title: Personal factors influence use of cervical cancer screening services: epidemiological survey and linked administrative data address the limitations of previous research.
abstract: BACKGROUND
  National screening programs have reduced cervical cancer mortality; however participation in these programs varies according to women's personal and social characteristics. Research into these inequalities has been limited by reliance on self-reported service use data that is potentially biased, or administrative data that lacks personal detail. We address these limitations and extend existing research by examining rates and correlates of cervical screening in a large epidemiological survey with linked administrative data.
  
  
  METHODS
  The cross-sectional sample included 1685 women aged 44-48 and 64-68 years from the Australian Capital Territory and Queanbeyan, Australia. Relative risk was assessed by logistic regression models and summary Population Attributable Risk (PAR) was used to quantify the effect of inequalities on rates of cervical cancer screening.
  
  
  RESULTS
  Overall, 60.5% of women participated in screening over the two-year period recommended by Australian guidelines. Screening participation was associated with having children, moderate or high use of health services, employment, reported lifetime history of drug use, and better physical functioning. Conversely, rates of cervical screening were lower amongst women who were older, reliant on welfare, obese, current smokers, reported childhood sexual abuse, and those with anxiety symptoms. A summary PAR showed that effective targeting of women with readily observable risk-factors (no children, no partner, receiving income support payments, not working, obese, current smoker, anxiety, poor physical health, and low overall health service use) could potentially reduce overall non-participation in screening by 74%.
  
  
  CONCLUSIONS
  This study illustrates a valuable method for investigating the personal determinants of health service use by combining representative survey data with linked administrative records. Reliable knowledge about the characteristics that predict uptake of cervical cancer screening services will inform targeted health promotion efforts.
authors.affiliation: Psychiatric Epidemiology and Social Issues Unit, Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Building 63 Eggleston Road, Acton, ACT, Australia. Sarah.Olesen@anu.edu.au
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Olesen
authors.forename: Peter
authors.initials: P
authors.lastname: Butterworth
authors.forename: Patricia
authors.initials: P
authors.lastname: Jacomb
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Tait
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse; D000367:Age Factors; D000368:Aged; D020958:Australian Capital Territory / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000523:psychology* / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009313:National Health Programs; D009517:New South Wales / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000523:psychology* / Q000706:statistics & numerical data