PAP TESTING AMONG VIETNAMESE WOMEN

PAP TESTING AMONG VIETNAMESE WOMEN

Reported, January 10, 2012

Cervical cancer occurs more frequently among Vietnamese Americans than women of any other race/ethnicity. In addition, previous studies in California have documented low Papanicolaou (Pap) testing rates in Vietnamese communities. This study focused on health care system factors and physician characteristics associated with recent cervical cancer screening among Vietnamese women. A population-based survey was conducted in Seattle during 2002. In-person interviews were conducted by bilingual, bicultural female survey workers. The survey response rate was 82% and 518 women were included in the analysis. Seventy-four percent of the respondents reported having been screened for cervical cancer on at least one occasion, and 64% reported a Pap smear within the previous 2 years. Women with a regular doctor were more likely to have been recently screened than those without a regular doctor (OR = 2.33, 95% CI = 1.45–3.74). Among those with a regular doctor, having a male physician, receiving care at a private doctor’s office (rather than a community, hospital, or multi-specialty clinic), and concern about the cost of health care were independently associated with lower screening rates. Physician ethnicity was not associated with recent Pap smear receipt. The findings support targeted interventions for Vietnamese women without a regular physician and private doctors’ offices that serve Vietnamese Americans. The availability of low cost screening services should be publicized in Vietnamese communities.

In 2000, the United States (US) Census documented over one million Vietnamese.Because of continued immigration and high fertility rates, there will be an estimated four million Vietnamese in the US by 2030, and they will soon constitute the second largest Asian sub-group. Information from the Surveillance, Epidemiology, and End Results (SEER) program shows that Vietnamese American women are over five times more likely to be diagnosed with invasive cervical cancer than their non-Latina White counterparts. SEER data also indicate that cervical cancer is the most commonly occurring invasive malignancy among Vietnamese American women (incidence rate of 43 per 100,000 compared to 38 per 100,000 for breast cancer). 3 Given the high cervical cancer incidence rate among Vietnamese women, it is not surprising that studies have found that Vietnamese Americans report lower levels of Papanicolaou (Pap) testing use than any other racial/ethnic group.
There is a paucity of published information about the cervical cancer screening behavior of Vietnamese immigrants. Additionally, nearly all the previous population-based studies addressing Pap testing use among Vietnamese American women were conducted in California.We have initiated research to collect qualitative and quantitative information about the cervical cancer prevention behavior of Vietnamese American women, as well as to design and evaluate a culturally appropriate cervical cancer control outreach program. As part of this project, we conducted a population-based survey in Seattle, Washington during 2002. Our goal was to provide information about Pap testing barriers and facilitators that could be used to develop intervention strategies. For this report, we used our survey data to examine health care system factors and physician characteristics associated with interval adherence to Pap testing guidelines.

Questionnaire was completed by 544 women. The disposition of the remaining 336 addresses in the original sample was as follows: not a residential address (i.e., vacant dwelling or business)—44, eligibility not established (i.e., no contact after five attempts)—21, verified to be ineligible (i.e., household not Vietnamese or no Vietnamese woman aged 18–64 years)—165, and eligible but refused—106. The overall estimated response rate was 82% (assuming the proportion of eligible households was the same among those that were and were not contactable) and the cooperation rate (i.e., response among reachable and eligible households) was 84%. Five hundred and thirty two (97%) of the respondents completed the survey in Vietnamese. Ten women were excluded from the analysis because they did not provide sufficient information about their Pap testing history, and a further 16 were excluded because they were without uteri. Therefore, the final sample included 518 respondents.

Three hundred and eighty three (74%) of the women in our study sample reported they had received Pap testing on at least one occasion, and 332 (64%) had been screened within the last 2 years. Bivariate comparisons for the women who had received Pap testing in the last 2 years and the women who had not received recent cervical cancer screening; p-values are given for those variables with a p-value of < .10. The following characteristics were associated (p < .05) with recent cervical cancer screening in bivariate comparisons: older age, being married, having health insurance, having a regular physician, and not having cost concerns. There was no association between type of health insurance and Pap test receipt. Among those with a regular physician, practice setting was associated with Pap testing within the preceding two years (p < .001). Specifically, women who reported receiving care at a private doctor’s office were less likely to report cervical cancer screening. Additionally, women with a recent Pap smear were more likely to have a female than a male doctor (p = .001).

The Healthy People 2010 objectives specify that 97% of women aged 18 and older should have received at least one Pap test.These goals have already been met in some populations. For example, Hiatt et al. reported that 99% of White and 98% of Black women in San Francisco had been screened on at least one occasion.4 However, we found that current levels of cervical cancer screening among Vietnamese American women do not even approach these national goals. Specifically, less than three-quarters (74%) of our Seattle sample reported ever having received Pap testing, and only 64% reported a Pap smear within the preceding two years. These findings are consistent with a recent study by Nguyen et al. that found 78% of Vietnamese women in Santa Clara County, California and 74% of Vietnamese women in Harris County, Texas had ever been screened for cervical cancer.6 Similarly, in another study of Southeast Asian women, we found that 76% of Cambodian American women in Seattle had received Pap testing at least once.
Previous studies of Vietnamese American populations have consistently reported an association between marital status and cervical cancer screening adherence.We also found that married women were more likely to have been screened in the preceding 2 years than never married women. In a study that included unmarried, sexually active Vietnamese women, the belief that only married women need a Pap test was associated with Pap testing receipt.Unmarried women are less likely to be receiving family planning or obstetric services which provide an opportunity for cervical cancer screening.Additionally, the stigma associated with extra-marital sexual activity in Vietnamese culture may also deter unmarried women from getting Pap smears.

Specifically, we used population-based sampling methods, administered the survey face-to-face, and had a high response rate. In conclusion, we found that low levels of cervical cancer screening participation in Vietnamese American communities remain a significant public health problem. Educational interventions for Vietnamese women should specifically target women who are unmarried and/or without a regular doctor. Intervention programs should also target private doctors’ offices that serve Vietnamese patients. Finally, increasing awareness of the Breast and Cervical Cancer Early Detection Program may facilitate Pap testing among lower income Vietnamese American women. We are currently conducting an outreach worker intervention for Vietnamese women who have never been screened for cervical cancer. Outreach workers are trained to refer women without a regular doctor to a local clinic, encourage women with a male physician to ask him to arrange for Pap testing through a female provider (if a woman reports her doctor’s gender is a barrier to gynecologic care), and provide information about the Breast and Cervical Cancer Early Detection Program.

Credits:Victoria M. Taylor, MD, MPH, Full Member, Stephen M. Schwartz, PhD, Full Member, and Yutaka Yasui, PhD, Associate Member

More information at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1811063/?tool=pubmed