Reducing Pap Smears among young women in Title X Family Planning clinics

Background: In 2009, the American College of Obstetricians and Gynecologists revised recommendations for cervical cancer screening, delaying Pap Smear (PS) initiation to age 21. 285 Title X clinics in Region X (AK, ID, OR, WA) provide family planning services to 250,000 women annually and collect data at all clinic visits. Objective: Describe activities to promote awareness and adherence to recommendations in Region X and evaluate outcomes; examine temporal trends in and patient characteristics associated with PS in Region X Title X clinics. Methods: We compiled demographic and service data for all female patients under age 22 during 2008-2011 (n=305,655 patients), calculated the percentage of women receiving PS by age and year, and used multivariate analyses to assess associations between PS and client characteristics. Results: From 2008-2011, the percentage of women receiving PS declined from 18.8% to 1.6%; stratified by age—PS declined from 1.9% to 0.1% among patients 10-14 years; 8.6% to 0.4% among patients 15-17 years; 25.2% to 2.3% among patients 18-20 years. PS was least common in ID and most common in AK. PS was also significantly associated with patients' state, race/ethnicity, and insurance. PS was less common among American Indian, black, and Hispanic patients than white patients (AOR=.65, .70, .90, respectively). Compared to publically insured patients, PS was more common among uninsured (AOR=1.20) and privately insured (AOR=1.17) patients. Conclusions: Title X clinics adopted new recommendations and substantially decreased PS among women under age 21. Patients of certain demographic and insurance characteristics are still more likely to be tested.