Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
J Cancer Educ. 2023 Dec;38(6):1845-1852. doi: 10.1007/s13187-023-02340-6. Epub 2023 Jul 13.
Given ongoing gaps in adherence to Pap testing recommendations, this study examined: 1) adherence to Pap test screening recommendations; and 2) barriers to Pap test screening among those who were nonadherent, using constructs from the Andersen model. We analyzed Spring 2022 survey data among 541 US young adults who reported having a cervix (n = 541; mean age = 27.73, 42.1% heterosexual, 57.9% sexual minority, 86.0% woman, 3.7% transgender man, 68.2% White, 31.8% racial/ethnic minority). Multivariable logistic regression examined sociodemographic correlates of nonadherence to Pap testing recommendations (i.e., no Pap testing in the past 3 years). Among those who were nonadherent, barriers to Pap testing were assessed. 68.6% (n = 371) were defined as adherent and 31.4% (n = 170) nonadherent. Multivariable regression findings indicated significant differences by race/ethnicity such that Asians (vs. Whites) were more likely to be nonadherent (OR = 2.41, CI = 1.11, 3.70, p = .021); no other differences in relation to race/ethnicity or sexual/gender identity were found. The most commonly reported barriers were: "I have not gotten around to it" (42.9%), "getting a Pap test is just not a priority for me" (30.6%), "fear/worry" (28.2%), "dislike/don't like having procedures done" (27.1%), "my healthcare provider has never mentioned it" (21.2%), "haven't had sex so I don't consider myself at high risk" (20.6%), and "COVID-19 pandemic prevented me" (15.3%). Pap testing is underutilized among young adults in the US, particularly Asians. Multilevel interventions must address barriers within the healthcare system (e.g., provider recommendation), external environment (e.g., societal factors), and individual realm (e.g., perceptions).
鉴于目前人们对巴氏涂片检查建议的依从性存在差距，本研究利用安德森模型中的概念，考察了：1）巴氏涂片检查筛查建议的依从性；以及 2）不依从巴氏涂片检查筛查的人群中存在的障碍。我们分析了 2022 年春季在 541 名有宫颈的美国年轻成年人中进行的调查数据（n=541；平均年龄 27.73 岁，42.1%为异性恋，57.9%为性少数群体，86.0%为女性，3.7%为跨性别男性，68.2%为白人，31.8%为种族/族裔少数群体）。多变量逻辑回归分析了社会人口统计学因素与不遵守巴氏涂片检查建议（即，在过去 3 年内未进行巴氏涂片检查）之间的相关性。在不依从的人群中，评估了巴氏涂片检查的障碍。68.6%（n=371）被定义为依从，31.4%（n=170）为不依从。多变量回归分析结果表明，种族/族裔差异显著，亚洲人（与白人相比）更有可能不依从（OR=2.41，CI=1.11，3.70，p=0.021）；在种族/族裔或性/性别认同方面没有发现其他差异。报告的最常见障碍包括：“我还没有来得及做”（42.9%），“进行巴氏涂片检查对我来说不是优先事项”（30.6%），“担心/害怕”（28.2%），“不喜欢/不喜欢接受治疗”（27.1%），“我的医疗保健提供者从未提及过”（21.2%），“没有发生性行为，所以我不认为自己处于高风险”（20.6%），以及“COVID-19 大流行阻止了我”（15.3%）。在美国，年轻成年人中巴氏涂片检查的使用率较低，尤其是亚洲人。多层次干预措施必须解决医疗保健系统（例如，提供者建议）、外部环境（例如，社会因素）和个人领域（例如，观念）中的障碍。
