Pap smear rates among Haitian immigrant women in eastern Massachusetts.
OBJECTIVE
Given limited prior evidence of high rates of cervical cancer in Haitian immigrant women in the U.S., this study was designed to examine self-reported Pap smear screening rates for Haitian immigrant women and compare them to rates for women of other ethnicities.


METHODS
Multi-ethnic women at least 40 years of age living in neighborhoods with large Haitian immigrant populations in eastern Massachusetts were surveyed in 2000-2002. Multivariate logistic regression analyses were used to examine the effect of demographic and health care characteristics on Pap smear rates.


RESULTS
Overall, 81% (95% confidence interval 79%, 84%) of women in the study sample reported having had a Pap smear within three years. In unadjusted analyses, Pap smear rates differed by ethnicity (p=0.003), with women identified as Haitian having a lower crude Pap smear rate (78%) than women identified as African American (87%), English-speaking Caribbean (88%), or Latina (92%). Women identified as Haitian had a higher rate than women identified as non-Hispanic white (74%). Adjustment for differences in demographic factors known to predict Pap smear acquisition (age, marital status, education level, and household income) only partially accounted for the observed difference in Pap smear rates. However, adjustment for these variables as well as those related to health care access (single site for primary care, health insurance status, and physician gender) eliminated the ethnic difference in Pap smear rates.


CONCLUSIONS
The lower crude Pap smear rate for Haitian immigrants relative to other women of color was in part due to differences in (1) utilization of a single source for primary care, (2) health insurance, and (3) care provided by female physicians. Public health programs, such as the cancer prevention programs currently utilized in eastern Massachusetts, may influence these factors. Thus, the relatively high Pap rate among women in this study may reflect the success of these programs. Public health and elected officials will need to consider closely how implementing or withdrawing these programs may impact immigrant and minority communities.
Green
Eric H
EH
Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, USA. ergreen@montefiore.org
Freund
Karen M
KM
Posner
Michael A
MA
David
Michele M
MM
D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D004522:Educational Status; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006205:Haiti / Q000208:ethnology; D015438:Health Behavior / Q000208:ethnology*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008403:Mass Screening / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D065006:Papanicolaou Test; D011320:Primary Health Care / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014504:Urban Health; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D014930:Women / Q000193:education / Q000523:psychology