Association between sociodemographic and knowledge, attitude, and behavioral factors and Pap test; Health Information National Trends Survey 2020.

Purpose In the past two decades, cervical cancer cases have decreased in the U.S., largely attributed to the secondary prevention by Papanicolaou (Pap) test to detect alterations in cervical cytology. However, racial and ethnic minority women are underscreened and report higher incidence and mortality from cervical cancer. Updated (2018) screening guidelines recommended Pap testing every 3 years for women ages 21-29 years and Pap testing every 3 years, or co-testing with HPV every 5 years, or HPV testing every 5 years for 30-65 years age group. Lack of knowledge regarding risk factors and negative attitudes towards cancer-preventive behaviors may affect adherence to screening recommendations, but research is limited. This study examines the association of sociodemographic and knowledge, attitude, and behavioral factors with adherence to Pap testing among a nationally representative sample of U.S. women. Methods The cross-sectional study was conducted using the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4; n=1,089 women of screening age, 21-65 years). The outcome variable, adherence to cervical cancer screening recommendations were dichotomized into Pap testing within the last 3 years (adherent) or Pap test beyond 3 years/no Pap testing (non-adherent). Questions representing sociodemographic features and knowledge, attitudes, and behavioral measures were selected. Survey-weighted adjusted multivariable logistic regression models were used to assess the association of the sociodemographic and knowledge, attitude, and behavioral factors with Pap testing. Variables associated with Pap test adherence in the regression models were stratified into racial/ethnic groups. Results Approximately 79.3% of women reported being guideline adherent. Most of the sample were Non-Hispanic White women (63.1%), with 61.7% reporting Pap testing guideline adherence. 15.09% of Hispanic women and 14.1% of African American women reported Pap tests within the last 3 years. Compared to women up to high school education, college graduate/post-graduate women (aOR=1.95, 95%CI 1.01-3.79) had higher odds of being guideline adherent. Women with health insurance had higher odds of guideline adherence (aOR=3.60, 95%CI 1.49-8.73), compared to those uninsured. Compared to those with lower knowledge, those with higher knowledge of HPV (aOR=2.41, 95%CI 1.31-4.43) showed higher odds of guideline adherent Pap testing. Non-Hispanic White women with college/post-graduate degree (aOR=3.06, 95%CI 1.27-7.38) and health insurance (aOR=5.26, 95%CI 1.43-19.30) were more likely to be guideline adherent than those with up to high school education and no insurance. The odds of receiving guideline adherent Pap testing are higher for those non-Hispanic White women with knowledge of HPV (aOR=2.98, 95%CI 1.59-5.57) as compared to those who are unaware of it. Conclusion With changes in recommendation guidelines, lack of higher education, lack of health insurance, and lower HPV knowledge may be factors associated with the underscreening of racial and ethnic minority women. Future studies focusing on the HPV and Pap testing knowledge, attitudes, and behaviors of women by race and ethnicity will help to identify and address culture-specific barriers related to Pap testing and ultimately reduce racial disparities in cervical cancer incidence and deaths.