A steady decline in cervical cancer incidence and mortality in the United States has been attributed to increased uptake of cervical cancer screening tests such as Papanicolau (Pap) tests. However, disparities in Pap test compliance exist, and may be due in part to perceived barriers or lack of knowledge about risk factors for cervical cancer. This study aimed to assess correlates of cervical cancer risk factor knowledge and examine socio-demographic predictors of self-reported barriers to screening among a group of low-income uninsured women. Survey and procedure data from 433 women, who received grant-funded cervical cancer screenings over a span of 33 months, were examined for this project. Data included demographics, knowledge of risk factors, and agreement on potential barriers to screening. Descriptive analysis showed significant correlation between educational attainment and knowledge of risk factors (r = 0.1381, P < 0.01). Multivariate analyses revealed that compared to Whites, Hispanics had increased odds of identifying fear of finding cancer (OR 1.56, 95% CI 1.00–2.43), language barriers (OR 4.72, 95% CI 2.62–8.50), and male physicians (OR 2.16, 95% CI 1.32–3.55) as barriers. Hispanics (OR 1.99, 95% CI 1.16–3.44) and Blacks (OR 2.06, 95% CI 1.15–3.68) had a two-fold increase in odds of agreeing that lack of knowledge was a barrier. Identified barriers varied with age, marital status and previous screening. Programs aimed at conducting free or subsidized screenings for medically underserved women should include culturally relevant education and patient care in order to reduce barriers and improve screening compliance for safety-net populations.

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Effective development and implementation of strategies to improve screening rates should aim at improving access to health care, taking into account demographic characteristics such as rural versus urban residence.

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Background: Administrative churn occurs when a household exits the Supplemental Nutrition Assistance Program (SNAP) and then returns to the program within 4 months. Although a number of studies have examined health care utilization patterns related to Medicaid administrative churn less is known about health care utilization patterns among Medicaid-insured SNAP enrollees. Objectives: To investigate the characteristics and health care utilization patterns of Medicaid insured SNAP participants who experience SNAP administrative churn. Research Design: Retrospective cohort study using 2010–2013 SNAP benefit data from the state of Missouri linked to Medicaid claims data for the same time period. Individual fixed effect regression analysis was used to investigate differences in health care claims for churners and nonchurners across various health care settings. Subjects: Missouri residents ages 18–64 who were Medicaid-insured SNAP enrollees. Measures: Inpatient, outpatient, emergency department (ED), and pharmacy claims, and churn status. Results: Half of our sample (49.63%) experienced administrative churn. In the descriptive analyses, churners had fewer claims for prescription drugs than nonchurners (25.42% vs. 30.47%), but more claims for ED visits (3.79% vs. 2.74%). Adjusting for individual fixed characteristics, inpatient claims occurred with more frequency during periods of churn than while on SNAP, whereas ED, outpatient, and pharmacy claims occurred with less frequency during periods of churn than while on SNAP. Conclusions: SNAP administrative churn was very common among our study sample. Given that health care utilization patterns varied for churners compared with nonchurners, it is important that researchers and public health professionals not assume stable SNAP receipt among participants.