title: Cervical cytology screening among low-income, minority adolescents in New York City following the 2009 ACOG guidelines.
abstract: OBJECTIVE
  In December 2009, the American College of Obstetricians and Gynecologists recommended that cervical cancer screening begin at age 21 for young women. In this study, we examine receipt of first lifetime Papanicolaou (Pap) test and predictors of over-screening among adolescents within a large urban ambulatory care network.
  
  
  METHODS
  We compared the proportion of first lifetime Pap test of adolescents aged 13-20years between June 2007 - November 2009 (n=7700) and December 2009-June 2012 (n=9637) using electronic health records. We employed multivariable regression models to identify demographic and health care factors associated with receiving a first lifetime Pap test at age <21years in the post-guideline period (over-screening).
  
  
  RESULTS
  The proportion of Pap tests declined from 19.3% to 4.2% (p<0.001) between the two periods. Multivariable logistic regression results showed receiving care from gynecologic/obstetric/family planning clinics compared to pediatric clinics, having more clinic encounters, and older age were associated with over-screening in the post-guideline period.
  
  
  CONCLUSIONS
  We found that guideline adherence differed by clinic type, insurance status, and health care encounters. In the quickly evolving field of cervical cancer control, it is important to monitor practice trends as they relate to shifts in population-based guidelines, especially in high-risk populations.
authors.affiliation: Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY 10032, USA. Electronic address: jt2140@columbia.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tsui
authors.affiliation: Columbia University Medical Center, Division of Child and Adolescent Health, 622 West 168th St., New York, NY 10032, USA.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Hofstetter
authors.affiliation: Columbia University Medical Center, Division of Child and Adolescent Health, 622 West 168th St., New York, NY 10032, USA; Columbia University, Mailman School of Public Health, Department of Population and Family Health, 722 West 168th St., New York, NY 10032, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Soren
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008913:Minority Groups / Q000706:statistics & numerical data*; D009519:New York City; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult
keywords: Cervical cancer; Guideline adherence; Papanicolaou test