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Canadian Journal of Public Health

, Volume 95, Issue 2, pp 95–98 | Cite as

Community-based Cultural Predictors of Pap Smear Screening in Nova Scotia

  • Grace M. JohnstonEmail author
  • Christopher J. Boyd
  • Margery A. MacIsaac
Article

Abstract

Background

Pap smear screening is effective in reducing the incidence of cervical cancer. However, some subgroups of women are less likely to be screened than others. Since Canadian provincial health databases do not contain data fields identifying ethnicity or language, analyses employing these variables are typically not available. This paper overcomes this problem by using community- rather than person-based measures. Associations with having had a recent Pap smear are reported by community income, language, ethnic group, and urban/rural status, as well as the woman’s age.

Methods

The provincial Health Card Number and Cytology Registries were linked to ascertain the screening status of women in mainland Nova Scotia and Cape Breton. Postal codes were linked to census enumeration areas and then to Statistics Canada census data to create community-based cultural measures for each woman.

Results

Women in mainland Nova Scotia were more likely to have had a recent Pap smear (Odds Ratio (OR)=1.36; 95% Confidence Interval (CI):1.33-1.39). Women living in low income (OR=1.19;CI:1.15-1.22), Aboriginal (OR=1.60,CI:1.46-1.76), mixed Black (OR=1.25;CI:1.19-1.30) and rural (OR=1.09;CI:1.07-1.11) communities and who were older were less likely to have had a recent Pap smear.

Discussion

These findings were not unexpected. In the United States and elsewhere, associations between Pap screening status and women with low income, rural residence, Aboriginal and Black heritage have been reported using person-based methods. Our findings demonstrate a method of providing measures of ethnicity and language that should be considered for use in Canadian studies of service utilization, disease status, and well-being.

Résumé

Contexte

Le test de Papanicolaou est un moyen efficace de réduire l’incidence du cancer du col utérin. Cependant, certaines catégories de femmes sont moins susceptibles que d’autres de subir un test de dépistage. Comme les bases de données sanitaires des provinces canadiennes ne contiennent pas de champs de données indiquant l’appartenance ethnique ou la langue, nous ne disposons pas en général d’analyses employant de telles variables. Nous avons contourné le problème en utilisant des mesures collectives plutôt qu’individuelles pour déterminer la relation entre le fait d’avoir subi récemment un test de Papanicolaou et le revenu de la collectivité, la langue, le groupe ethnique, le milieu (urbain ou rural) et l’âge de la femme.

Méthode

Nous avons mis en correspondance le numéro de carte Santé et les registres cytologiques provinciaux afin d’établir avec précision la situation des femmes de la NouvelleÉcosse continentale et du cap Breton à l’égard du dépistage. Nous avons relié les codes postaux aux arrondissements de secteurs de dénombrement, puis aux données du recensement de Statistique Canada pour créer des mesures culturelles collectives pour chaque femme.

Résultats

Les femmes de la Nouvelle-Écosse continentale étaient plus susceptibles d’avoir subi récemment un test de Papanicolaou (rapport de cotes [RC]=1,36; intervalle de confiance [IC] de 95 %=1,33-1,39). Les femmes vivant dans des collectivités à faible revenu (RC=1,19; IC=1,15-1,22), autochtones (RC=1,60; IC=1,46-1,76), à population noire mixte (RC=1,25; IC=1,19-1,30) et rurales (RC=1,09; IC=1,07-1,11) et qui étaient par ailleurs plus âgées étaient moins susceptibles d’avoir subi récemment un test de Papanicolaou.

Discussion

Nous nous attendions à de tels résultats. Aux États-Unis et ailleurs, les méthodes individuelles ont permis de constater des associations entre la situation à l’égard du dépistage par le test de Papanicolaou et les femmes à faible revenu, vivant en milieu rural et d’ascendance autochtone ou noire. Nos constatations font état d’une méthode de mesure de l’appartenance ethnique et de la langue dont on pourrait envisager l’utilisation dans les études canadiennes sur l’utilisation des services, l’état de santé et le bien-être.

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Copyright information

© The Canadian Public Health Association 2004

Authors and Affiliations

  • Grace M. Johnston
    • 1
    Email author
  • Christopher J. Boyd
  • Margery A. MacIsaac
    • 2
  1. 1.School of Health Services Administration, Dalhousie University and Surveillance and Epidemiology Unit (SEU)Cancer Care Nova ScotiaHalifaxCanada
  2. 2.Gynaecological Cancer Screening ProgramCancer Care Nova ScotiaCanada

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