DESCRIPTION (provided by applicant): Cervical cancer incidence and mortality rates have decreased significantly during the last 50 years due to widespread screening with the Papanicolaou (Pap) test. However, subgroups of women continue to be at elevated risk of cervical cancer due to underutilization of screening services. Lesbians are an underserved group of women who participate in routine cervical cancer screening at rates below below recommended rates and below that of the general population of women. Failure to be screened is of great importance for these women because inadequate screening may lead to later diagnosis, diagnosis of more advanced disease, greater morbidity and mortality, and thus, disproportionate burden of disease for this subgroup of women. The primary aim of this proposal is to identify factors associated with participation in routine cervical cancer screening in lesbians based on constructs from the Health Belief and PRECEDE-PROCEED models. Factors that will be explored include: knowledge of cervical cancer risk factors and screening guidelines; perceived susceptibility, barriers, and benefits of cervical cancer screening; and cues to action (e.g., physician recommendation for Pap). We will also explorate contextual factors that are unique to lesbians and are related to cervical cancer screening behavior; factors that will be explored will include: perceived discrimination, insurance status, experiences in health care settings, and differing reproductive health care needs of lesbians. We hypothesize that compared to lesbians who participate in routine screening, lesbians that do not participate in routine cervical cancer screening will: (1)be less knowledgeable about cervical cancer risk factors and guidelines; (2)have lower perceived susceptibility to cervical cancer, and perceive greater barriers; (3)perceive fewer benefits to screening; and (4)be less likely to receive physician recommendation for Pap test. We propose a cross-sectional study of approximately 1,000 self-identified lesbians randomly selected from a large pool of internet survey respondents maintained by Harris Interactive. The proposed study will use Internet survey methodology. Successful completion of this study will contribute to the public health objective of increasing women's overall rates of participation in cervical cancer screening-a Healthy People 2010 objective-- and allow us to design an intervention to address barriers to screening in lesbians and increase their adherence to recommended screening guidelines. Lesbians are an underserved, understudied group of women who may be at greater risk for cervical cancer due to their health habits, perceptions, and behaviors. Reducing cancer disparities in underserved groups of women is a major public health objective outlined in the Healthy People 2010 plan. The proposed study will allow us to identify critical barriers to Pap screening in lesbians and to use these findings to design an intervention to address barriers to screening in order to increase rates of screening in this underserved group of women.
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