Abstract
Objective: To determine relationships of socio-economic factors and contraceptive behaviours with PAP testing in sexually active women aged 15–19 who had received physician services in northern Nova Scotia in the previous year.
Methods: A cross-sectional survey was completed by adolescents attending four high schools in three counties in northern Nova Scotia. Questions concerned contraceptive behaviours, socio-economic status and health services use, including PAP testing. Associations of socio-economic factors and contraceptive behaviours with receipt of a PAP test in the previous year were examined in women who were sexually active for at least one year, and who also had visited a physician during the previous year.
Results: One thousand and ninety adolescent women aged 15–19 completed surveys, with a response rate of 91%. Of the 396 (36.3%) who reported being sexually active and having visited a physician in the previous year, 393 provided information about PAP testing. Of these, 214 (54.5%) reported receiving a PAP test. Factors associated with PAP testing included viewing one’s family as advantaged and living in a major town as opposed to a more rural area. Compared with using hormonal contraception, using either condom without other effective contraception or no effective contraception at last intercourse were negatively associated with PAP testing.
Conclusions: These findings suggest that physicians use hormonal contraception as a cue for PAP testing in adolescent women. Guidelines call for regular PAP testing of sexually active adolescents, and efforts to increase adolescent PAP testing should include professional development to increase recognition of sexual activity.
MeSH terms: Adolescent, Papanicolaou smear, contraception
Résumé
Objectif: Déterminer les liens entre les facteurs socioéconomiques et les schémas de contraception, d’une part, et le dépistage cytologique du cancer du col (test de Papanicolaou), d’autre part, chez les adolescentes sexuellement actives de 15 à 19 ans ayant consulté un médecin dans le Nord de la Nouvelle-Écosse au cours de l’année précédente.
Méthode: Des élèves de quatre écoles secondaires situées dans trois comtés du Nord de la Nouvelle-Écosse ont répondu à un questionnaire transversal. Les questions portaient sur les schémas de contraception, le statut socioéconomique et l’utilisation des services de santé, y compris le dépistage du cancer du col. Nous avons examiné les liens des facteurs socioéconomiques et des schémas de contraception avec le fait d’avoir subi un test de dépistage du cancer du col au cours de l’année précédente chez les adolescentes sexuellement actives depuis au moins un an et qui avaient aussi consulté un médecin pendant l’année précédente.
Résultats: Mille quatre-vingt-dix (1 090) adolescentes de 15 à 19 ans ont rempli des questionnaires, soit un taux de réponse de 91 %. Sur les 396 répondantes ayant dit être sexuellement actives et avoir consulté un médecin au cours de l’année précédente (36,3 %), 393 ont fourni de l’information sur le dépistage du cancer du col. Parmi elles, 214 (54,5 %) ont déclaré avoir subi un test de dépistage du cancer du col. Les facteurs associés à ce test étaient le fait de se considérer comme faisant partie d’une famille aisée et le fait de vivre dans une grande ville plutôt que dans une région rurale. Par opposition à la contraception hormonale, l’utilisation d’un condom sans autre moyen contraceptif efficace ou l’absence de tout moyen contraceptif efficace lors de la dernière relation sexuelle avec pénétration étaient négativement associées au dépistage du cancer du col.
Conclusions: Ces constatations donnent à penser que les médecins se basent sur la contraception hormonale pour administrer le test de dépistage du cancer du col aux adolescentes. Or, le dépistage périodique du cancer du col est recommandé pour toutes les adolescentes sexuellement actives; les efforts pour accroître ce type de dépistage devraient prévoir des mesures de perfectionnement professionnel pour permettre aux médecins de reconnaître plus facilement l’activité sexuelle chez les adolescentes.
Footnotes
Acknowledgement: This research was funded by the Social Sciences and Humanities Research Council (SSHRC) Grant no. 828-1999-1024.
References
- 1.Walsh G, Saint-Jacques N, MacIsaac M, MacIntyre M, Grimshaw R, Dewar R, et al. Cancer Care Nova Scotia. 2003. Gynecological cancer and cervical screening in Nova Scotia: A portrait for the period ending 2001. [Google Scholar]
- 2.Elovainio L, Nieminen P, Miller AB. Impact of cancer screening on women’s health. Int J Gynaecol Obstet. 1997;58:137–47. doi: 10.1016/S0020-7292(97)02859-2. [DOI] [PubMed] [Google Scholar]
- 3.Boyce W, Doherty M, Fortin C, MacKinnon D. Council of Ministers of Education of Canada. 2003. Canadian Youth, Sexual Health and HIV/AIDS Study Factors Influencing Knowledge, Attitudes and Behaviours. [Google Scholar]
- 4.Langille DB, Beazley R, Shoveller J, Johnston G. Prevalence of high risk sexual behaviour in adolescents attending school in a county in Nova Scotia. Can J Public Health. 1994;85:227–30. [PubMed] [Google Scholar]
- 5.Poulin C. Nova Scotia Student Drug Use 1998: Highlights Report. Halifax: Nova Scotia Department of Health.; 1998. [Google Scholar]
- 6.Lipskie TL. A summary of cancer screening guidelines. Chron Dis Can. 2000;19:1–23. [PubMed] [Google Scholar]
- 7.Maticka-Tyndale E. Sexual health and Canadian youth: How do we measure up? Can J Human Sexual. 2001;10:1–17. [Google Scholar]
- 8.Langille D. Adolescent sexual behaviours and teenage pregnancy; 2004. [Google Scholar]
- 9.Gupta S, Roos LL, Walld R, Traverse D, Dahl M. Delivering equitable care: Comparing preventive services in Manitoba. Am J Public Health. 2003;93:2086–92. doi: 10.2105/AJPH.93.12.2086. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Johnston GM, Boyd CJ, MacIsaac MA. Community-based cultural predictors of PAP smear screening in Nova Scotia. Can J Public Health. 2004;95:95–98. doi: 10.1007/BF03405774. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Mullan E, Currie C. Socio-economic inequalities in adolescent health. In: Curri C, Hurrelman K, Setterobulte W, Smith R, Todd J, editors. Health and Health Behaviour in Young People. 2000. [Google Scholar]
- 12.Liberatos P, Link B, Kelsey J. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121. doi: 10.1093/oxfordjournals.epirev.a036030. [DOI] [PubMed] [Google Scholar]
- 13.Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to Their Development and Use. New York, NY: Oxford University Press; 1995. pp. 116–18. [Google Scholar]
- 14.Fu H, Darroch JE, Haas T, Ranjit N. Contraceptive failure rates: New estimates from the 1995 National Survey of Family Growth. Fam Plann Perspect. 1999;31:56–63. doi: 10.2307/2991640. [DOI] [PubMed] [Google Scholar]
- 15.Hislop TG, Deschamps M, Band PR, Smith J, Clarke HF. Participation in the British Columbia cervical cytology screening programme by Native Indian women. Can J Public Health. 1992;83:344–45. [PubMed] [Google Scholar]
- 16.Hislop TG, Clarke HF, Deschamps M, Joseph R, Band PR, Smith J, et al. Cervical cancer screening: How can we improve rates among First Nations women in urban British Columbia? Can Fam Phys. 1996;42:1702–812. [PMC free article] [PubMed] [Google Scholar]
- 17.Young TK, Kliewer E, Blanchard J, Mayer T. Monitoring disease burden and preventive behavior with data linkage: Cervical cancer among aboriginal people in Manitoba, Canada. Am J Public Health. 2000;90:1466–68. doi: 10.2105/AJPH.90.9.1466. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Statistics Canada. Community Profiles. 2001. [Google Scholar]
- 19.Langille D, Hughes J, Tomblin Murphy G, Rigby JA. Contraception among young women attending high school in rural Nova Scotia. Can J Public Health. 2002;93:461–64. doi: 10.1007/BF03405040. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Moser M. Results of a national survey of physician’s knowledge and application of preventative capabilities. Am J Prev Med. 1991;7:384–90. doi: 10.1016/S0749-3797(18)30876-6. [DOI] [PubMed] [Google Scholar]
- 21.Maheux B, Haley N, Rivard M, Gervais A. STD risk assessment and risk-reduction counselling by recently trained family physicians. Acad Med. 1995;70:726–28. doi: 10.1097/00001888-199508000-00018. [DOI] [PubMed] [Google Scholar]
- 22.Langille DB, Gailiunas P, Mann K. Perceptions of their adolescent pregnancy and STD prevention practices by primary care physicians in a Nova Scotia county. Am J Prev Med. 1997;13:324–30. doi: 10.1016/S0749-3797(18)30183-1. [DOI] [PubMed] [Google Scholar]