The Role of Attitudes and Emotions and the Receipt of Pap Smears Among Older Hispanic, African American, and Non-Hispanic White Women

Background and Purpose: In 2016, 20% of cervical cancer diagnoses occurred in women age 65 and older. African-Americans are more likely to die from cervical cancer and Hispanics are at higher risk of diagnosis with late stage cervical cancer than non-Hispanic White (NHW) women. Despite initiatives designed to increase cervical cancer screening, African-American and Hispanic populations are less likely to participate. Few empirical investigations have examined and compared psychosocial factors, such as attitudes and emotions of older women’s cervical cancer screening behaviors by race and ethnicity over time. This study explored the relationship between attitudes about life, aging, and anxiety as reported in 2008 and participation in cervical cancer screening in 2012 among older Hispanic, African-American, and NHW women.

Methods: Guided by the social ecological model, this investigation examined attitudinal and emotional factors (life satisfaction, satisfaction with aging, anxiety) and subsequent cervical cancer screening participation. Participants had to 1) respond to cervical cancer screening question, and 2) respond to all questions about life satisfaction, satisfaction with aging and anxiety, resulting in a final sample of 11,927 women from the 2008 and 2012 waves of the Health and Retirement Study. Mixed effects logistic regression models were conducted to 1) estimate the effect of attitudinal and emotional factors on cervical cancer screening and changes in participation over time, and 2) examine the effect of socioeconomic and patient health status on the relationship between attitudinal and emotional factors and cervical cancer screening participation over time.

Results: Findings indicate that 5,656 (47%) women received a pap smear in 2012. For every one point increase African Americans reported the ‘same amount of energy as the previous year’ in 2008, they were more likely (OR=2.60) to participate in cervical cancer screening in 2012. In addition, for every one point increase African American reported ‘getting older has brought with it many things I do not like’ in 2008, African Americans were more likely (OR=3.25) to participating in cervical cancer screenings in 2012. Hispanics were more likely to participate in cervical cancer screening in 2012 for every one point increase in reported feeling satisfied with life  (OR=1.34) and having important things in life (OR=1.28) in 2008. NHWs were more likely to obtain cervical cancer screening in 2012 for every one point increase in reporting a ‘fear of the worst happening’ (OR=2.38) in 2008.

Conclusions and Implications: Given the national conversations about preventative screening in older adults, it remains important for social workers to account for the heterogeneity in the older female population. Findings from this study support this diversity and provide areas of inquiry for providers to better understand the perspectives of older women regarding pap smears. Social workers are well-positioned in health care settings to incorporate older women’s perspectives. Quality patient-provider communication is one mechanism to achieve health equity and justice and increase cervical cancer screening among older women. Findings support the use of interventions that increase quality patient-provider communication for older women’s decision-making processes about cervical cancer screening.