- Email: [email protected]
Personal meaning of HPV and Pap test results in adolescents
130
Abstracts / 36 (2005) 111-154
put teens at risk for further STD acquisition. Providers must do more to improve their patients’ understanding of the testing done during their SHV and the interpretation of these test results. Support: Ctr. of Excellence for Minority Health, Univ. of Pennsylvania Sch. of Med.
PII: S1054-139X(04)00341-6
38.
PERSONAL MEANING OF HPV AND PAP TEST RESULTS IN ADOLESCENTS Jessica A. Kahn MD, Gail B. Slap MD MS, David I. Bernstein MD, Abbigail M. Tissot BS, Linda M. Kollar MSN, Paula A. Hillard MD, Susan L. Rosenthal PhD. Depts. of Pediatrics, Cincinnati Children’s Hosp. Med. Ctr., Cincinnati, OH, and Univ. of Texas at Galveston, Galveston, TX. Purpose: Little is known about the psychological, behavioral and interpersonal responses of female adolescents to their HPV and Pap test results. Adult studies suggest that these responses may depend upon personal meaning of the test result. Our objectives were to identify the dimensions of personal meaning when an adolescent is informed of her HPV/Pap results and to develop a theoretical model that explains how personal meaning is derived. Methods: The study sample consisted of 100 sexually active, 14-21 year-old female adolescents recruited from an urban, hospital-based teen health center. Standardized protocols were used for pre-test participant education about HPV/Pap testing, collection of cervicovaginal specimens for testing, discussion of test results with participants, and post-test individual interviews to explore participants’ responses to their results. A five-stage qualitative analytic method was used to identify dimensions of personal meaning and develop a conceptual framework explaining the pathways by which it develops.
Results: Mean age of the sample was 17.2 (⫹ 1.9) yrs, and 82% of participants were Black. HPV tests were positive in 51% and Pap tests were abnormal in 23%. As shown in the conceptual framework, the data suggest that personal meaning included four core dimensions: labeling a result as a sexually transmitted infection (STI) or cancer; perceived risk (severity of and susceptibility to genital warts/cancer); perceived personal accountability for the result; and anticipated internal shame/external social stigma. Cognitive understanding of HPV and Pap test results (including an understanding of the abstract linkages between HPV infection, test result, and health outcomes) was the primary mechanism through which receipt of a test result led to the generation of personal
meaning. HPV/Pap education affected cognitive understanding, and previous experience with STI or cancer affected both cognitive understanding and its translation to personal meaning. Conclusions: When clinicians and educators communicate HPV and Pap test results to adolescents, they should provide accurate information that will help young women understand HPV and Pap results and their health consequences; explore cognitive understanding of results and personal experiences with STI and cancer; and address those dimensions of personal meaning (e.g. anticipated stigma) that may be associated with adverse psychological, behavioral and interpersonal outcomes. Support: Grant # AI50923-01, National Institute of Allergy and Infectious Diseases (Dr. Kahn).
PII: S1054-139X(04)00342-8 39.
OBTAINING SEXUAL HISTORIES AND SCREENING TEENS FOR CHLAMYDIA: ARE PROVIDERS BIASED? Kathleen Tebb, PhD, Jody Williams, MS (presenter), Roselle Branch, BS, Alison Goldberg, BA, Meaghan Pai-Dhungat, BS, Charles Wibbelsman, MD, Mary-Ann Shafer, MD. University of California, Department of Pediatrics, San Francisco, California. Purpose: Less than 1/2 of the sexually active young females are being screened annually for C. trachomatis(CT). To address barriers to screening, this study examined gender, ethnicity, and age disparities in adolescents who are screened for CT during regularly scheduled pediatric health checks. Methods: This study was part of a larger randomized controlled trial to increase CT screening among sexually active teens (14-18 years old) during their regularly scheduled health checks in 10 pediatric clinics between April 2000-March 2002 at a large Northern California health maintenance organization. Teens attending the 5 intervention clinics were asked to complete an anonymous survey at the end of their visit to determine site specific sexual activity rates in order to monitor CT screening rates. The survey gathered basic demographic information on the teens’ age, gender, and race/ethnicity. In addition, the survey asked: “Have you ever had sexual intercourse?” and “Did you have a test for STDs today?” Patients could respond, “Yes,” “No,” or “I don’t know.” The response rate was 74% with 4,371 participants. Results: There were 4,368 participants (49.5% female, 46.4% male and 4.1% did not report gender). The mean age was 15.4 years for females and 15.3 for males. The ethnicity of the overall population was: Asians 26.7%; Blacks 13.2%; Latino19.5%; Caucasian 25.5%; Multi-ethnic/other ethnicity 14.3%. Teens reported that 83% were asked about sexual activity by their provider; 19.7% had had sex (20.4% for females and 19.0% for males); 7% had an STD test on the day of their visit, 80.1% were not tested for an STD, and 12.5% did not know whether they were tested for an STD. The data indicated that there was no difference in STD screening across gender, ethnicity, or age groups; however, there were significant ethnic, age and gender differences in queries about sexual activity. Blacks were significantly more likely to report being asked than Asians (89% vs 81%, p⬍0.001) and Latinos (89% vs 81%, p⬍0.001); older teens were more likely to be asked about their sexual histories than younger teens (p⬍0.05); and female adolescents were more likely than males to be asked about their sexual histories (85% vs 83%, p⫽0.01).
Abstracts / 36 (2005) 111-154
put teens at risk for further STD acquisition. Providers must do more to improve their patients’ understanding of the testing done during their SHV and the interpretation of these test results. Support: Ctr. of Excellence for Minority Health, Univ. of Pennsylvania Sch. of Med.
PII: S1054-139X(04)00341-6
38.
PERSONAL MEANING OF HPV AND PAP TEST RESULTS IN ADOLESCENTS Jessica A. Kahn MD, Gail B. Slap MD MS, David I. Bernstein MD, Abbigail M. Tissot BS, Linda M. Kollar MSN, Paula A. Hillard MD, Susan L. Rosenthal PhD. Depts. of Pediatrics, Cincinnati Children’s Hosp. Med. Ctr., Cincinnati, OH, and Univ. of Texas at Galveston, Galveston, TX. Purpose: Little is known about the psychological, behavioral and interpersonal responses of female adolescents to their HPV and Pap test results. Adult studies suggest that these responses may depend upon personal meaning of the test result. Our objectives were to identify the dimensions of personal meaning when an adolescent is informed of her HPV/Pap results and to develop a theoretical model that explains how personal meaning is derived. Methods: The study sample consisted of 100 sexually active, 14-21 year-old female adolescents recruited from an urban, hospital-based teen health center. Standardized protocols were used for pre-test participant education about HPV/Pap testing, collection of cervicovaginal specimens for testing, discussion of test results with participants, and post-test individual interviews to explore participants’ responses to their results. A five-stage qualitative analytic method was used to identify dimensions of personal meaning and develop a conceptual framework explaining the pathways by which it develops.
Results: Mean age of the sample was 17.2 (⫹ 1.9) yrs, and 82% of participants were Black. HPV tests were positive in 51% and Pap tests were abnormal in 23%. As shown in the conceptual framework, the data suggest that personal meaning included four core dimensions: labeling a result as a sexually transmitted infection (STI) or cancer; perceived risk (severity of and susceptibility to genital warts/cancer); perceived personal accountability for the result; and anticipated internal shame/external social stigma. Cognitive understanding of HPV and Pap test results (including an understanding of the abstract linkages between HPV infection, test result, and health outcomes) was the primary mechanism through which receipt of a test result led to the generation of personal
meaning. HPV/Pap education affected cognitive understanding, and previous experience with STI or cancer affected both cognitive understanding and its translation to personal meaning. Conclusions: When clinicians and educators communicate HPV and Pap test results to adolescents, they should provide accurate information that will help young women understand HPV and Pap results and their health consequences; explore cognitive understanding of results and personal experiences with STI and cancer; and address those dimensions of personal meaning (e.g. anticipated stigma) that may be associated with adverse psychological, behavioral and interpersonal outcomes. Support: Grant # AI50923-01, National Institute of Allergy and Infectious Diseases (Dr. Kahn).
PII: S1054-139X(04)00342-8 39.
OBTAINING SEXUAL HISTORIES AND SCREENING TEENS FOR CHLAMYDIA: ARE PROVIDERS BIASED? Kathleen Tebb, PhD, Jody Williams, MS (presenter), Roselle Branch, BS, Alison Goldberg, BA, Meaghan Pai-Dhungat, BS, Charles Wibbelsman, MD, Mary-Ann Shafer, MD. University of California, Department of Pediatrics, San Francisco, California. Purpose: Less than 1/2 of the sexually active young females are being screened annually for C. trachomatis(CT). To address barriers to screening, this study examined gender, ethnicity, and age disparities in adolescents who are screened for CT during regularly scheduled pediatric health checks. Methods: This study was part of a larger randomized controlled trial to increase CT screening among sexually active teens (14-18 years old) during their regularly scheduled health checks in 10 pediatric clinics between April 2000-March 2002 at a large Northern California health maintenance organization. Teens attending the 5 intervention clinics were asked to complete an anonymous survey at the end of their visit to determine site specific sexual activity rates in order to monitor CT screening rates. The survey gathered basic demographic information on the teens’ age, gender, and race/ethnicity. In addition, the survey asked: “Have you ever had sexual intercourse?” and “Did you have a test for STDs today?” Patients could respond, “Yes,” “No,” or “I don’t know.” The response rate was 74% with 4,371 participants. Results: There were 4,368 participants (49.5% female, 46.4% male and 4.1% did not report gender). The mean age was 15.4 years for females and 15.3 for males. The ethnicity of the overall population was: Asians 26.7%; Blacks 13.2%; Latino19.5%; Caucasian 25.5%; Multi-ethnic/other ethnicity 14.3%. Teens reported that 83% were asked about sexual activity by their provider; 19.7% had had sex (20.4% for females and 19.0% for males); 7% had an STD test on the day of their visit, 80.1% were not tested for an STD, and 12.5% did not know whether they were tested for an STD. The data indicated that there was no difference in STD screening across gender, ethnicity, or age groups; however, there were significant ethnic, age and gender differences in queries about sexual activity. Blacks were significantly more likely to report being asked than Asians (89% vs 81%, p⬍0.001) and Latinos (89% vs 81%, p⬍0.001); older teens were more likely to be asked about their sexual histories than younger teens (p⬍0.05); and female adolescents were more likely than males to be asked about their sexual histories (85% vs 83%, p⫽0.01).