Factors associated with PAP testing in adolescents in northern Nova Scotia

To determine relationships of socio-economic factors and contraceptive behaviours with PAP testing in sexually active women aged 15-19 who had received physician services in northern Nova Scotia in the previous year.

A cross-sectional survey was completed by adolescents attending four high schools in three counties in northern Nova Scotia. Questions concerned contraceptive behaviours, socio-economic status and health services use, including PAP testing. Associations of socio-economic factors and contraceptive behaviours with receipt of a PAP test in the previous year were examined in women who were sexually active for at least one year, and who also had visited a physician during the previous year.

One thousand and ninety adolescent women aged 15-19 completed surveys, with a response rate of 91%. Of the 396 (36.3%) who reported being sexually active and having visited a physician in the previous year, 393 provided information about PAP testing. Of these, 214 (54.5%) reported receiving a PAP test. Factors associated with PAP testing included viewing one's family as advantaged and living in a major town as opposed to a more rural area. Compared with using hormonal contraception, using either condom without other effective contraception or no effective contraception at last intercourse were negatively associated with PAP testing.

These findings suggest that physicians use hormonal contraception as a cue for PAP testing in adolescent women. Guidelines call for regular PAP testing of sexually active adolescents, and efforts to increase adolescent PAP testing should include professional development to increase recognition of sexual activity.