title: Changes to cervical cancer prevention guidelines: effects on screening among U.S. women ages 15-29.
abstract: OBJECTIVE
  A shift toward later initiation of cervical cancer screening for women began in 2002. We generated national estimates of screening prevalence rates and guideline-consistent screening among U.S. women ages 15-29 before and after the first evidence-based recommendations for reduced cervical cancer screening.
  
  
  METHODS
  We used National Survey of Family Growth data to compare self-reported cervical cancer screening in 2002 and 2006-2008, stratified by age (15-17, 18-20, 21-29) and sexual activity. We also assessed receipt of guideline-consistent screening by selected demographic variables.
  
  
  RESULTS
  Among females ages 15-17, the proportion screened decreased from 23% to 12%, and screening was significantly more likely to be guideline-consistent. Among females ages 18-20, 24% were screened too early in 2006-2008, but among those not yet sexually active, screening declined to 8%, appropriately reflecting new guidelines. In multivariable analysis, private health insurance, pregnancy, and hormonal contraceptive use were associated with guideline-consistent screening among sexually-active women.
  
  
  CONCLUSIONS
  Fewer adolescents were being screened before sexual initiation, representing newer guidelines. However, sexually-active young adult women also should have later screening initiation. Factors related to health care access contribute to receipt of screening. Monitoring and provider education are needed to improve guideline-consistent screening, as newer guidelines call for less screening.
authors.affiliation: University of California, San Francisco, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA 94118, USA. HendersonJ@obgyn.ucsf.edu
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
authors.forename: Gladys
authors.initials: G
authors.lastname: Martinez
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D019538:Health Care Surveys; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D008403:Mass Screening / Q000592:standards* / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data; D055815:Young Adult