title: Factors associated with cervical cancer screening in a safety net population.
abstract: OBJECTIVE
  To identify factors associated with Papanicolaou-smear (Pap-smear) cervical cancer screening rates in a safety net population.
  
  
  METHODS
  From January 2012 to May 2013, the use of Pap-smear was determined for all patients seen at the breast clinic in a safety net hospital. Health literacy assessment was performed using the validated Newest Vital Sign. The records of patients were reviewed to determine if they had undergone Pap-smears for cervical cancer screening. Sociodemographic information was collected included age, education, monthly income, race/ethnicity, employment, insurance status, and primary care provider of the patient. Logistic regression analysis was then performed to determine factors associated with utilization of Pap-smears. Crude and adjusted odds ratios derived from multivariate logistic regression models were calculated as well as the associated 95%CIs andP-values.
  
  
  RESULTS
  Overall, 39% had Pap-smears in the prior 15 mo, 1377 consecutive women were seen during the study period and their records were reviewed. Significantly more patients with adequate health literacy underwent Pap-smears as compared to those with limited health literacy (59%vs34%,P< 0.0001). In multivariate analysis, patients with adequate health literacy, younger patients, and those with later age of first live birth were more likely to undergo Pap-smears. Patients whose primary care providers were gynecologists were also significantly more likely to have Pap-smears compared to other specialties (P< 0.0001). Patients younger than 21 years or older than 65 years underwent screening less frequently (11% and 11%, respectively) than those 21-64 years (41%,P< 0.0001). Race, ethnicity, language, and insurance status were not associated with Pap-smear screening rates.
  
  
  CONCLUSIONS
  Patient health literacy and primary care physician were associated with Pap-smear utilization. Development of interventions to target low health literacy populations could improve cervical cancer screening.
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Meredith A
authors: MA
authors: Heberer
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Ian K
authors: IK
authors: Komenaka
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Jesse N
authors: JN
authors: Nodora
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Chiu-Hsieh
authors: CH
authors: Hsu
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Sonal G
authors: SG
authors: Gandhi
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Lauren E
authors: LE
authors: Welch
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Marcia E
authors: ME
authors: Bouton
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Paula
authors: P
authors: Aristizabal
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Barry D
authors: BD
authors: Weiss
authors: Meredith A Heberer, Ian K Komenaka, Lauren E Welch, Marcia E Bouton, Maricopa Medical Center, Phoenix, AZ 85008, United States.
authors: Maria Elena
authors: ME
authors: Martinez
keywords: Cervical cancer; Health literacy; Pap-smear; Prevention; Screening