Substantial evidence exists that regular screening is effective in preventing cervical cancer. However, the existing services are underused by many women in Taiwan. To examine the effects of sociodemographic characteristics on the underuse of Papanicolaou (Pap) smear screening, from September to December 1993 we conducted a questionnaire interview on a sample of 4,400 women aged 20 years and older in Taipei city using multistage sampling with probability proportional to size. Our results indicate that 40% of the women sampled have never had a Pap smear and 86% have not had one in the past year. Age is the strongest factor affecting Pap smear use, particularly for women below age 30 and over the age of 65. In addition, women with lower levels of education, women who are not employed, never-married women and women who live outside the city tend to underuse Pap smear screening. These findings help indicate priority groups which should be targeted to increase screening and consequently reduce cervical cancer. Our data also provides a good baseline for comparison of rates of Pap smear screening by various sociodemographic factors in the future.
PIP: This study determined the extent of Pap smear screening and identified the determinants of Pap smear screening among a probability sample of women in the greater Taipei area of northern Taiwan. The sample includes 3564 women interviewed during September-December 1993. Findings show that about 40% of women aged 20 years and older reported never having had a Pap smear. 86% did not have a Pap smear within the last year before the survey. Almost 30% of women aged under 20 years had never been screened compared to 18% among women aged 40-49 years. Other significant determinants of a lack of screening were residence in the southern part of the urban area, a lower level of education, unemployment status, and an unmarried status. Sociodemographic characteristics varied between women who had never had a Pap smear and women who had not had one in the past year. Women aged 65 years and older were 13 times more likely not to have had a Pap smear in the past year compared to women aged under 30 years. Not having a recent Pap smear was associated with women who were descended from mainlanders only in the bivariate model. A higher level of education was related negatively to never having had a Pap smear. Unemployment was more strongly related to the lack of a recent smear. An illiterate woman had the greatest risk of never having been screened in the multivariate model. Age was the most important factor in determining Pap smear use. Findings differ from the findings of Hayward et al. particularly for women in the younger age group and confirm the findings of Swan et al. Findings were consistent with other studies showing that women aged 65 years and older were a risk group that needed targeting.