Health Disparity in Effective Cervical Cancer Screening: Findings from a National Survey of U.S.

Background: Cervical cancer is one of the most common causes of cancer death for women, but it can often be detected early and sometimes even prevented entirely by having regular tests. An effective way to prevent cervical cancer is to have screening tests. Even though cervical cancer screening programs are implemented in many countries and regions especially in developed countries, cervical cancer incidence has not been effectively controlled and there is still certain health disparity in the population. Inappropriate screening frequency may be the cause of the health disparity. Methods: Drawing on the data from the 2017 Health Information National Trends Survey (Cycle5.1), a national survey conducted by the National Cancer Institute (NCI), we characterized cervical cancer screening (CCS) as two dimensions by the item of screening frequency, namely, active screening and effective screening. We compared the differences between these two screening behavior applying ordered logistic regression and binary logistic regression, and explored the mechanisms of effective screening. Results: The impact factors differed between active screening and effective screening based on theory. Only self-efficacy (β=0.16, p=0.023) had a positively significant association with active screening behavior and both online health information seeking (β=-0.102, p<0.001) and social media participation (β=-0.466, p=0.001) negatively and significantly influenced effective screening behavior. Second, a theory-based mechanism of effective screening behavior found that traditional health perception factors no longer influence effective screening behavior, while environmental factors (social media) significantly reduce women's effective screening. In addition, the higher the level of education, the less inclined to conduct effective screening, but the more inclined to active screening for cervical cancer. Conclusions: Our results indicate that while the Internet has become the main channel through which women acquire health resources, and social media has become a main platform for people to obtain health information, online information cannot guide people to engage in appropriate healthy behaviors. Overloading of online health information and digital divide may cause excessive screening or screening avoidance. Consequently, we must pay attention to the health disparity caused by unreasonable health behaviors caused by factors such as environmental factors and the divide in the use of IT.