title: Demographic factors associated with overuse of Pap testing.
abstract: BACKGROUND
  Since 2003, U.S. Preventive Services Task Force guidelines recommend against Pap testing for women without a cervix following a hysterectomy and those aged >65 years. Few population-based studies have investigated factors associated with overuse of Pap testing in the U.S.
  
  
  OBJECTIVE
  To evaluate patient characteristics associated with overuse of Pap testing.
  
  
  METHODS
  A cross-sectional study was conducted using data from the 2010 National Health Interview Survey (NHIS) for women aged ≥30 years. NHIS is a nationally representative survey that employs a random, stratified, multi-stage cluster sampling design. In 2010, the NHIS administered a Cancer Control Supplement with questions on cervical cancer screening and hysterectomy status. Conducted in 2011-2013, all analyses account for the stratification and clustering of data within the complex NHIS survey design. Multivariate logistic regression models were used in all analyses.
  
  
  RESULTS
  Among women who have undergone a hysterectomy, younger age, Hispanic and black race/ethnicity, exceeding 400% of poverty level, and private health insurance coverage were significantly associated with receipt of a recent Pap test since hysterectomy. Among women aged >65 years, non-Hispanic white ethnicity, higher education level, exceeding 400% of poverty level, and no hysterectomy were significantly associated with receipt of a recent Pap test.
  
  
  CONCLUSIONS
  Targeted efforts to reduce unnecessary testing among older women and women with a hysterectomy in compliance with clinical recommendations for cervical cancer prevention are needed. Specific attention should be paid to privately insured women with incomes above 400% of the federal poverty level.
authors.affiliation: Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, College of Nursing, Salt Lake City, Utah; NIH, National Cancer Institute, Health Services and Economics Branch, Rockville. Electronic address: deanna.kepka@hci.utah.edu.
authors.forename: Deanna
authors.initials: D
authors.lastname: Kepka
authors.affiliation: NIH, National Cancer Institute, Health Services and Economics Branch, Rockville.
authors.forename: Nancy
authors.initials: N
authors.lastname: Breen
authors.affiliation: CDC, Cancer Surveillance Branch.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: King
authors.affiliation: NIH, Tobacco Regulatory Science Program, Office of Disease Prevention, Bethesda, Maryland.
authors.forename: Helen I
authors.initials: HI
authors.lastname: Meissner
authors.affiliation: CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Roland
authors.affiliation: CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia.
authors.forename: Vicki B
authors.initials: VB
authors.lastname: Benard
authors.affiliation: CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia.
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data