Pap smear receipt among Vietnamese immigrants: The importance of health care factors

Introduction: The cervical cancer incidence rates among Vietnamese and white women in California during 2000-2002 were 14.0 and 7.3 per 100,000, respectively. Further, only 70% of Vietnamese women who participated in the 2003 California Health Interview Survey reported a recent Pap smear, compared to 84% of white women. Methods: We conducted a community-based survey of Vietnamese women living in metropolitan Seattle. Bilingual survey workers conducted interviews in participants' homes. The questionnaire included Pap testing history, demographic, health care, and knowledge/belief items. Our survey response rate was 72% and the study sample included 1,532 women. Results: Eighty-one percent of the respondents had been screened for cervical cancer in the previous three years. In a multivariable analysis, recent Pap testing was strongly associated (p<0.001) with having a regular doctor, having received a physical in the last year, a previous physician recommendation for testing, and having requested testing. However, women whose doctor was a Vietnamese man were no more likely to have received a recent Pap smear than those with no regular doctor. Discussion: Our findings indicate that cervical cancer disparities between Vietnamese and other groups may be decreasing. Efforts to further increase Pap smear receipt in Vietnamese communities should enable women without a source of health care to find a regular provider. Additionally, intervention programs should improve patient-provider communication by encouraging health care providers (especially male Vietnamese physicians serving women living in ethnic enclaves) to recommend Pap testing, as well as by empowering women to ask for testing.