title: Intention to return for papanicolaou smears in adolescent girls and young women.
abstract: OBJECTIVE
  Sexually active adolescent girls have high rates of abnormal cervical cytology. However, little is known about factors that influence intention to return for Papanicolaou screening or follow-up. The aim of this study was to determine whether a theory-based model that assessed knowledge, attitudes, and behaviors predicted intention to return.
  
  
  METHODS
  The study design consisted of a self-administered, cross-sectional survey that assessed knowledge, beliefs, perceived control over follow-up, perceived risk, cues for Papanicolaou smears, impulsivity, risk behaviors, and past compliance with Papanicolaou smear follow-up. Participants were recruited from a hospital-based adolescent clinic that provides primary and subspecialty care, and the study sample consisted of all sexually active girls and young women who were aged 12 to 24 years and had had previous Papanicolaou smears. The main outcome measure was intention to return for Papanicolaou smear screening or follow-up.
  
  
  RESULTS
  The enrollment rate was 92% (N = 490), mean age was 18.2 years, 50% were black, and 22% were Hispanic. Eighty-two percent of participants intended to return. Variables that were independently associated with intention to return included positive beliefs about follow-up (odds ratio [OR]: 1.07; 95% confidence interval [CI]: 1.02-1.11), perception that important others believe that the participant should obtain a Papanicolaou smear (OR: 1.93; 95% CI: 1.38-2.74), perceived control over returning (OR: 1.24; 95% CI: 1.06-1.46), and having received cues to obtain a Papanicolaou smear (OR: 1.31; 95% CI: 1.08-1.60).
  
  
  CONCLUSIONS
  Analysis of this novel theoretical framework demonstrated that knowledge and previous behaviors were not associated with intention to return for Papanicolaou smear screening and follow-up in this population of young women. However, modifiable attitudinal components, including personal beliefs, perception of others' beliefs, and cues to obtaining Papanicolaou smears, were associated with intention to return.
authors.affiliation: Division of Adolescent Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. kahnj1@chmcc.org
authors.forename: J A
authors.initials: JA
authors.lastname: Kahn
authors.forename: E
authors.initials: E
authors.lastname: Goodman
authors.forename: G B
authors.initials: GB
authors.lastname: Slap
authors.forename: B
authors.initials: B
authors.lastname: Huang
authors.forename: S J
authors.initials: SJ
authors.lastname: Emans
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology; D000297:Psychology, Adolescent; D012309:Risk-Taking; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology; D014626:Vaginal Smears / Q000523:psychology* / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology