Validity of adolescent and young adult self-report of Papanicolaou smear results

doi:10.1016/S0029-7844(00)00987-X

Obstetrics & Gynecology

Volume 96, Issue 4, October 2000, Pages 625-631

https://doi.org/10.1016/S0029-7844(00)00987-X Get rights and content

Abstract

Objective: To assess the validity of adolescent and young adult report of Papanicolaou smear results and to determine sociodemographic, cognitive, and behavioral factors associated with incorrect reporting.

Methods: We conducted a cross-sectional study of 477 female subjects aged 12 to 24 years who attended an adolescent clinic and had a previous Papanicolaou smear. Subjects completed a self-administered survey assessing self-report of Papanicolaou smear results, knowledge about Papanicolaou smears and human papillomavirus (HPV), attitudes about Papanicolaou screening and follow-up, and risk behaviors. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported results were calculated using the cytology report as the standard. Variables significantly associated with incorrect reporting were entered into logistic regression models controlling for age and race to determine independent predictors for incorrect reporting.

Results: Of the 477 participants, 128 (27%) had abnormal cytology reports and 66 (14%) had incorrect self-reports. Sensitivity of self-report was 0.79, specificity 0.89, positive predictive value 0.72, negative predictive value 0.92, and kappa (κ) 0.66. The adjusted odds ratios (OR) and 95% confidence intervals (CI) of the variables comprising a logistic regression model predicting incorrect reporting were an HPV knowledge source of zero (OR 2.4, CI 1.0, 5.8), low perceived communication with the provider (OR 2.1, CI 1.1, 4.0), and no contraception at last intercourse (OR 5.5, CI 2.7, 11.0).

Conclusion: The validity of adolescent and young adult self-reported Papanicolaou smear result is high, except among those who lack knowledge of HPV, perceive poor communication with the provider, and use contraception inconsistently.

Section snippets

Materials and methods

We used baseline cross-sectional survey data from a prospective study of adolescents and young adults. The target population consisted of 558 female subjects aged 12 to 24 years seen in an urban, hospital-based adolescent clinic between October 1998 and June 1999 who had a history of sexual intercourse and prior Papanicolaou smear(s) done at the hospital. Exclusion criteria were inability to complete the written questionnaire independently (n = 24) and patient report of an abnormal Papanicolaou

Results

The mean age of the 477 participants was 18 ± 2.1 years. Approximately half were non-Hispanic black. Most subjects were in school, and approximately half were enrolled in Medicaid (Table 1). The mean age at menarche was 11.8 ± 1.7 years, the mean age at coitarche was 15.0 ± 2.1 years, the median number of lifetime sexual partners was three, and the median number of previous Papanicolaou smears was two. Sixty-three percent of patients had had more than one previous Papanicolaou smear. Of those

Discussion

The validity of self-reported Papanicolaou smear results as normal compared with abnormal was high in this population of young women attending an urban, hospital-based adolescent clinic. The concordance of 86% between adolescent and laboratory reports refutes our hypothesis that young women would not report Papanicolaou results correctly. However, the findings support our hypotheses that low knowledge of HPV, poor perceived communication with the provider, and sexual risk behaviors are

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^☆: This study was supported by the Deborah Munroe Noonan Memorial Fund, and by Projects No. MCJ-MA259195 and MCJ-000964 from the Maternal-Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Resources.

¹: The authors gratefully acknowledge the valuable contributions of Frank Biro, MD, for critical review of the manuscript; Victoria Chiou, for subject recruitment, data entry, and assistance with data analysis; and Jonathan Ellen, MD, Lawren Daltroy, PhD, and Karen Emmons, PhD, for assistance with scale development and analysis.

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Validity of adolescent and young adult self-report of Papanicolaou smear results1☆,

Abstract

Section snippets

Materials and methods

Results

Discussion

J Adolesc Health

Am J Obstet Gynecol

J Adolesc Health

J Pediatr

Am J Obstet Gynecol

J Adolesc Health

Am J Obstet Gynecol

J Pediatr

J Pediatr Adolesc Gynecol

J Adolesc Health

J Adolesc Health

Organ Behav Hum Decis Processes

Am J Prev Med

Am J Prev Med

J Clin Epidemiol

J Clin Epidemiol

Prev Med

Am J Prev Med

Abnormal cervical cytology in adolescentsA 15-year experience

J Reprod Med

Is the nature of cervical carcinoma changing in young women?

Obstet Gynecol Surv

Increased prevalence of abnormal Papanicolaou smears in urban adolescents

Arch Pediatr Adolesc Med

Colposcopic and histologic findings and human papillomavirus DNA test variability in young women positive for HPV DNA

J Infect Dis

Validity of adolescent and young adult self-report of Papanicolaou smear results¹☆,