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Abstract
In this exploratory study the authors investigated characteristics, including reported experiences of violence, related to incarcerated women's self-report of cervical cancer screening and cancer history and treatment. During a four month period in 2010, 204 women in Kansas City jails were surveyed. Multiple logistic regression models were used to examine the relations of socio-demographic and community characteristics and history of violence among the women to their cervical cancer screening, diagnosis, and treatment histories. Forty percent of the women in the current sample reported abnormal Pap histories, though only 6% of all Pap smears done in the U.S. are abnormal. Women who reported abuse histories in this study were found to be more likely to report having ever had an abnormal Pap smear (for physical abuse Odds Ratio [OR] = 6.05; CI 2.36, 15.54 and for past year intimate partner violence OR = 2.41; CI 1.09, 5.31). Participants who did not fear neighborhood violence were less likely to report an abnormal Pap history (OR = 0.57; CI 0.34, 0.96) and more likely to visit a family doctor for their Pap screenings (OR = 1.91; CI 1.01, 3.60). Women who perceived greater neighborhood violence had increased odds of reporting that they received Pap screenings in a hospital setting (OR = 1.47; CI 1.08, 2.00). Frequency of Pap screening did not differ in women who did and did not have fear of neighborhood violence. This study highlights the heightened cervical cancer risk experienced by women with criminal justice histories and suggests that violence at several levels has implications for cervical cancer prevention for these women.
Notes
This project was funded by an American Cancer Society Institutional Research Grant to the University of Kansas School of Medicine (Principal Investigator of present study, Megha Ramaswamy; Principal Investigator of Institutional Research Grant, Bruce Kimler).
The authors would like to thank the administration of the Jackson County Detention Center/Regional Correctional Center and Wyandotte County Detention Center for their hospitality and support. Thanks also to the study participants for their time and contribution to this project. Finally, they thank Shiwani Srivastava for editorial support and Purna Mukhopadhyay for statistical consultation.
Notes. 1Drug dependence (Wilson et al., 1997), DSM IV criteria for drug dependence, 3 or more out of 6 criteria = drug dependence.
2CAGE measure of alcoholism (CitationEwing, 1984), 2 or more out of 4 questions = at risk for problem alcohol use.
3“In the neighborhood where you lived before being incarcerated, were you afraid you would be hurt by violence?” 1 = All the time, 2 = Most of the time, 3 = A little bit of the time, 4 = None of the time.
4Level of neighborhood violence (CitationSampson et al., 1997; CitationWright et al., 2004), High summary score = greater perceived neighborhood violence.
5Other categories included, Other health care provider = 7, Never had a Pap test = 6, 4 = Missing data.
Notes. 1“How often do you have Pap test usually?” Every year or every two–three years.
2Models for abnormal Pap, diagnosis of HPV, cervical cancer, and cervical cancer treatment were based on a reduced sample (N = 179) to reflect only those participants who had ever reported Pap screening when asked, “How often do you have a Pap test usually?”
3“Where do you go to get a Pap test usually?” My family doctor; Health center, community clinic, city or county health department; A hospital emergency room or clinic.
4Models for all three location of Pap screening variables were based on a reduced sample (N = 194) to reflect only those participants who reported a usual location of Pap screening (excluding those who never had a Pap test or had missing data) when asked, “Where do you go to get a Pap test usually?”
5Black race and White race were treated as dummy variables. All other racial/ethnic categories were excluded in this table due to low sample size, e.g., not enough data in cells to perform regression analysis.
6“If you have ever taken oral contraceptives or “the pill,” for how many years did you take them?”
7“Did anyone ever do any of the following things when you didn't want them to: touch the private parts of your body, make you touch their private parts, threaten or try to have sex with you, sexually force themselves on you?” 0 = Never; 1 = 1–2 times, 3 = 3–5; 4 = 6–10, 5 = >10.
*p ≤ 0.05
**p ≤ 0.01
***p ≤ 0.001.
Notes. 1The main independent variables in these models were individual and community level indicators of violence. All models were adjusted for other factors associated at the p ≤ 0.05 level with the dependent variables in bivariate analysis. In addition, the models for abnormal Pap, diagnosis of HPV, cervical cancer, and cervical cancer treatment were all adjusted for self-reported frequency of Pap screening.
2Models for abnormal Pap, diagnosis of HPV, cervical cancer, and cervical cancer treatment were based on a reduced sample (N = 179) to reflect only those participants who had ever reported Pap screening when asked, “How often do you have a Pap test usually?”
*p ≤ 0.05
**p ≤ 0.01
***p ≤ 0.001.
Notes. 1The main independent variables in these models were individual and community level indicators of violence. All models were adjusted for other factors associated at the p ≤ 0.05 level with the dependent variables in bivariate analysis.
2Models for all three location of Pap screening variables were based on a reduced sample (N = 194) to reflect only those participants who reported a usual location of Pap screening (excluding those who never had a Pap test or had missing data on this variable) when asked, “Where do you go to get a Pap test usually?”
*p ≤ 0.05
**p ≤ 0.01
***p ≤ 0.001.