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Impact of health-related behavioral factors on participation in a cervical cancer screening program: the lifelines population-based cohort

Introduction: Regular participation in cervical cancer screening (CCS) is a critical to reduce cervical cancer mortality. Although sociodemographic factors (socioeconomic status, age, etc.) are well-known factors related to one-time participation in CCS, little is known about other factors related to regular participation. This study aimed to evaluate the association between health-related behavioral factors and regular participation in CCS, adjusted by sociodemographic factors.
Study design and setting: Lifelines population-based cohort was linked to CCS-related data from the Dutch Nationwide Pathology Databank. Women eligible for the four screening rounds between 2000 to 2019 were included and classified as regular (participated four-times), irregular (participated one to three-times), and non-participants. Multinomial logistic regression was performed to evaluate the association between behavioral factors and participation regularity adjusted by country of birth/ethnicity, educational level, income level, and marital status.
Results: In total, 48,325 women were included, of which 55.9% were regular participants, 35.1% were irregular, and 9% non-participants. After adjustment for sociodemographic factors, smoking, obesity, marginal and inadequate sleep duration, and low physical activity increased the likelihood of irregular or non-participation, while hormonal contraception use decreases the likelihood of irregular or non-participation in CCS.
Conclusion: These findings show that unhealthy behavioral factors are associated with irregular or non-participation in the CCS, even after adjustment for sociodemographic factors.

Key words: Uterine Cervical Neoplasms, Early Detection of Cancer, Patient Compliance, Life Style; Reproductive History.

Year of publication



BMC public health


CastaƱeda, K.M.
Sidorenkov, G.
Mourits, M.J.E.
van der Vegt, B.
Siebers, A.G.
Vermeulen, K.M.
et al.

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