Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania.
OBJECTIVE
The incidence of cervical cancer in Eastern Europe has been on the rise, in contrast to the reduction in incidence in most countries of Western Europe. The objectives of the paper are to delineate the inequalities in cervical cancer screening in Romania and Bulgaria and identify explanations for these inequalities.


METHODS
Representative samples of women - 1,099 in Bulgaria and 1,053 in Romania, were interviewed through a structured questionnaire.


RESULTS
We found multiple dimensions of inequalities in cervical cancer prevalence and prevention, including disparities in comparison to other countries, disparities due to socioeconomic status, education, residency and ethnicity, as well as differential barriers faced by women in access to screening and in relationships with providers. We identified mediators of the effects of socio-economic status on screening history.


CONCLUSIONS
The study concludes that the effect of SES on screening is mediated mainly by the structural barriers in accessing the healthcare system, as well as women's perceptions of the multiple costs of the smear. These conclusions are relevant to the development of national screening programs and health promotion in the two countries.
Todorova
Irina
I
Health Psychology Research Center, Sofia 1113, Bulgaria. Irina_Todorova@post.harvard.edu
Baban
Adriana
A
Alexandrova-Karamanova
Anna
A
Bradley
Janet
J
D000328:Adult; D000368:Aged; D002031:Bulgaria / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening / Q000639:trends; D008875:Middle Aged; D015995:Prevalence; D012111:Residence Characteristics; D012383:Romania / Q000453:epidemiology; D012923:Social Class; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult