206955 Promoting maternal Pap testing during a child visit

Sunday, November 8, 2009

William B. Jordan, MD MPH , Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY
Laura Wyatt , Dept of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY
Shiu M. Young , Bureau of Chronic Diseases / Cancer Prevention, New York City Department of Health and Mental Hygiene, New York, NY
Elizabeth J. Garland, MD, MS , Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY
Diane McKee, MD, MS , Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY

Some groups of women in New York City lag 10-20% behind citywide Pap testing rates.


In 2008, a NYC Department of Health and Mental Hygiene pilot focused on cervical cancer screening disparities. Focus groups in 2007 with unscreened women suggested using child HPV vaccination as an opportunity to promote Pap testing with female guardians.


An online recruitment survey, completed by 184 of 3000 providers, gauged attitudes about female guardian intervention. Sixty-eight recruited primary care providers intercepted 565 female guardians during office visits of girls aged 9-17, completing cards with provider feedback and baseline female guardian Pap testing status. Providers registered, consented, and read a motivational paragraph to unscreened women. A 3-month follow-up phone survey reassessed Pap testing status among registered women.


Forty percent of the providers planned to adopt the intervention. Of 565 female guardians, 489 women (87%) were current with Pap testing. Of 76 women unscreened in the prior 3 years, 35 (46%) were reached 3 months after provider intercept. Among women who recalled the conversation, all were open to Pap test recommendation by the child's provider. Twenty women (26%) scheduled or obtained a Pap test following the provider's recommendation.


This strategy is acceptable to both providers and female guardians, and holds promise as a potentially effective way of moving unscreened women towards Pap testing. Study limitations include provider selection bias and lack of randomization to a control group, so external validity is uncertain.

Learning Objectives:
1. Assess the acceptability of primary care providers addressing female guardian Pap testing practices during a child visit; and 2. Evaluate the effectiveness of reaching out to unscreened women through their children.

Keywords: Cancer Screening, Cervical Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a family physician and preventive medicine resident pursuing my MPH. I have 3 peer-reviewed journal publications and several past poster presentations at professional conferences.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.