Racial Disparities in Cervical Cancer Screening: Implications for Relieving Cervical Cancer Burden in Asian American Pacific Islander Women

Background:While cervical cancer is considered preventable and the overall Pap test utilization rate has gradually increased in the U.S. (ACS, 2016), Asian American Pacific Islander (AAPI) women consistently rate lower in Pap test receipt compared to non-Latina whites (NLW), leading to a higher cervical cancer mortality rate for certain AAPI communities (Thompson et al., 2014; Torre et al., 2016). Few studies, however, have focused on female AAPI college students’ cervical cancer screening behavior in comparison with NLW students. This study aims to investigate cervical cancer screening behaviors among college-aged females by (1) determining AAPIs and NLW’ screening rates; (2) assessing their knowledge about Pap tests, and (3) discovering factors associated with Pap test receipt.

Methods: Andersen’s Health Behavioral Model (Andersen, 1995) was used as the current study’s theoretical framework and a simple random sampling strategy was employed to recruit participants. 2,270 female college students (15% AAPIs, 85% NLW) enrolled in a Midwestern university completed an online health survey. Descriptive statistics examined Pap test receipt rates, age at time of first Pap test, and knowledge about the Pap test differences between AAPIs and NLW, while hierarchical logistic regression model with three different groups of predictors guided by Andersen’s model was employed to identify significant predictors on Pap test receipt rates.    

Results: Study results indicate significantly lower Pap test uptake rate (17.9% vs. 31.2%) and lower knowledge about Pap tests (59.5% vs. 74.4%) among AAPI students compared to NLW.  Completion of HPV vaccination was also found to be significantly different with 60.7% of NLW indicating they completed the 3-dose HPV vaccination compared to only 38.6% of AAPIs.  Age, nativity, HPV vaccination completion, frequency of obstetrician/gynecologist (OB/GYN) visits, and the number of sexual partners were associated with AAPI students’ lower Pap test receipt while NLW students were influenced by the same factors, except for nativity, with the addition of having increased prior knowledge about Pap tests.

Conclusions and Implications: Findings confirmed that AAPI students had lower Pap test knowledge, Pap test uptake, and HPV vaccination rates as compared to NLW students, which indicate an urgent need for developing AAPI-targeted intervention programs.  When developing such programs, we should consider the importance of OB/GYN visits for college-aged AAPI students on obtaining Pap tests.  Health care providers should also provide cancer-related health education regarding the importance of receiving regular Pap tests among their college-aged AAPI patients during clinic visits.  Health practitioners should pay attention to students’ race/ethnicity in their practice and provide corresponding ethnic group-specific cervical cancer preventive care.