates, failure to obtain Pap testing rates in Kentucky and Louisiana were at least 6% greater for farmwomen than women living in the state. Farmwomen, a subgroup of the rural population, have unique barriers to obtaining screening services. Geographical isolation and minimal role involvement on the farm may contribute to the likelihood that women are not seeking cervical cancer screening.

Adolescent↗