ASPO Abstracts
Use of cervical cancer preventive services among U.S. women aged 21-29: An analysis of the impact of the 2010 Affordable Care Act requirement for coverage of preventive services without cost-sharing
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Since the 2010 rollout, the Affordable Care Act (ACA) has provided millions of people with health insurance
coverage (Berchick, Hood, & Barnett, 2018) and facilitated routine cancer screening by requiring insurance
providers to cover preventive services without cost-sharing (Kaiser Family Foundation, 2013). Despite greater
access to affordable cancer screening, trends in Pap testing continue to show declines over time (Hall et al., 2018;
Watson, Benard, & Flagg, 2018). Using multi-year responses from the Behavioral Risk Factor Surveillance
System, we examined the effect of the ACA on participation in and adherence to Pap testing and HPV vaccination
behaviors as set by guidelines from the American Cancer Society. The sample included women aged 21-29 who
completed the survey between 2008 and 2018 (every other year) and who live in 24 U.S. States. As predicted,
results showed significant and consistent decreases in Pap testing rates but increases in the uptake of the HPV
vaccine series for all age groups and across all demographic variables. However, post-ACA year significantly
predicted increases in HPV + Pap co-testing participation and adherence. Women with health insurance coverage
were consistently more likely to engage in both behaviors. Results raise concerns around declines in the
proportion of women receiving and adhering to Pap testing guidelines. Evidence suggests that increases in HPV
vaccination uptake may be responsible for decreases in Pap testing among women in our study. We highlight a
need for effective strategies that aim to increase cervical cancer screening uptake among women who have been
vaccinated against HPV.
Keywords: Cervical cancer screening Affordable Care Act HPV vaccination