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Predictors of Papanicolaou Smear Return in a Hospital-Based Adolescent and Young Adult Clinic

From the Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and Division of Adolescent/Young Adult Medicine, Children’s Hospital, Boston, Massachusetts.

Address reprint requests to: Jessica A Kahn, MD, MPH, Cincinnati Children’s Hospital Medical Center, Division of Adolescent Medicine, MLC 4000, 3333 Burnet Avenue, Cincinnati, OH 45229-3039; E-mail: jessica.kahn{at}chmcc.org.

OBJECTIVE: Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits.

METHODS: Participants in this longitudinal cohort study were sexually active young women 12–24 years of age presenting to a hospital-based adolescent clinic. Participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. Logistic regression modeling was used to determine variables independently associated with return. RESULTS: The outcome measure, return, was available for 439 of 490 participants (90%). Mean participant age (± standard deviation) was 18.3 (± 2.2) years, 49% were black, 23% were Hispanic, and 51% had Medicaid health insurance. Variables independently associated with return included belief that the Papanicolaou smear will not be painful (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.08, 2.83), belief that return for follow-up will prevent cervical cancer (OR 1.83, 95% CI 1.12, 3.07), likelihood that the doctor will be honest (OR 4.07, 95% CI 1.37, 17.5), and low self-reported impulsivity (OR 1.66, 95% CI 1.06, 2.63). Family history of cervical cancer was associated with decreased likelihood of return (OR 0.28, 95% CI 0.08, 0.78).

CONCLUSION: Specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits. These findings may guide the design of interventions to increase compliance with recommendations for Papanicolaou smear return.

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