Beliefs about sexual behavior and other predictors of Papanicolaou smear screening among Latinas and Anglo women

Background: Latinas use cervical cancer prevention services less often than Anglo women. Objective: To assess whether beliefs about cervical cancer influence the use of Papanicolaou (Pap) smears among Latinas and Anglo women in Orange County, California. Methods: We conducted a telephone survey using the computer-assisted telephone interview system, random-digit dialing, and an instrument adapted from national surveys and a previous ethnographic study. Results: Participants included 1225 noninstitutionalized Spanish- or English-speaking respondents 18 years or older-803 Latinas (533 immigrants and 270 US born) and 422 Anglo women. Latina immigrants were more likely than US-born Latinas or Anglo women to believe that a variety of behaviors were risk factors for this disease. These behaviors included medically accepted risk factors such as early initiation of sexual intercourse (53% vs 41% vs 39%; P<.01) as well as unaccepted factors such as having sex during menstruation (56% vs 10% vs 3%; P<.01). Logistic regression analysis revealed that Latinas who held such beliefs were significantly less likely than others to report receiving a Pap smear within the past 3 years. Other independent predictors of Pap smear use included health insurance status, marital status, and acculturation. Conclusions: Latinas have culturally based beliefs about cervical cancer that reflect the moral framework within which they interpret diseases and that may influence their use of Pap smears, These beliefs are most prevalent among Latina immigrants. Because the known risk factors for cervical cancer are primarily related to sexual activities and because such activities are private and sensitive for many Latinas, physicians should be cautious when counseling these patients about the cause of this disease. Indeed, stressing the sexual transmission of cervical cancer could even discourage Latina immigrants from obtaining appropriate Pap smear screening.