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 a nd Anglo women in Orange County, California. Methods: We conducted a t elephone survey using the computer-assisted telephone interview system , random-digit dialing, and an instrument adapted from national survey s and a previous ethnographic study. Results: Participants included 12 25 noninstitutionalized Spanish- or English-speaking respondents 18 ye ars or older-803 Latinas (533 immigrants and 270 US born) and 422 Angl o women. Latina immigrants were more likely than US-born Latinas or An glo women to believe that a variety of behaviors were risk factors for this disease. These behaviors included medically accepted risk factor s such as early initiation of sexual intercourse (53% vs 41% vs 39%; P <.01) as well as unaccepted factors such as having sex during menstrua tion (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 sta tus, marital status, and acculturation. Conclusions: Latinas have cult urally based beliefs about cervical cancer that reflect the moral fram ework within which they interpret diseases and that may influence thei r use of Pap smears, These beliefs are most prevalent among Latina imm igrants. Because the known risk factors for cervical cancer are primar ily related to sexual activities and because such activities are priva te and sensitive for many Latinas, physicians should be cautious when counseling these patients about the cause of this disease. Indeed, str essing the sexual transmission of cervical cancer could even discourag e Latina immigrants from obtaining appropriate Pap smear screening.