title: Sociodemographic factors associated with pap test adherence and cervical dysplasia in surgically sterilized women.
abstract: BACKGROUND
  Routine dysplasia screening decreases the rates of cervical cancer. Since many women seek gynecological care to secure contraception, it was hypothesized that sterilized women will be less likely to undergo routine cervical cancer screening. Prior studies tried to evaluate this relationship, but results were conflicting. The study sought to further explore the sociodemographic and behavioral risk factors that might predispose sterilized women to be screening non-adherent and more likely to have cervical dysplasia.
  
  
  METHODS
  Secondary analysis of women (n=1688) enrolled in a cross-sectional study in North America and divided into screening (n=925) and diagnostic (n=763) groups was performed. Information about sociodemographic and behavioral risk factors, surgical sterilization and date of last Pap test were obtained from questionnaires. Cervical histology was obtained from pathology records. Univariable analyses identified differences in risk factors between groups. Multivariable logistic regression models were constructed to evaluate Pap adherence and cervical dysplasia.
  
  
  RESULTS
  Sterilized women were 39% more likely to be screening non-adherent (p≤0.05) especially if divorced, separated or widowed (OR=1.62), Hispanic (OR=1.57) and with a higher number of vaginal births (OR=2.00). Education was an effect measure modifier, significantly associated with non-adherence (OR=1.60). The association between sterilization and non-adherence remained significant when adjusted for confounders (AOR=1.47). Sterilization was associated with an 80% increased odds of cervical dysplasia in women over 40.
  
  
  CONCLUSIONS
  Sterilized women with certain sociodemographic factors are more likely to be non-adherent with Pap screening and more prone to dysplasia. These findings may assist practitioners in counseling at-risk patients.
authors.affiliation: Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Whitehouse
authors.affiliation: Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA ; Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Montealegre
authors.affiliation: Department of Obstetrics and Gynecology School of Medicine, Philadelphia, Pennsylvania ; Center for Women's Health Research Drexel University, School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Follen
authors.affiliation: Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA ; Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Scheurer
authors.affiliation: Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, Texas, USA ; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Aagaard
keywords: Cervical dysplasia screening; Pap test cervical dysplasia; Sterilization; Tubal ligation