Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey.
BACKGROUND
Cervical cancer screening is not fully utilized among all groups of women in the United States, especially women without access to health care and older women.


METHODS
Papanicolaou (Pap) test use among U.S. women age 18 and older is examined using data from the 2000 National Health Interview Survey (NHIS).


RESULTS
Among women who had not had a hysterectomy (n = 13,745), 83% reported having had a Pap test within the past 3 years. Logistic regression analyses showed that women with no contact with a primary care provider in the past year were very unlikely to have reported a recent Pap test. Other characteristics associated with lower rates of Pap test use included lacking a usual source of care, low family income, low educational attainment, and being unmarried. Having no health insurance coverage was associated with lower Pap test use among women under 65. Despite higher insurance coverage, being age 65 and older was associated with low use. Rates of recent Pap test were higher among African-American women.


CONCLUSIONS
Policies to generalize insurance coverage and a usual source of health care would likely increase use of Pap testing. Also needed are health system changes such as automated reminders to assist health care providers implement appropriate screening. Renewed efforts by physicians and targeted public health messages are needed to improve screening among older women without a prior Pap test.
Hewitt
Maria
M
National Cancer Policy Board, Institute of Medicine, National Academy of Sciences, Washington, DC 20001, USA. Mhewitt@nas.edu
Devesa
Susan S
SS
Breen
Nancy
N
D000328:Adult; D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D007044:Hysterectomy; D015994:Incidence; D007341:Insurance / Q000706:statistics & numerical data; D007407:Interviews as Topic; D016015:Logistic Models; D017533:Marital Status; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D014626:Vaginal Smears / Q000706:statistics & numerical data