Background/Objective:
Despite widespread availability of the Papanicolaou (Pap) smear test for cervical cancer screening/prevention, cervical cancer rates in the U.S. continue to rise. We investigate how trust in health information, health self-efficacy, and cancer knowledge are associated with non-adherence to Pap smear testing guidelines.

Methods:
We analyzed data from HINTS-6 (2022), a national population-based health information survey from the U.S. National Cancer Institute. Univariate logistic regression models predicted associations between trust in medical information, health self-efficacy, and cancer knowledge and non-adherence to Pap smear testing guidelines (NAPG).

Results:
Of 2,233 female respondents aged 21-65, 25.0% were NAPG and 13.5% expressed a lack of trust in health information from scientists. Hispanic ethnicity (OR=0.748;p=0.0284), marriage (OR=0.735;p=0.0112), higher education (OR=0.565;p<0.001), and higher income (OR=0.790;p=0.0343) predicted NAPG. Mistrust in scientific information also predicted NAPG (OR=1.595;p=0.0005). Self-efficacy variables including reporting worse health (OR=1.577;p=0.0001), expressing confidence in the ability to take care of one’s health (OR=1.429, p=0.0007), actively seeking cancer information (OR=1.280;p<0.0118), believing in the possibility of cancer prevention (OR=1.462;p=0.0402), and thinking the search for cancer information did not require excessive effort (OR=2.242;p=0.0151) predicted NAPG. Lack of awareness about HPV (OR=1.781;p<0.0001), the HPV vaccine (OR=1.548;p=0.0001), and the fact that HPV causes cervical cancer (OR=1.704;p<0.0001) predicted NAPG.

Conclusions:
Efforts to increase pap smear adherence should mitigate medical mistrust while supporting self-efficacy. Clinicians and public health professionals should equip patients with appropriate resources and disseminate health information in an accessible manner. Future efforts should mitigate demographic disparities by increasing pap-smear adherence among unmarried, low-income, and undereducated individuals.