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The association of socioeconomic status with cervical cancer risk misperceptions, Pap smear screening adherence and cervical outcomes among Ohio Appalachian women

Bernardo, Brittany Marie
http://rave.ohiolink.edu/etdc/view?acc_num=osu1585049392819132

Abstract Details

2020, Doctor of Philosophy, Ohio State University, Public Health.
Compared to the rest of the United States (U.S), Appalachia experiences significant health and economic disparities. Appalachian women are at increased risk for many chronic diseases, including cervical cancer. Prior research has suggested that the prevalence of risk factors for cervical cancer, including high-risk human papillomavirus (HPV) infection, is high among Appalachian women. Prior research also suggests that Appalachian women mostly perceive themselves to be at average risk of cervical cancer. One goal of this research was to compare an objective measure of cervical cancer risk to a woman’s perceived risk of cervical cancer to determine misperceptions of risk. The main interest in misperception is to determine if there is an association of socioeconomic status (SES) at an individual as well as county-level with cervical cancer risk misperceptions. Considering that there is no published research investigating cervical cancer risk misperceptions, this dissertation will present novel findings in the domain of cervical cancer risk misperception research. Additionally, it is of interest to determine if cervical cancer risk misperception mediates the relationship between an individual’s socioeconomic status and their adherence to cervical cancer screening guidelines. Lastly, this research will examine the association between individual and county-level SES with the outcomes of high-risk HPV infection and current abnormal Pap smear. Data for these studies were drawn from the Community Awareness Resources and Education (CARE) 1 project 3 study, a case-control study designed to determine variables associated with cervical cancer abnormalities among Ohio Appalachian women. HPV status was determined by biological specimen, and information regarding risk factors for cervical cancer were obtained from study surveys to construct an index for cervical cancer risk. Participants were categorized as low, average, or high risk for cervical cancer and this objective classification was compared to an individual’s subjective determination of risk to determine potential risk misperceptions. Individual socioeconomic status was a composite score based on education, occupation, and income and county-level SES was a second composite score based on 6 county-level variables associated with socioeconomic status. The outcome for Aim 1 was risk misperception, a categorical variable consisting of optimistic risk perception (under-estimation of risk), pessimistic risk perception (over-estimation of risk), or accurate risk misperception. Multiple imputation was performed to impute missing data and multinomial logistic regression models with a random effect for county were utilized. Results from Aim 1 revealed that the majority of women in this study did not perceive their risk of cervical cancer accurately. Though there was no significant association of risk misperceptions with socioeconomic status, results revealed that age was significantly associated with unrealistic pessimism for cervical cancer and alcohol use was significantly associated with unrealistic optimism for cervical cancer. The outcome for Aim 2 was adherence to cervical cancer screening guidelines, which was based on date of current Pap smear and date of last self-reported Pap smear. The exposure of interest for this aim was individual socioeconomic status and it was of interest to determine if risk misperception, as defined previously, mediated the relationship between individual socioeconomic status and adherence to cervical cancer screening guidelines. Results revealed that 26% of participants were not within guidelines for cervical cancer screening. Using Valeri and Vanderwheele’s approach to mediation analysis, misperception was investigated as a potential mediator of the association between individual socioeconomic status and adherence to cervical cancer screening guidelines. Results revealed no evidence of misperception as a mediator of the relationship between SES and adherence to screening guidelines. Despite these null findings, these results are informative regarding the proposed relationship between risk misperception and adherence to screening, which suggests that there is no significant relationship between risk misperception and adherence to screening in this population. Therefore, we do not have evidence from this aim to suggest that intervening upon misperception would change the relationship between individual SES and screening. However, these results need to be interpreted cautiously considering the limitations of a clinic population and the inability to generalize these conclusions to non-clinic populations. For Aim 3, the outcomes of interest were high-risk human papillomavirus (HPV) infection and current abnormal Pap smear. Multiple imputation was utilized to impute missing data for variables of interest. Mixed models including a random effect for clinic as well as stratum to account for matching between the cases and controls were run and the relationship between individual socioeconomic status (SES) and the outcomes of high-risk HPV infection and current abnormal Pap smear were examined. Results revealed no significant association of individual socioeconomic status with abnormal Pap smear, but did reveal a significant relationship between individual SES and high-risk HPV infection. Overall, participants mostly misperceived their risk of cervical cancer, over a quarter of participants were not within guidelines for cervical cancer screening, and lower socioeconomic status was associated with increased odds for high-risk HPV infections. These results suggest there is a need for multi-level interventions in Appalachia. At the individual level, cervical cancer risk education as well as recommendations for adherence to appropriate cervical cancer screening could help to reduce misperceptions of risk as well as increase adherence to screening guidelines. Additionally, at the provider/clinic level, implementing ways to facilitate the identification of patients who may be at increased risk for cervical cancer or who are outside of screening guidelines would be beneficial to this population. Implementation science strategies such as these offer the opportunity for reduction of the cervical cancer burden in Ohio Appalachian women by facilitating identification of women most at risk for cervical cancer and utilizing provider and clinic-level strategies to mitigate that risk and create long-term change. These changes could include provider-patient risk education, leading to more accurate perceptions of cervical cancer risk and informed decision making by the patient, as well as increased adherence to cervical cancer screening among those outside of screening guidelines.
Electra Paskett (Advisor)
Tasleem Padamsee (Committee Member)
Michael Pennell (Committee Member)
Paul Reiter (Committee Member)
213 p.
Epidemiology; Public Health
Appalachia, Ohio Appalachia, Cervical Cancer, Risk Perception, Risk Misperception, Socioeconomic Status, Pap Smear, Screening Adherence, Human Papillomavirus, HPV, Abnormal Pap Smear

Recommended Citations

Citations

  • Bernardo, B. M. (2020). The association of socioeconomic status with cervical cancer risk misperceptions, Pap smear screening adherence and cervical outcomes among Ohio Appalachian women [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1585049392819132

    APA Style (7th edition)

  • Bernardo, Brittany. The association of socioeconomic status with cervical cancer risk misperceptions, Pap smear screening adherence and cervical outcomes among Ohio Appalachian women. 2020. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1585049392819132.

    MLA Style (8th edition)

  • Bernardo, Brittany. "The association of socioeconomic status with cervical cancer risk misperceptions, Pap smear screening adherence and cervical outcomes among Ohio Appalachian women." Doctoral dissertation, Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1585049392819132

    Chicago Manual of Style (17th edition)

osu1585049392819132
288
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This open access ETD is published by The Ohio State University and OhioLINK.