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The determinants of cervical cancer screening uptake in women with obesity: application of the Andersen’s behavioral model to the CONSTANCES survey

  • Jeanna-eve FranckEmail author
  • Virginie Ringa
  • Mireille Cœuret-Pellicer
  • Pierre Chauvin
  • Gwenn Menvielle
Original Paper
  • 9 Downloads

Abstract

Purpose

Despite their higher risk for and mortality from cervical cancer, evidence indicates low rates of cervical cancer screening (CCS) among women with obesity. The literature on the specific factors related to CCS nonadherence in this population is limited.

Methods

We examined the data on 2,934 women with obesity included in the CONSTANCES survey from 2012 to 2015. Using the Andersen’s behavioral model, we studied the relationships between the socioeconomic, sociodemographic, health, health personal behaviors, and healthcare use-related factors with CCS nonadherence. The analysis was performed using structural equation models.

Results

Regular follow-up by a gynecologist, good quality of primary care follow-up, and comorbidities were negatively associated with CCS nonadherence. Limited literacy, older age, being single, living without children, and financial strain were positively associated with CCS nonadherence. Our results do not point to competitive care, since women with comorbidities had better CCS behaviors, which were explained by a good quality of primary care follow-up.

Conclusion

Our study identified the factors that explain CCS nonadherence among women with obesity and clarified the effects of health status and healthcare use on screening. Further efforts should be undertaken to reduce the obstacles to CCS by improving care among women with obesity.

Keywords

Cervical cancer screening Obesity Healthcare use Health status Competitive care Andersen’s model 

Notes

Acknowledgments

We thank the Inserm-Versailles Saint Quentin en Yvelines University “Epidemiological Population-Based Cohorts Unit” (UMS 11) who designed and is in charge of the CONSTANCES Cohort Study. They also thank the “Caisse nationale d’assurance maladie des travailleurs salaries” (CNAMTS) and the “Centres d’examens de santé” of the French Social Security which are collecting a large part of the data, as well as the “Caisse nationale d’assurance vieillesse”, ClinSearch, Asqualab and Eurocell in charge of the data quality control.

Author contributions

GM and JF designed the study. JF ran the analyses and wrote the paper. JF and MP prepared the dataset. All authors discussed the results and their interpretation, participated to the writing of the paper and approved the final version of the manuscript.

Funding

This work was supported by a Grant from the French Agency on Cancer (INCa, Grant Number 2014-1-PL SHS-05); the CONSTANCES cohort benefits from a Grant from ANR (Grant Number ANR-11-INBS-0002); CONSTANCES is also partly funded by MSD, AstraZeneca and Lundbeck.

Compliance with ethical standards

Conflict of interest

The authors do not have competing interests to declare.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Social Epidemiology, Institut Pierre Louis D’Epidémiologie Et de Santé Publique IPLESPSorbonne Université, INSERMParisFrance
  2. 2.INSERM, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, CESPVillejuifFrance
  3. 3.Population-Based Epidemiologic Cohorts UnitINSERM, UMS 011VillejuifFrance
  4. 4.INSERM IPLESP – ERESParisFrance

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