Three specific aims are proposed to examine the effect of age on the use of cervical cancer screening, and the factors leading to differential use of Pap smear screening by women. (1) To explain the impact of predisposing, enabling, and need factors (perceived and reported health status, and knowledge of screening guidelines), on use of Pap smear screening. (2) To identify specific groups of women who need to be targeted for screening by calculating population level rates, aggregating data on various combinations of variables (i.e. age-source of care, age-income, age-ethnicity). (3) To evaluate whether the recommendation to not screen beyond age 65 that was in place prior to 1987 was responsible for the lower utilization of Pap smear screening among the elderly. If so, to determine if the findings are indicative of whether the new recommendations removing the age ceiling are likely to ensure that elderly women are screened for cervical cancer. Secondary data analyses will be performed on the 1987 National Health Interview Survey (NHIS), Cancer Control Supplement. The survey is a personal interview on randomly selected households, uses an observational design with multistage sampling, and is representative of the civilian, noninstitutionalized population of the United States. Using a split- sample design, one half (22,043 persons) of the households received the Cancer Control Supplement. The analytical sample for the proposed study will use all women in the supplement (n= 12,868), and present findings comparing utilizers and non-utilizers of physicians visits in the year prior to the interview, and women with and without hysterectomies. Statistical analysis will involve an exploratory phase to ensure that the denominator of the sample will include only women receiving a Pap smear for preventive screening and not for diagnostic or follow-up reasons. Bivariate analyses will be performed on all combinations of independent and dependent variables. Logistic regression will be performed to estimate the likelihood of using Pap smears as explained by the predisposing, enabling and need factors. Finally, aggregate rates will be calculated on demographic and age subgroups of interest.
