title: Use of Pap test among Hispanics and non-Hispanic whites in a rural setting.
abstract: BACKGROUND
  Hispanic women in the United States have a higher incidence of invasive cervical cancer than non-Hispanic whites. A key factor related to the relatively high incidence is the underutilization of cancer-screening services. Several previous investigations have reported that Hispanic women are less likely to comply with screening recommendations for Pap testing; some have identified factors that are associated with non-compliance with screening recommendations.
  
  
  METHODS
  Using baseline personal interview data from a randomized community trial on cancer prevention in a rural area, we assessed the association between health barriers and non-compliance with cervical screening recommendations.
  
  
  RESULTS
  Among Hispanic women (n = 382), those with a lower level of acculturation were more likely than highly acculturated Hispanic and non-Hispanic white women (n = 385) to report personal barriers as reasons for not getting an initial or subsequent screening exam. Such barriers include fear of finding cancer, fear of finding diseases other than cancer, and embarrassment about receiving a physical exam. Certain structural barriers, such as cost of care, no time off work, and lack of transportation, were reported to be associated with non-compliance with routine cervical cancer screening, especially among non-Hispanic white women.
  
  
  CONCLUSIONS
  Future research should examine barriers related to initial and subsequent screening among Hispanics with varying levels of acculturation.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA 98195-7234, USA. gcoronad@fhcrc.org
authors.forename: Gloria D
authors.initials: GD
authors.lastname: Coronado
authors.forename: Beti
authors.initials: B
authors.lastname: Thompson
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Dale
authors.initials: D
authors.lastname: McLerran
mesh_terms: D000328:Adult; D001294:Attitude to Health; D018864:Cultural Diversity; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D012424:Rural Population; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D014861:Washington; D044465:White People