Although long-term trends demonstrate a decreasing incidence of cervical cancer in U.S. women, a disproportionate share of low-income and minority women experience high rates of precancerous cervical abnormalities and invasive cervical cancer. Despite this, women of lower income and education levels are less likely to receive recommended Pap smear testing than women of higher socioeconomic status. Numerous studies have attempted to identify the underlying causes of this pattern of care by examining psychosocial and health-related burdens present in the lives of poor women. Associations between receipt of Pap smear screening and homelessness, race/ethnicity, child care needs, language barriers, culturally based belief models, chronic medical disease, poor functional health status, and high-risk lifestyle practices have been previously demonstrated. Other studies have emphasized the importance of having access to medical care as the key determinant of receiving adequate Pap smear screening. Yet, with the exception of a single study with a small sample of homeless women, the relative contribution of access factors compared with a broad range of social, physical, and mental health barriers to cervical cancer screening among poor women has not been well described.

The rates and correlates of receipt of Pap testing among a sample of homeless and very low-income housed women with dependent children are reported here, with data available on a wide variety of psychosocial, physical, and mental health domains. This information was obtained during in-depth interviews with study participants in the Worcester Family Research Project.