title: Correlates of intent to seek unnecessary pap tests among elderly women.
abstract: OBJECTIVE
  Cervical cancer screening may be over-used by elderly women who might not benefit from the test. The purpose of this study was to examine the relative importance of objective factors (e.g. intact cervix) and subjective factors (e.g. patients' Pap-smear related beliefs/attitudes) as correlates of elderly women's intention to have a Pap smear.
  
  
  METHODS
  This study was a secondary data analysis using a subset sample of the elderly women (>or=65 years) who participated in the Texas Tech 5000 Survey Wave 4, a cross-sectional phone interview study conducted in 2002. Intent to have a Pap test, previous gynecologic history, and beliefs/attitudes related to Pap tests were measured. chi2 tests and logistic regression were conducted.
  
  
  RESULTS
  Among the 1,044 women in the analytical sample, 70.2% (733) reported intending to have a Pap smear test within the next 2 years. About 77% (449/582) of the women who had not undergone a hysterectomy reported the intend to have a Pap smear, whereas 62% (284/462) of the women who had undergone a hysterectomy reported the same intent (chi 2 = 30.26; df = 1; p = .000). Among women who had undergone a hysterectomy, having received a Pap smear within the past 2 years (odds ratio OR, 21.32; 95% confidence interval [CI], 11.52-39.47), perceiving that their doctors might feel having the test is a good idea (OR, 7.14; 95% CI, 3.15-16.19), and insurance covering the test (OR, 2.21; 95% CI, 1.18-4.15) were positive correlates of intent to have a Pap test. Among women who had not undergone a hysterectomy, previous Pap smear history (OR, 19.28; 95% CI, 10.15-37.10), perceived doctor's opinion (OR, 5.39; 95% CI, 2.38-12.19), perceived pain of the test (OR, 0.52; 95% CI, .28-.99), perceived importance (OR, 4.00; 95% CI, 1.32-12.10), and perceived risk of developing cervical cancer (OR, 4.27; 95% CI, 1.27-14.33) were correlates.
  
  
  CONCLUSIONS
  Public health educational messages intended to increase appropriate use of Pap screening should include factual information about risk factors such as age and possession of an intact cervix. Other messages intended to reduce inappropriate use of Pap screening should be directed at physicians, since many elderly women intend to inappropriately seek Pap tests based on erroneous beliefs/attitudes.
authors.affiliation: Department of Family and Community Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA. yan.zhang@ttuhsc.edu
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Tyrone F
authors.initials: TF
authors.lastname: Borders
authors.forename: James E
authors.initials: JE
authors.lastname: Rohrer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000517:prevention & control; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health