title: Community-based cultural predictors of Pap smear screening in Nova Scotia.
abstract: BACKGROUND
  Pap smear screening is effective in reducing the incidence of cervical cancer. However, some subgroups of women are less likely to be screened than others. Since Canadian provincial health databases do not contain data fields identifying ethnicity or language, analyses employing these variables are typically not available. This paper overcomes this problem by using community- rather than person-based measures. Associations with having had a recent Pap smear are reported by community income, language, ethnic group, and urban/rural status, as well as the woman's age.
  
  
  METHODS
  The provincial Health Card Number and Cytology Registries were linked to ascertain the screening status of women in mainland Nova Scotia and Cape Breton. Postal codes were linked to census enumeration areas and then to Statistics Canada census data to create community-based cultural measures for each woman.
  
  
  RESULTS
  Women in mainland Nova Scotia were more likely to have had a recent Pap smear (Odds Ratio (OR)=1.36; 95% Confidence Interval (CI):1.33-1.39). Women living in low income (OR=1.19; CI:1.15-1.22), Aboriginal (OR=1.60; CI:1.46-1.76), mixed Black (OR=1.25; CI:1.19-1.30) and rural (OR=1.09; CI:1.07-1.11) communities and who were older were less likely to have had a recent Pap smear.
  
  
  CONCLUSIONS
  These findings were not unexpected. In the United States and elsewhere, associations between Pap screening status and women with low income, rural residence, Aboriginal and Black heritage have been reported using person-based methods. Our findings demonstrate a method of providing measures of ethnicity and language that should be considered for use in Canadian studies of service utilization, disease status, and well-being.
authors.affiliation: School of Health Services Administration, Dalhousie University, Halifax, NS. grace.johnston@dal.ca
authors.forename: Grace M
authors.initials: GM
authors.lastname: Johnston
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Boyd
authors.forename: Margery A
authors.initials: MA
authors.lastname: MacIsaac
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003466:Cultural Characteristics; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D016017:Odds Ratio; D065006:Papanicolaou Test; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014626:Vaginal Smears / Q000706:statistics & numerical data*