According to the American Cancer Society, over 10,000 women are diagnosed with cervical cancer in the United States every year. It is estimated that almost 4,000 women will die from this disease every year. Among the most common risk factors for cervical cancer are human papillomavirus (HPV) infection (the risk of acquiring is increased by intercourse at an early age, having many sexual partners, and having sex with uncircumcised males), smoking, HIV infection, Chlamydia infection, unhealthy diet, use of oral contraceptives, multiple pregnancies, and low socioeconomic status.
One of the most effective ways for women to avoid cervical cancer is to have a regular screening. This screening is done through the Papanicolaou Smear, also known as a Pap test or Pap smear. This simple test detects precancerous abnormalities in cells that can then be treated, allowing the patient to avoid developing cervical cancer.
Health disparities exist in the incidence and mortality rate of cervical cancer and in the use of screening services by women. According to the American Cancer Society, in 2000, 83.9 percent of Caucasian women 18 and over had a Pap test in the last three years, while 77.9 percent of Latina women had. The cervical cancer incidence rate for Caucasian women from 1996-2000 was 9.2 per 100,000 women and 16.8 per 100,000 for Latina women. The mortality rate was 2.7 per 100,000 for Caucasian women and 3.7 for Latina women.
A number of studies exist that have explored the lowered rates of Pap screening use among Latina women in the United States. These studies have utilized a variety of health behavior theories to explain and understand this health behavior. The following is a discussion of one of these studies.
In her article, Predicting Intentions to Obtain a Pap Smear Among African American and Latina Women: Testing the Theory of Planned Behavior, which appeared in the journal Nursing Research, Kathleen Jennings-Dozier explicitly tests the usefulness of the intrapersonal level theory of planned behavior to explain cervical cancer screening use activities among African American and Latina women. The theory of planned behavior reasons that behavioral intention is the product of three forces: the attitude towards the behavior, the subjective norm regarding the behavior, and the perceived behavioral control.
To test the applicability of the theory of planned behavior, Jennings-Dozier used a sample of 108 African American women and 96 Latina women. She designed and used The Pap Smear Questionnaire to measure intention, attitude, subjective norm, and perceived behavioral control, the four major components of the theory of planned behavior. To measure intention to obtain Pap Smears, the researchers used a three-question scale. To measure attitude, subjects rates annual Pap tests as good or bad and beneficial or harmful. To measure subjective norm, subjects rated their agreement with the statement “Most people I care about think I should get a Pap smear every year.” To measure behavioral control, subjects were asked to respond to questions regarding the ease of accessing Pap testing. The study also utilized a Demographic Assessment survey to gather information about demographics and socioeconomic status.
The findings of the study in regard to Latina women was that women who had more favorable attitudes toward Pap smears and perceived that obtaining a Pap smear was easy (increased behavioral control), had stronger intentions to access Pap test services. Interestingly, perceived support from others about being screened for cervical cancers did not have this effect. Therefore, attitudes and perceived behavioral control seem to have an influence on intention to utilize Pap smear services, which subjective norm does not.
The theory of planned behavior seems to be helpful in understanding Latina women’s intention to access cervical cancer screenings. When planning programs, enhancing attitudes and behavioral control should in included as important factors.
American Cancer Society, www.cancer.org
Jennings-Dozier, Kathleen. Predicting Intentions to Obtain a Pap Smear Among African American and Latina Women: Testing the Theory of Planned Behavior. Nursing Research. 1999; 48; 198-205.