Social determinants of Pap smear utilization among Asian subgroups in the US

Background: While low rates of Pap smear use by U.S. Asians are well documented, previous studies suffer from non-representative samples or small sample size. Purpose: To describe Pap smear utilization rates in U.S. Asian subgroups and identify salient social determinants of Pap smear use. Method: We used 1998-2005 National Health Interview Survey (NHIS) data to examine social determinants of Pap smear use in four Asian subgroups: Chinese, Filipinos, Asian Indians, and Other Asian or Pacific Islanders (API). Outcome variables are ever had a Pap smear and had a Pap smear within the past 3 years. Results: Although rates of ever having had a Pap smear by Filipino women were consistently above 80%, rates for all other Asian subgroups were lower than 80%. Since 2003, Pap smear use increased for Filipinos, remained constant for Asian Indians, and declined for Chinese and Other API women. Determinants of Pap smear use vary by subgroup. Non-U.S. born Chinese are less likely to ever have had a Pap smear than U.S. born Chinese, though this difference is not present for Asian Indians. Having insurance increases the probability of Pap smear use among Asian Indian and Other API women, but not among Chinese and Filipino women. Conclusions: Given the differential determinants of Pap smear use among Asian subgroups, targeted strategies to increase use are needed. Especially worrisome is the recent decrease in Pap smear use by Chinese and Other API women. This decrease merits attention and thoughtful intervention based on an understanding of the social determinants.