The determinants of cervical cancer screening uptake in women with obesity: application of the Andersen’s behavioral model to the CONSTANCES survey
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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.
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.
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.
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.
KeywordsCervical cancer screening Obesity Healthcare use Health status Competitive care Andersen’s model
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.
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.
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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