title: Adherence over time to cervical cancer screening guidelines: insights from the Canadian National Population Health Survey.
abstract: BACKGROUND
  A substantial percentage of North American women are nonadherent to cervical cancer screening guidelines despite the effectiveness of the Papinicolaou (pap) test for papillomavirus. Our objective was to determine factors associated with changes in adherence for cervical cancer screening guidelines over a 14-year period.
  
  
  METHODS
  Using data from cycles 1 (1994-1995) through 7 (2006-2007) of the Canadian National Population Health Survey, we used logistic regression to compare the regularity of pap testing (at least once every 36 months) among women. We compared women with increasing adherence to pap testing guidelines to those who were never adherent, and women with decreasing adherence to those who were always adherent. The sample included women aged 20-70 years who responded in at least three of seven waves of data collection and had not undergone a hysterectomy (n=4949). Independent variables were based on Andersen's Behavioral Model of predisposing, enabling, and need variables.
  
  
  RESULTS
  The majority of our sample were either always adherent (61.4%) or had increasing adherence (9.9%) over the course of the study. Another 4.8% were never adherent, and 6.6% had decreasing adherence over their involvement in the study. Predominantly, both enabling (e.g., presence of regular doctor) and need (e.g., birth control pill use, obesity) factors were associated with changing patterns of adherence.
  
  
  CONCLUSIONS
  Physicians have a crucial role to play in the trajectories of adherence to cervical cancer screening guidelines over time. In addition, women with obesity need to be particularly targeted for services because they are vulnerable to negative trajectories in adherence over time.
authors: School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.
authors: Catherine
authors: C
authors: Worthington
authors: Kendra
authors: K
authors: McLeish
authors: Esme
authors: E
authors: Fuller-Thomson
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D004641:Emigration and Immigration; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D027383:Papillomaviridae; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult