title: Ohio Appalachian women's perceptions of the cost of cervical cancer screening.
abstract: BACKGROUND
  Despite evidence of the importance of cervical cancer screening, screening rates in the United States remain below national prevention goals. Women in the Appalachia Ohio region have higher cervical cancer incidence and mortality rates along with lower cancer screening rates. This study explored the expectations of Appalachian Ohio women with regard to Papanicolaou (Pap) test cost and perceptions of cost as a barrier to screening.
  
  
  METHODS
  Face-to-face interviews were conducted with 571 women who were part of a multilevel, observational community-based research program in Appalachia Ohio. Eligible women were identified through 14 participating health clinics and asked questions regarding Pap test cost and perceptions of cost as a barrier to screening. Estimates of medical costs were compared with actual costs reported by clinics.
  
  
  RESULTS
  When asked about how much a Pap test would cost, 80% of the women reported they did not know. Among women who reportedly believed they knew the cost, 40% overestimated test cost. Women who noted cost as a barrier were twice as likely to not receive a test within screening guidelines as those who did not perceive a cost barrier. Furthermore, uninsured women were more than 8.5 times as likely to note cost as a barrier than women with private insurance.
  
  
  CONCLUSIONS
  Although underserved women in need of cancer screening commonly report cost as a barrier, the findings of the current study suggest that women may have a very limited and often inaccurate understanding concerning Pap test cost. Providing women with this information may help reduce the impact of this barrier to screening.
authors.affiliation: Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, Ohio 43210, USA. mcalearney.1@osu.edu
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
authors.forename: Paula H
authors.initials: PH
authors.lastname: Song
authors.forename: Dale A
authors.initials: DA
authors.lastname: Rhoda
authors.forename: Cathy
authors.initials: C
authors.lastname: Tatum
authors.forename: Stanley
authors.initials: S
authors.lastname: Lemeshow
authors.forename: Mack
authors.initials: M
authors.lastname: Ruffin
authors.forename: J Phil
authors.initials: JP
authors.lastname: Harrop
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
mesh_terms: D000293:Adolescent; D000328:Adult; D001061:Appalachian Region; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D009820:Ohio; D065006:Papanicolaou Test; D010465:Perception; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics; D014626:Vaginal Smears / Q000191:economics* / Q000706:statistics & numerical data