The Association Between Sexual Abuse and Adherence to Risk-Appropriate Cervical Cancer Screening Guidelines: A Study of Women in Appalachian Ohio

Abstract

Our objective was to determine if a history of forced sex influenced the likelihood of meeting risk-appropriate cervical cancer (CC) screening guidelines among women in Appalachian Ohio. Methods: We used data collected from initial recruitment for Community Awareness Resources and Education (CARE) I projects 1 and 2. Women were randomly selected from 14 Ohio Appalachian clinics. Risk-appropriate guidelines were defined as having had a Pap smear within 13 months of study interview among high risk women and within 37 months of interview among low risk women. High risk was defined as meeting any of the following criteria: 5 or more sexual partners during their lifetime; intercourse before 18; a current smoker; diagnosis of an STI; or a sexual partner diagnosed with an STI. Low-risk women did not meet any of these criteria. Associations between meeting guidelines and patient characteristics were evaluated by calculating odds ratios (OR) and corresponding 95% confidence intervals (CI) using logistic mixed model regression, with clinic incorporated as a random effect. Significant factors were included in a multivariable regression model assessing the association between exposure to forced sex and meeting CC screening guidelines. Results: Of the 571 women in this study, 105 (18.4%) reported being forced to have sex, 456 (79.9%) did not report forced sex, and 10 (1.8%) refused to answer or didn't know. We observed significant crude associations between meeting risk-appropriate CC screening guidelines and potential confounders: socioeconomic status (low vs. intermediate: OR = 2.46, CI:1.48–4.09; low vs. high: OR = 2.78, CI:1.65–4.72), marital status (divorced/widowed/separated vs. married/member of couple: OR = 2.03, CI:1.90–6.92; divorced/widowed/separated vs. never married: OR = 3.63, CI:1.90–6.92), and smoking status (never vs. former: OR = 2.46, CI:0.32–0.84; never vs. current: OR = 0.51, CI:0.33–0.78). Adjusted for these factors and current age, women forced to have sex had significantly lower odds of being within screening guidelines (OR = 0.32, CI:0.20–0.53). Conclusions: Women exposed to forced sex have lower odds of meeting risk-appropriate CC screening guidelines. This population needs additional efforts to ensure adherence to CC screening guidelines.