Factors associated with not having Pap Smears in São Leopoldo, Rio Grande do Sul, Brazil, 2015: a cross-sectional population-based study

Juvenal Soares Dias-da-Costa

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Cândido Norberto Bronzoni de Mattos

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Heloísa Marquardt Leite

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Heloísa Theodoro

Universidade de Caxias do Sul, Área do Conhecimento da Vida, Caxias do Sul, RS, Brasil

Lisiane Morelia Weide Acosta

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Melina Wedoy de Freitas

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Rafaela Balzaretti Bordin

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Fernanda Bairros

Universidade Federal do Rio Grande do Sul, Departamento de Assistência e Orientação Profissional, Porto Alegre, RS, Brasil

Tonantzin Ribeiro Gonçalves

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Maria Teresa Anselmo Olinto

Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, São Leopoldo, RS, Brasil

Correspondence: Juvenal Soares Dias-da-Costa - Universidade do Vale do Rio dos Sinos, Programa de Pós-Graduação em Saúde Coletiva, Avenida Unisinos, No. 950, São Leopoldo, RS, Brazil. Postcode: 93022-000. E-mail: episoares@terra.com.br

Authors’ contributions

Dias-da-Costa JS participated in the design, analysis, interpretation of data and drafting of the paper. Mattos CB, Leite HM, Theodoro H, Acosta LMW, Freitas MW and Bordin RB participated in the analysis, interpretation of data and drafting of the paper. Bairros F, Gonçalves TR and Olinto MTA participated in the study design, interpretation of relevant data and critical review of the intellectual content of the manuscript. All authors approved the final version of the manuscript and declared themselves to be responsible for all aspects of the study, ensuring its accuracy and integrity.

Variables	N (%)	% delayed	% never tested
Economic Classification
A/ B	347 (38.0)	8.6	3.5
C	465 (50.9)	20.4	9.0
D-E	102 (11.1)	36.3	17.6
Education level (in years of schooling )
≥15	83 (9.1)	6.0	2.4
12-14	126 (13.8)	14.3	6.4
8-11	333 (36.4)	13.5	7.5
5-7	203 (22.2)	26.6	11.8
0-4	169 (18.5)	23.7	7.7
Family income (in monthly minimum wages)
≥3	59 (6.6)	10.2	1.7
1-2.9	301 (33.7)	8.0	3.7
<1	534 (59.7)	23.6	11.0
Age (in years)
20-29	207 (22.5)	33.8	23.7
30-39	228 (24.8)	15.8	6.1
40-49	242 (26.3)	9.9	1.2
50-59	167 (18.2)	13.8	1.8
60-69	75 (8.2)	14.7	6.7
Ethnicity/skin color
White	684 (74.4)	17.4	7.5
Non-White	235 (25.6)	19.2	9.8
Marital status
Married/partnership	670 (72.9)	16.4	6.7
Single/divorced/widowed	249 (27.1)	21.7	11.6
Number of children
None	178 (19.4)	18.5	15.2
1-3	636 (69.4)	15.9	5.8
≥4	103 (11.2)	29.1	9.7
Age of menarche
8-11	217 (23.7)	19.8	7.8
12-13	422 (46.2)	18.2	9.2
≥14	275 (30.1)	15.6	6.2
Use of condoms
Use	179 (23.1)	16.9	9.6
Do not use	594 (76.9)	18.7	8.7
Number of medical appointments
≥5	326 (35.5)	13.2	6.1
3-4	170 (18.5)	9.4	3.5
1-2	277 (30.1)	15.2	6.1
None	146 (15.9)	43.2	21.2
Nature of health service
Private/healthcare plan	160 (57.1)	34.4	46.7
Public	120 (42.9)	65.6	42.7

Variables	Crude analysis		Adjusted analysis
Variables	PR^c(95%CI^d)	P-value	PR^c(95%CI^d)	P-value
First block - sociodemographic
Economic classificationa		<0.001		0.021
A/ B	1.0		1.0
C	2.4 (1.6;3.6)		1.5 (1.0;2.3)
D-E	4.2 (2.6;6.8)		2.1 (1.3;3.5)
Education level (in years of schooling )^a		<0.001		0.038
≥15	1.0		1.0
12-14	2.4 (0.9;6.4)		1.4 (0.6;3.5)
8-11	2.2 (0.9;5.6)		1.3 (0.5;3.1)
5-7	4.4 (1.8;11.0)		2.3 (0.9;5.6)
0-4	3.9 (1.6;9.9)		2.1 (0.9;5.0)
Family income (in monthly minimum wages)^a		<0.001		0.005
≥3	1.0		1.0
1-2.9	0.8 (0.3;1.9)		0.6 (0.2;1.5)
<1	2.3 (1.0;5.3)		1.1 (0.4;3.1)
Age (in years)^a		<0.001		<0.001
40-49	1.0		1.0
20-29	3.4 (2.1;5.4)		3.2 (2.1;4.9)
30-39	1.6 (0.9;2.7)		1.5 (0.9;2.4)
50-59	1.4 (0.8;2.5)		1.3 (0.7;2.5)
60-69	1.5 (0.7;3.0)		1.4 (0.7;2.8)
Ethnicity/skin color		0.584
White	1.0
Non-White	1.1 (0.8;1.5)		-
Marital status^a		0.094		0.258
Married/Partnership	1.0		1.0
Single/divorced/widowed	1.3 (0.9;1.8)		1.2 (0.9;1.6)
Second block - clinical
Number of children^b		0.014		0.073
None	1.0		1.0
1-3	0.9 (0.6;1.3)		0.7 (0.5;0.9)
≥4	1.6 (0.9;2.6)		0.8 (0.5;1.3)
Age of menarche		0.533
8-11	1.0
12-13	0.9 (0.6;1.3)
≥14	0.8 (0.5;1.2)		-
Condom use		0.618
Yes	1.0
No	1.1 (0.7;1.7)		-
Second block - clinical
Number of medical appointments^b		<0.001		<0.001
≥5	1.0		1.0
3-4	0.7 (0.4;1.3)		0.7 (0.5;1.1)
1-2	1.1 (0.7;1.8)		1.1 (0.7;1.8)
None	3.3 (2.2;4.8)		3.0 (2.1;4.1)
Nature of health service		0.012		0.124
Private/healthcare plan	1.0		1.0
Public	2.5 (1.2;5.3)		2.0 (0.8;4.8)

Variables	Crude analysis		Adjusted analysis
Variables	PR^c( 95%CI^d)	P-value	PR^c( 95%CI^d)	P-value
First block - sociodemographic
Economic classificationa		<0.001		0.015
A/ B	1.0		1.0
C	2.6 (1.4;5.0)		1.7 (1.0;3.0)
D/E	5.1 (2.5;10.6)		2.6 (1.4;5.0)
Education level (in years of schooling )^a		0.138		0.285
≥15	1.0		1.0
12-14	2.6 (0.6;12.4)		1.2 (0.3;6.1)
8-11	3.1 (0.7;13.1)		1.2 (0.3;5.2)
5-7	4.9 (1.2;20.8)		1.9 (0.4;8.8)
0-4	3.2 (0.7;14.7)		1.2 (0.3;5.6)
Family income (in monthly minimum wages)^a		<0.001		0.230
≥3	1.0		1.0
1-2.9	2.2 (0.3;16.7)		1.4 (0.2;13.2)
<1	6.5 (0.9;47.0)		2.4 (0.2;27.7)
Age (in years)^a		<0.001		<0.001
40-49	1.0		1.0
20-29	19.1 (5.9;61.3)		24.1 (6.4;90.9)
30-39	4.9 (1.4;17.2)		6.2 (1.6;23.4)
50-59	1.4 (0.3;7.2)		2.2 (0.3;14.0)
60-69	5.4 (1.3;22.5)		8.6 (1.6;46.8)
Ethnicity/skin color		0.279
White	1.0
Non-White	1.3 (0.8;2.1)		-
Marital status a		0.021		0.310
Married/Partnership	1.0		1.0
Single/divorced/widowed	1.7 (1.1;2.8)		1.2 (0.8;1.7)
Second block - clinical
Number of children^b		<0.001		<0.001
None	1.0		1.0
1-3	0.4 (0.2;0.6)		0.3 (0.2;0.5)
≥4	0.6 (0.3;1.3)		0.4 (0.2;0.8)
Age of menarche		0.379
8-11	1.0
12-13	1.2 (0.7;2.1)
≥14	0.8 (0.4;1.5)		-
Condom use		0.726
Yes	1.0
No	0.9 (0.5;1.6)		-
Second block - clinical
Number of medical appointments^b		<0.001		<0.001
≥5	1.0		1.0
3-4	0.6 (0.2;1.4)		0.6 (0.2;1.2)
1-2	1.0 (0.5;1.9)		0.9 (0.4;1.8)
None	3.5 (2.0;6.1)		2.9 (1.7;4.8)
Nature of health service		0.416
Private/healthcare plan	1.0		-
Public	1.5 (0.5;4.2)

Brasil