Psychosocial Correlates of Ever Having a Pap Test and Abnormal Pap Results in a Sample of Rural Appalachian Women

Kristen P. Mark, Richard A. Crosby, Robin C. Vanderpool

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Despite known prevention and screening efforts, there are higher invasive cervical cancer rates in Appalachia than in other areas of the United States and higher mortality rates in the Appalachian region of Kentucky compared to Appalachian regions of other states. Purpose: The primary purpose of this study was to investigate the association of psychosocial factors relevant to cervical cancer and the outcome of ever having a Pap test in a rural sample of women. The secondary purpose was to determine whether any of the same psychosocial factors were also associated with ever having an abnormal Pap test result among women with a self-reported history of having one or more Pap tests in their lifetime. Methods: Data were collected in fall of 2013 from 393 women in 8 economically distressed counties of rural Appalachian Kentucky. Women completed an interviewer-administered survey assessing sociodemographic and health information as well as beliefs about cervical cancer. Findings: Multivariate logistic regression results indicated that low income and greater perceived local fatalism were significant predictors of never having a Pap test. Lack of personal control over prevention, and peer and family influences were significant predictors of ever having an abnormal Pap test result. Conclusions: Educational efforts targeted in rural Appalachia would be supported by encouraging the benefits of early and consistent screening, altering the established norms of community fatalism and lack of personal control over prevention, and creating targeted messages through public campaigns that convince rural Appalachian women that cervical cancer is highly preventable and screenable.

Original languageEnglish
Pages (from-to)148-154
Number of pages7
JournalJournal of Rural Health
Issue number2
StatePublished - Mar 1 2018

Bibliographical note

Publisher Copyright:
© 2017 National Rural Health Association


  • Appalachian women
  • Pap screening
  • community fatalism
  • psychosocial predictors
  • women's cervical health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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