(WITHDRAWN) Correlates of Cervical Cancer Knowledge Among American Indian Women in Northern Plains

Background and Purpose: Cervical cancer remains a significant cause of morbidity and mortality among women globally; yet cancer burden is unevenly distributed among racial/ethnic groups. Cervical cancer is the top cause of death among American Indian (AI) women and the most frequently diagnosed cancer in women. Identifying factors related to cervical cancer knowledge is critical for increasing cervical cancer screening among AI women. The purpose of this study was to examine the correlates of cervical cancer knowledge among AI women adapting Andersen’s behavioral model.

Methods: Using a cross-sectional design, data were collected from a convenience sample of rural and off-reservation self-identified AI women (N=230) aged 18 and 65 years in a Midwestern state. We conducted a series of hierarchical regression analyses to assess the associations of predisposing (age, marital status, tribe member, religion), need (family cancer experience and health barriers), and enabling factors (education, monthly income, awareness of Pap test, health benefits, method of health literacy: TV/radio, and knowledge of human Papillomavirus).

Results: Approximately 59% of participants reported receiving cervical cancer screening within the past two years. The hierarchical multiple regression results revealed that being a tribe member was significantly associated with a lower level of cervical cancer knowledge (B = -0.73, SE = 0.36, p ≤ .05). Education significantly associated with a higher level of cervical cancer knowledge (B = 0.52, SE = 0.17, p ≤ .01). People who answered that TV/radio were appropriate methods for health literacy were significantly related to a higher level of cervical cancer knowledge (B = 0.55, SE = 0.26, p ≤ .05). A higher level of health benefits was significantly related to a higher level of cervical cancer knowledge (B = 0.07, SE = 0.03, p ≤ .05). A higher level of knowledge of human Papillomavirus was significantly associated with a higher level of cervical cancer knowledge (B = 0.32, SE = 0.07, p ≤ .001).

Conclusions & Implications: Cervical cancer poses a serious health threat among AI women. Increasing cervical cancer knowledge is a key determinant of tackling cancer morbidity and mortality. Our findings indicate that education, methods for health literacy: TV/radio, health benefits, and knowledge of human Papillomavirus had significantly positive associations with cervical cancer knowledge after controlling for predisposing and need factors. This study provide important implications and culture specific guidelines for intervention strategies aimed at improving cervical cancer knowledge among AI women. Given that culture is an intrinsic part of health practices and attitudes toward cancer screening, understanding how AI women perceive cervical cancer screening is crucial in designing culturally tailored interventions targeting this population to offer optimum cancer screening services and decrease cancer burden. In the face of persistent cancer disparity, public health efforts to address unique needs and concerns about screening and reduce environmental, systemic, and cultural barriers that may prevent AI women from undergoing cervical cancer screening, would be one step toward diminishing cervical cancer morbidity and mortality in this vulnerable group of racial/ethnic minority women.