Cancer Causes & Control

, Volume 29, Issue 11, pp 1105–1113 | Cite as

Chronic comorbidities and cervical cancer screening and adherence among US-born and foreign-born women

  • Leslie E. CofieEmail author
  • Jacqueline M. Hirth
  • Rebeca Wong
Original paper



Whereas chronic conditions and foreign-birth have an inverse relationship with cervical cancer screening, the combined effect of these factors on screening is unknown. This study examined the associations between chronic comorbidities and Pap screening recommendations and adherence, and whether these associations vary between foreign- and US-born women.


In 2017, data from 2013 and 2015 National Health Interview Survey on women aged 21–65 years (N = 20,080) were analyzed. Bivariate associations between chronic comorbidities (hypertension, diabetes, and obesity) and cervical cancer screening recommendation and adherence (screened in the last 3 years) were examined using Chi-square analysis. Multivariate binary logistic regression was used to examine the association between foreign-born status and participant Pap test adherence, adjusting for physician Pap test recommendation and chronic comorbidities.


Obesity, hypertension, and diabetes were positively associated with Pap screening recommendation. Hypertension and diabetes were negatively associated with screening adherence. Pap screening recommendation (60% vs. 57%, p < 0.05) and adherence (85% vs. 78%, p < 0.001) were higher among foreign-born than US-born women. After adjusting for chronic conditions, foreign-born women had significantly lower odds of receiving Pap tests compared with US-born women (OR 0.8, 95% CI 0.6–0.9). In stratified analysis, only obesity was associated with Pap testing among US-born and foreign-born women. Among foreign-born women, the association between obesity and Pap testing was attenuated after controlling for years lived in the US and citizenship.


Public health intervention efforts must improve regular access to preventive care and encourage Pap screening among women diagnosed with chronic conditions. Future research should further identify additional factors driving the cervical cancer screening practices of both US- and foreign-born women with and without chronic conditions.


Cervical cancer screening Obesity Diabetes Hypertension Foreign-born women 



This research was supported by an institutional training grant (National Research Service Award T32HD055163, Berenson, PI) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at NIH, and from the Office of Research on Women’s Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Leslie E. Cofie
    • 1
    • 2
    • 3
    Email author
  • Jacqueline M. Hirth
    • 1
    • 2
  • Rebeca Wong
    • 2
    • 4
  1. 1.Department of Obstetrics and GynecologyUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Center for Interdisciplinary Research in Women’s HealthUniversity of Texas Medical BranchGalvestonUSA
  3. 3.Department of Health Education and PromotionEast Carolina UniversityGreenvilleUSA
  4. 4.Preventive Medicine and Community HealthUniversity of Texas Medical BranchGalvestonUSA

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