Immigrant women and cervical cancer screening uptake: a multilevel analysis.

BACKGROUND Contextual factors may play an influential role in determining individual uptake of preventive health care services, especially among potentially vulnerable subpopulations. Using cervical cancer screening as a case study, this paper examines the multilevel factors associated with Pap testing in native-born and immigrant women. METHODS Cross-sectional multilevel logistic regression models were used to identify the individual- and neighbourhood-level characteristics that might explain differences in the lifetime uptake of Pap testing among immigrants and native-born women between the ages of 18 and 69 residing in the Montreal, Toronto and Vancouver Census Metropolitan Areas (CMAs). Individual-level data were drawn from the Canadian Community Health Survey (Cycle 2.1, 2003) and linked with census tract profile data from the Canadian Census (2001). RESULTS Findings reveal significant between-neighbourhood variation in uptake. After controlling for age, marital status, access to a regular doctor and socio-economic status, a woman's immigrant status and cultural origin appear to be significantly associated with ever having had a Pap test. In particular, the uptake of cervical cancer screening is less common among recent immigrant women and women of Chinese, South Asian and other Asian backgrounds. INTERPRETATION There appear to be significant differences between neighbourhoods and CMAs in the uptake of Pap testing. Findings point to the role of cultural origin, which largely accounts for these differences. This indicates the need to promote greater information and awareness of public health services for cervical cancer screening, especially among recent immigrant women with such backgrounds.