title: Sociodemographic inequalities in sexual activity and cervical cancer screening: implications for the success of human papillomavirus vaccination.
abstract: BACKGROUND
  Papanicolaou smear screening has significantly reduced cervical cancer morbidity and mortality. However, inequalities still persist across different socioeconomic status (SES) groups. These inequalities have been associated with differential participation in screening. However, even with equal participation to screening, some women may still have greater risk of cervical cancer because of sexual behavior. We aim to identify the sociodemographic characteristics of women who reported greater sexual activity and/or screening underuse.
  
  
  METHODS
  We used data from (i) the Canadian Community Health Survey-2005, a population-based survey of 130,000 Canadians, and (ii) a multicenter study including 952 women screened for cervical cancer.
  
  
  RESULTS
  Aboriginals and women with lower SES reported greater sexual activity and lower screening participation, which may produce synergetic effects toward higher cervical cancer risk. Women who did not complete high school and aboriginals were, respectively, 3.6 and 2.5 times more likely to report sexual debut before 15 years old compared with women with university degree and Caucasians. Women who did not complete high school were 2.2 times more likely to have never been screened compared with women with university degree. East and South Asian women were, respectively, 4.3 and 3.1 times more likely to have never been screened than Canadian-born women but reported lower levels of sexual activity and were adherent to screening guidelines when screened at least once.
  
  
  CONCLUSIONS
  The success of human papillomavirus vaccination at reducing cervical cancer and inequalities will depend on achieving high coverage among high-risk subpopulations.
  
  
  CONCLUSIONS
  These groups must be monitored closely, and if need be, targeted for additional interventions.
authors.affiliation: Centre de recherche du CHU de Québec Hôpital Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec G1S 4L8, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Drolet
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Boily
authors.forename: Christina
authors.initials: C
authors.lastname: Greenaway
authors.forename: Shelley L
authors.initials: SL
authors.lastname: Deeks
authors.forename: Caty
authors.initials: C
authors.lastname: Blanchette
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Laprise
authors.forename: Marc
authors.initials: M
authors.lastname: Brisson
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012725:Sexual Behavior; D012923:Social Class; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears
chemical_list: D053918:Papillomavirus Vaccines