Life Stressors Are an Important Reason for Women Discontinuing Follow-up Care for Cervical Neoplasia
- 1School of Public Health, University of Texas Health Science Center, Houston, Texas; 2College of Nursing, Medical University of South Carolina, Charleston, South Carolina; and 3Department of Pathology, School of Medicine, University of South Carolina, Columbia, South Carolina
- Requests for reprints:
Ann L. Coker, School of Public Health, University of Texas, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225. Phone: 713-500-9955; Fax: 713-500-9264. E-mail: ann.l.coker{at}uth.tmc.edu
Abstract
Although studies have addressed psychosocial factors associated with obtaining follow-up care for an abnormal Pap test, none have explored the effect of stressful life events in predicting the receipt of follow-up care for an abnormal Pap test. Data from a program (1995-2001) that provided free follow-up care for women with low-grade cervical lesions (n = 601) was used to determine whether life stressors increased risk of study discontinuation. Women were interviewed at baseline and offered follow-up at 4- to 6-month intervals for up to 24 months. Of the 556 women recruited and interviewed (92% response rate), 53 were referred out because they had high-grade cervical lesions and 33 had a health condition precluding follow-up. Among 470 women who began follow-up, 175 (37.2%) discontinued before completing three visits. Women who discontinued were significantly more likely to report more stressful life events in the past year [age-adjusted relative risk (aRR), 1.19; 95% confidence interval (95% CI), 1.08-1.30; 17-item scale]. Events most strongly associated with discontinuation included having a problem with a boss (aRR, 1.9; 95% CI, 1.5-2.4), severe physical partner violence (aRR, 1.7; 95% CI, 1.3-2.2), being homeless (aRR, 2.1; 95% CI, 1.6-2.8), and having an unplanned pregnancy (aRR, 1.5, 95% CI, 1.2-2.1). Life stressors may be important predictors of discontinuation of free follow-up care among women in need of immediate follow-up care to prevent lesion progression. (Cancer Epidemiol Biomarkers Prev 2006;15(2):321–5)
Footnotes
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Grant support: National Cancer Institute First Award, NIH grant R29-CA-57466 (A.L. Coker), U.S. Department of Defense grant N00014-96-1-1298 (Medical University of South Carolina), and The Healthy South Carolina Initiative.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted December 22, 2005.
- Received March 2, 2005.
- Revision received November 29, 2005.
