Mamon J A, Shediac M C, Crosby C B, Sanders B, Matanoski G M, Celentano D D
Health Policy and Management, Health Services Research and Development Center, Johns Hopkins University, Baltimore, Maryland 21205.
Prev Med. 1990 Jul;19(4):363-76. doi: 10.1016/0091-7435(90)90036-j.
This study investigated the relationships between health care utilization, knowledge, attitudes, sociodemographic characteristics, and adequacy of cervical cancer screening among a random sample of women from inner-city neighborhoods with high rates of cervical cancer mortality. Of 416 women interviewed, 30.3% reported hysterectomies; women with intact uteri (N = 290) are the subjects of this analysis. Over two-fifths (44.1%) reported not receiving adequate Pap testing during the previous 4 years. Compared with adequately screened women, they were more likely to be 45 years or older, have no medical insurance, report never having been to an obstetrician-gynecologist, recall never having been told by a medical provider how often to get a Pap test, rely on providers for adequate screening, report not seeking care as often as they think they should, have less knowledge of risk factors for cervical cancer, and believe that women should get Pap tests less than yearly. Separate models for younger and older women showed that these factors vary by age, demonstrating the need for interventions to be sensitive to age subgroups. These findings suggest that cancer control activities should place more emphasis on motivating women as well as influencing the health care delivery system to maximize reductions in cervical cancer.
本研究调查了宫颈癌死亡率较高的市中心社区随机抽取的女性样本中，医疗保健利用情况、知识、态度、社会人口学特征与宫颈癌筛查充分性之间的关系。在接受访谈的416名女性中，30.3%报告接受了子宫切除术；子宫完整的女性（N = 290）是本分析的对象。超过五分之二（44.1%）的女性报告在过去4年中未接受充分的巴氏试验。与筛查充分的女性相比，她们更有可能年龄在45岁及以上、没有医疗保险、报告从未看过妇产科医生、回忆从未有医疗服务提供者告知她们多久进行一次巴氏试验、依赖医疗服务提供者进行充分筛查、报告没有像她们认为应该的那样经常寻求医疗护理、对宫颈癌危险因素的了解较少，并且认为女性应该每年进行少于一次的巴氏试验。针对年轻女性和年长女性的单独模型显示，这些因素因年龄而异，这表明干预措施需要对年龄亚组敏感。这些发现表明，癌症控制活动应更加注重激励女性以及影响医疗保健提供系统，以最大限度地降低宫颈癌发病率。
