Journal of Women's Health - 19

JOURNAL OF WOMEN'S HEALTH an eBook Series Cervical Cancer Screening in the United States, 1993-2010: Characteristics of Women Who Are Never Screened

1,665,169 total respondents, ranging from 58,840
in 1993 to 268,449 in 2010. The median BRFSS
response rate ranged from 72% to 49%.8 The Health
Sciences Institutional Review Board at the University
of Wisconsin Milwaukee determined this study to be
nonhuman subjects research, and an IRB review was
not required.

Outcome measure
The main study measure was the last time the
respondent had a Pap test, based on the response
to the following questions: (1) A Pap test is a test for
cancer of the cervix. Have you ever had a Pap test? (2)
How long has it been since you had your last Pap test?

Statistical analyses
We calculated the cervical cancer screening rate
for (1) all adult women, (2) all adult women who had
a recent (within 2 years) routine checkup, defined as
a general physical examination not an examination
for a specific injury, illness, or condition, and (3) all
adult women who had a hysterectomy, defined as an
19 | Liebertpub.com/JWH

operation to remove the uterus (womb). Because the
routine checkup item was not included in the 2002 and
2004 surveys, data were not available for those years.
We also calculated the cervical cancer screening rate
by sociodemographic factors, including age (18-20,
21-29, 30-39, 40-49, 50-59, 60-69, ≥70 years), race
(non-Hispanic white, non-Hispanic black, Hispanic,
other), education (less than high school, completed high
school, above high school), annual household income
(<$15,000, $15,000-$35,000, $35,000-$50,000,
≥$50000, unknown), marital status (married, living as
married, divorced, widowed, separated, never married),
and health insurance status (currently insured, currently
uninsured). Annual household income was categorized
as unknown if the respondent reported don't know, not
sure, or refused. Marital status was categorized as living
as married when the respondent was a member of an
unmarried couple.
We performed a survey-logistic regression
analysis to examine the association between all
sociodemographic factors and the outcome of never

had a Pap test (yes vs. no, ever had a Pap test) while
adjusting for covariates of sociodemographic factors;
p<0.05 was considered as statistically significant. All
analyses were conducted using SAS 9.2, and survey
weights were employed to account for sampling
methodology and nonresponse.

Results
From 1993 to 2010, 1,665,169 adult women
participated in the survey. In Table 1, we present
the prevalence of adult women having a Pap test as
the following groups: never, within 1 year (any time
<12 months ago), within 2 years (any time <2 years
ago), and within 3 years (any time <3 years ago).
Among all respondents, 62.9%, 76.4%, and 81.3%
reported that they had a Pap test within 1, 2, and
3 years, respectively; 6.2% reported never having
a Pap test. The prevalence of having been screened
within 3 years was consistently above 80% until
2008 (Table 1).

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