Cervical cancer prevention and control practices, knowledge, and preferences among women living in the Southeastern United States

Background Marked disparities in cervical cancer mortality exist despite widespread screening. The objective of this study is to examine the effects of access, social determinants, and women's knowledge and preferences on cervical cancer prevention and control practices.

Methods Adult women, 18-70 years old, were randomly selected for random-digit dial telephone interviews in a statewide population-based survey (n=986). Screening was measured by recent Pap tests. Vaccine acceptability was measured by either uptake or acceptability. Multivariate logistic regression models using appropriate survey design procedures in SAS 9.2 were built.

Results While most respondents (87%) reported Pap tests, more African Americans (70.3%) preferred annual Pap tests even if advised by a provider about longer intervals compared to white women (55.4%, p<.0001). Nearly half of the African-American respondents reported provider counseling during their last Pap compared to a third of white women; however, African Americans reported lower knowledge than white women (p<.0001). A regular provider (AOR=2.819; 95% CI 1.449, 5.483) and private health insurance (AOR=2.970 CI 1.364, 6.469) were predictive of screening, controlling for race and knowledge. Twenty percent reported HPV vaccine uptake; however, 77% were willing to vaccinate. Provider counseling had an impact on Pap tests (AOR=2.007 CI 1.27, 3.19), not vaccine acceptability.

Conclusions/Discussion High acceptability for HPV vaccines was reported and the majority of participants were recently screened for cancer. However, African-American women viewed the health care system more negatively and reported more discrimination, which may contribute to a lack of trust in provider recommendations.