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Utilization of papanicolaou smears by South Asian women living in the United States

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Abstract

OBJECTIVES: Papanicolaou (Pap) smears are an underutilized screening modality among racial and ethnic minorities. However, no data exist on Pap smear utilization among South Asians, a rapidly growing population in the United States, whose country of origin includes India, Pakistan, Bangladesh, and Sri Lanka. We determined rates and identified variables associated with Pap smear receipt by South Asians.

DESIGN: A self-administered survey instrument was mailed to a random sample of South Asians nationwide over a 3-month time period. South Asian households were identified by surnames that were used to search white pages in telephone directories, Department of Motor Vehicle records, and voter registries. Questions regarding Pap smear receipt were taken from the 1999 National Health Interview Survey. Socio-demographic information and measures of acculturation were obtained.

PARTICIPANTS: A nationwide nonprobability sample of South Asian women.

INTERVENTION: Cross-sectional observational study.

MEASUREMENTS AND MAIN RESULTS: The overall response rate was 42%. In this sample, South Asians belonged to a high socioeconomic strata (SES), with 45% having a household income of >$80,000 and 42% having a master’s degree. Three quarters of the respondents (73%) reported having a Pap smear in the last 3 years. In multivariate logistic regression analysis, South Asian women had greater odds of having had a Pap smear if they were married (P<.001), more educated (P=.004), had a usual source of care (P=.002), and were more acculturated (P=.004).

CONCLUSIONS: Despite the high SES of South Asian women, their rates of Pap smear receipt were lower than national recommendations. Marital status, socioeconomic status, and acculturation are all associated with Pap smear receipt. South Asian communities should be targeted for outreach to promote Pap smear utilization.

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References

  1. Eddy DM. Screening for cervical cancer. Ann Intern Med. 1990;113:214–26.

    PubMed  CAS  Google Scholar 

  2. Harlan LC, Bernstein AB, Kessler LG. Cervical cancer screening: who is not screened and why? Am J Public Health. 1991;81:885–90.

    PubMed  CAS  Google Scholar 

  3. Norman SA, Talbott EO, Kuller LH, Krampe BR, Stolley PD. Demographic, psychosocial, and medical correlates of Pap testing: a literature review. Am J Prev Med. 1991;7:219–26.

    PubMed  CAS  Google Scholar 

  4. Martin LM, Calle EE, Wingo PA, Heath CW Jr. Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med. 1996;12:82–90.

    PubMed  CAS  Google Scholar 

  5. Schairer C, Brinton LA, Devesa SS, Ziegler RG, Fraumeni JF Jr. Racial differences in the risk of invasive squamous-cell cervical cancer. Cancer Causes Control. 1991;2:283–90.

    Article  PubMed  CAS  Google Scholar 

  6. McDonald CJ. Cancer statistics, 1999: challenges in minority populations. CA Cancer J Clin. 1999;49:6–7.

    PubMed  CAS  Google Scholar 

  7. Calle EE, Flanders WD, Thun MJ, Martin LM. Demographic predictors of mammography and Pap smear screening in US women. Am J Public Health. 1993;83:53–60.

    PubMed  CAS  Google Scholar 

  8. Hernandez-Hernandez DM, Garcia-Elizondo MR, Ornelas-Bernal L, Hernandez-Aleman F, Gonzalez-Lira G, Martinez-Garcia MC. Factors associated with non-use of Pap test. A population survey. Arch Med Res. 1998;29:263–70.

    PubMed  CAS  Google Scholar 

  9. Wismer BA, Moskowitz JM, Chen AM, et al. Rates and independent correlates of Pap smear testing among Korean-American women. Am J Public Health. 1998;88:656–60.

    PubMed  CAS  Google Scholar 

  10. Yi JK. Factors associated with cervical cancer screening behavior among Vietnamese women. J Community Health. 1994;19:189–200.

    Article  PubMed  CAS  Google Scholar 

  11. Kelly AW, Fores Chacori M, Wollan PC, et al. A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community. Mayo Clin Proc. 1996;71:437–44.

    PubMed  CAS  Google Scholar 

  12. 2000 Census. U.S. Bureau of the Census. March 2000 Current Population Survey.

  13. Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ. 2001;79:954–62.

    PubMed  CAS  Google Scholar 

  14. Prabhakar AK. Cervical cancer in India-strategy for control. Indian J Cancer. 1992;29:104–13.

    PubMed  CAS  Google Scholar 

  15. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.

    Article  PubMed  CAS  Google Scholar 

  16. Curtis HM, Leck I, Bamford FN. Incidence of childhood tuberculosis after neonatal BCG vaccination. Lancet. 1984;1:145–8.

    Article  PubMed  CAS  Google Scholar 

  17. Barker RM, Baker MR. Incidence of cancer in Bradford Asians. J Epidemiol Community Health. 1990;44:125–9.

    Article  PubMed  CAS  Google Scholar 

  18. National Center for Health Statistics. The National Health Interview Survey. Hyattsville, Md: Department of Health and Human Services; 1999.

    Google Scholar 

  19. Suinn RM. Measurement of acculturation of Asian Americans. Asian Am Pac Isl J Health. 1998;6:7–12.

    PubMed  Google Scholar 

  20. Gordon Willis KAR, Baldwin AK, Yeh W. Cognitive research on sensitive survey questions. In: Working Papers Series of the National Center for Health Statistics. Hyattsville, Md: Department of Health and Human Services; 1998;Number 24.

    Google Scholar 

  21. Design and estimation for the National Health Interview Survey, 1995–2004. Vital Health Stat 2. 2000:1–31.

  22. Andersen R, Harada N, Chiu V, Makinodan T. Application of the behavioral model to health studies of Asian and Pacific Islander Americans. Asian Am Pac Isl J Health. 1995;3:128–41.

    PubMed  Google Scholar 

  23. Bernstein AB, Thompson GB, Harlan LC. Differences in rates of cancer screening by usual source of medical care. Data from the 1987 National Health Interview Survey. Med Care. 1991;29:196–209.

    Article  PubMed  CAS  Google Scholar 

  24. U.S. Preventive Services Task Force Guide to Clinical Preventive Services (2nd ed). Washington DC: U.S. Department of Health and Human Services; 1990.

  25. Committee on Practice B-G. ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas, number 05, May 2002. Obstet Gynecol. 2002;99:855–67.

    Google Scholar 

  26. Zoorob R, Anderson R, Cefalu C, Sidani M. Cancer screening guidelines. Am Fam Physician. 2001;63:1101–12.

    PubMed  CAS  Google Scholar 

  27. Carlisle DM, Leake BD, Brook RH, Shapiro MF. The effect of race and ethnicity on the use of selected health care procedures: a comparison of south central Los Angeles and the remainder of Los Angeles county. J Health Care Poor Underserved. 1996;7:308–22.

    PubMed  CAS  Google Scholar 

  28. 1990 Census. Washington, DC: US Bureau of the Census, Department of Commerce; 1991.

  29. Farley R. The new census question about ancestry: what did it tell us? Demography. 1991;28:411–29.

    Article  PubMed  CAS  Google Scholar 

  30. Fein DJ. Racial and ethnic differences in U.S. Census omission rates. Demography. 1990;27:285–302.

    Article  PubMed  CAS  Google Scholar 

  31. Kester AD, Buntinx F. Meta-analysis of ROC curves. Med Decis Making. 2000;20:430–9.

    Article  PubMed  CAS  Google Scholar 

  32. Hooper LM, Bennett CE. The Asian and Pacific Islander Populations in the United States: March 1997 (Update). In: Current Population Reports. Washington, DC: U.S. Department of Commerce Economics and Statistic Administration; 1997.

    Google Scholar 

  33. Schmidley D, Alvarado HA. Profile of the foreign-born population in the United States: March 2000 (update). Curr Popul Rep Popul Charact. 2000:1.

  34. Healthy People 2000 A Final Review. In: National Center for Health Statistics. Hyattsville, Md: Public Health Service; 2000.

  35. Healthy People 2010: Understanding and Improving Health. Washington, DC: U.S. Department of Health and Human Services. 2000.

  36. Jenkins CN, Le T, McPhee SJ, Stewart S, Ha NT. Health care access and preventive care among Vietnamese immigrants: do traditional beliefs and practices pose barriers? Soc Sci Med. 1996;43:1049–56.

    Article  PubMed  CAS  Google Scholar 

  37. Carcillo JA, Diegel JE, Bartman BA, Guyer FR, Kramer SH. Improved maternal and child health care access in a rural community. J Health Care Poor Underserved. 1995;6:23–40.

    PubMed  CAS  Google Scholar 

  38. Prabhakar AK, Menon GR. Age at marriage and cervical cancer incidence. Indian J Cancer. 1995;32:63–8.

    PubMed  CAS  Google Scholar 

  39. Lantz PM, Weigers ME, House JS. Education and income differentials in breast and cervical cancer screening. Policy implications for rural women. Med Care. 1997;35:219–36.

    Article  PubMed  CAS  Google Scholar 

  40. Yi JK. Acculturation, access to care and use preventive health services by Vietnamese women. Asian Am Pac Isl J Health. 1995;3:30–41.

    PubMed  Google Scholar 

  41. Mishra SI, Luce-Aoelua PH, Hubbell FA. Predictors of Papanicolaou smear use among American Samoan women. J Gen Intern Med. 2001;16:320–4.

    Article  PubMed  CAS  Google Scholar 

  42. Solis JM, Marks G, Garcia M, Shelton D. Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982–4. Am J Public Health. 1990;80(suppl):11–9.

    PubMed  Google Scholar 

  43. Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work. 1998;23:136–45.

    PubMed  CAS  Google Scholar 

  44. Mandelblatt J, Gopaul I, Wistreich M. Gynecological care of elderly women. Another look at Papanicolaou smear testing. JAMA. 1986;256:367–71.

    Article  PubMed  CAS  Google Scholar 

  45. Gasquet I, Falissard B, Ravaud P. Impact of reminders and method of questionnaire distribution on patient response to mail-back satisfaction survey. J Clin Epidemiol. 2001;54:1174–80.

    Article  PubMed  CAS  Google Scholar 

  46. Hiatt RA, Perez-Stable EJ, Quesenberry C Jr, Sabogal F, Otero-Sabogal R, McPhee SJ. Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in northern California. Prev Med. 1995;24:278–85.

    Article  PubMed  CAS  Google Scholar 

  47. Gordon NP, Hiatt RA, Lampert DI. Concordance of self-reported data and medical record aduit for six cancer screening procedures. J Natl Cancer Inst. 1993;85:566–70.

    Article  PubMed  CAS  Google Scholar 

  48. Department of Health and Human Services Asian American and Pacific Islander Initiative Framework. Asian Am Pac Isl J Health. 1997;5:181–8.

    Google Scholar 

  49. Tatum C, Wilson A, Dignan M, Paskett ED, Velez R. Development and implementation of outreach strategies for breast and cervical cancer prevention among African American women. FoCaS Project. Forsyth County Cancer Screening. J Cancer Educ. 1997;12:43–50.

    PubMed  CAS  Google Scholar 

  50. Fernandez ME, DeBor M, Candreia MJ, Wagner AK, Stewart KR. Evaluation of ENCOREplus. A community-based breast and cervical cancer screening program. Am J Prev Med. 1999;16:35–49.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. the Section of General Internal Medicine and Outcomes Research, University of Chicago, Chicago, Ill

    Saima Chaudhry MD, MSHS

  2. UCLA Center for Health Sciences and the School of Medicine and Public Health, Los Angeles

    Arlene Fink PhD & Robert Brook MD,ScD

  3. RAND, Santa Monica, Calif

    Arlene Fink PhD & Robert Brook MD,ScD

  4. the Department of Family Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, Calif

    Lillian Gelberg MD, MSPH

Authors
  1. Saima Chaudhry MD, MSHS
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  2. Arlene Fink PhD
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  3. Lillian Gelberg MD, MSPH
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  4. Robert Brook MD,ScD
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Corresponding author

Correspondence to Saima Chaudhry MD, MSHS.

Additional information

This study was supported in part by grant 1 R01 HS10597-01A2 from the Agency for Health Care Quality and Research, the Robert Wood Johnson Foundation, and the Culpepper Foundation. The views expressed are those of the authors and do not necessarily reflect those of the Robert Wood Johnson Foundation.

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Chaudhry, S., Fink, A., Gelberg, L. et al. Utilization of papanicolaou smears by South Asian women living in the United States. J GEN INTERN MED 18, 377–384 (2003). https://doi.org/10.1046/j.1525-1497.2003.20427.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.20427.x

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