Young Women's Health Awareness: Perceptions of Risk Factors for Cervical Cancer Among High School and University Students of New Brunswick

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Principal Investigator:

    Dr. Koumari Mitra

    Professor, Department of Anthropology

    University of New Brunswick, Fredericton

Graduate Research Assistant:

    Julie Easley

    M.A. Candidate, Department of Anthropology

    University of New Brunswick, Fredericton

 

This research study is based on an ongoing study entitled "Perceptions of Cancer and Health Seeking Behaviour: Strategies for Cancer Prevention and Control in New Brunswick", which received funding from the New Brunswick Regional Research Development Program (NBRRDP) and National Cancer Institute of Canada (NCIC) in September 2000.

1. Rationale: 

  • This research project is designed as a focused study assessing the status of cervical cancer prevention and control among high school and university students of New Brunswick.
  • Research studies pertaining to cancer prevention and control strategies have found that population screening for cervical cancer can greatly reduce cancer mortality and prevention combined with screening can prove to be an effective tool against cancer susceptibility (Franco et al., 2001).
  • Nearly 1500 new cases of cervical cancer were diagnosed in Canadian women in 2000, and an estimated 430 women died from the disease in the same year (Canadian Cancer Statistics, 2000).
  • The provinces with the highest incidence rates are Nova Scotia, Newfoundland and Prince Edward Island (Canadian Cancer Statistics, 2001).
  • According to the National Population Health survey, New Brunswick has the second largest number of women who have declined Pap smear tests for a variety of reasons (Cancer Services Action Plan for New Brunswick 1998:12).
  • In New Brunswick existing data  indicate that cancer screening initiatives for breast, prostate, and cervical cancer need to be greatly enhanced (Cancer Services Advisory Committee ,1998: Cancer Services Action Plan for New Brunswickers;  Canadian Strategy for Cancer Control, 2001. Draft Synthesis Report).

2. Theoretical Background:

  • Cervical cancer like many other cancers is multi factorial in origin and the single cause for this type of cancer remains elusive.
  • According to the Canadian Medical Association, human papilloma viral (HPV) infection has been implicated as the leading cause of cervical cancer along with the role played by other coexisting risk factors (Franco et al., 2001).
  • Cervical cancer is most often diagnosed between the ages of 35 and 55, but the exposure to the risk factors may have occurred much earlier in life (Henderson, 2000; Wilcox and Mosher, 1993).
  • The incidence of cervical cancer has been linked to a considerable extent with the role of cultural factors such as sexual norms and practices of a community (Helman 2000; Chavez et al. 2001).
  • The risk factors include  number of sexual partners, age at first sexual intercourse, a history of sexually transmitted diseases, as well as the sexual behaviour of the woman’s male partner (Braun and Gavey, 1999).
  • Tobacco smoking, parity, long term use of oral contraceptives, low dietary intakes of certain vitamins have also been included as risk factors (Burkett et al., 1992).

3. Objectives:

The present study deals with adolescent and young women’s perception towards prevention and control of cervical cancer.

  • Sexually active adolescent women and men experience the highest rates of sexually transmitted infections (World Health Organization, 1993; Bailey, 1997).
  • The first years of sexual behaviour often involve the greatest number of partner changes.
  • Sexually active adolescents are more likely to have partners who have sexually transmissible infections (Bailey, 1997).

This study proposes to address the following research questions:

i.  What are the existing beliefs, attitudes and perceptions of risk factors towards the prevention and control of cervical cancer?

Despite considerable medical knowledge of risk factors and even causal factors, possible social- behavioural strategies for the prevention and control of cervical cancer have not been adequately addressed (Braun and Gavey, 1999:1463). Research indicates that there are gaps in knowledge regarding symptoms associated with genital warts, the purpose of Pap smears, and cervical cancer, specifically in younger age groups (Mays et al., 2000;Cothran and White, 2002). These gaps in women’s understanding about a potentially deadly disease suggest the need for more comprehensive education about preventing HPV infection, reducing other risk factors and the significance of Pap screening for cancer detection and prevention at an earlier stage (Mays et al., 2000:362).

ii. What are the existing barriers to screening for the prevention and control of cervical cancer?

  • Research has shown that the stage at which cervical carcinoma is detected is directly related to the age of the woman in whom it is discovered (White et al., 1993).
  • Clinical observations suggest that many adolescents are reluctant to have a pelvic examination because of their anxiety about the procedure (Millstein et al. 1984).
  • Also available literature show that women often participate in cervical cancer screening less regularly, leading to lesions that are found in more advanced and less curable stages (Franco, et al., 2001).

4. Research Design and Methodology:

Sources of Data and Methods:

  • I. Secondary Data: Relevant data will be collected from a variety of sources including resources at the University of New Brunswick, Department of Health, Dr. Everett Chalmers Hospital, and Saint John Regional Hospital. Additionally, data will also be obtained from local health care professionals working with cancer patients, local cancer society and other such organizations.
  • II. Primary Data: Qualitative data collection methods will be followed using techniques described in Bernard (1995; 2002) and Mikkelsen (1997). These  include:
  • (i). Structured Questionnaires were distributed in the selected high schools of New Brunswick in an attempt to broadly assess the knowledge levels of young female participants with respect to sexually transmitted diseases and the associated risk to cervical cancer. The response from the questionnaires were used to design the semi-structured interviews and the thematic focus group discussions. Four schools participated: Canterbury High School (Canterbury), Leo Hayes High School (Fredericton), Moncton High School (Moncton), Dalhousie Regional High School (Dalhousie).
  • (ii). Semi- Structured and open ended interviews with individuals from the sampled population under study with respect to their beliefs, awareness and health practices regarding cervical cancer.  20 semi- structured interviews were conducted on the university population.
  • (ii).Thematic Focus Group Discussion involving participants from the study high school population group with regard to their attitudes toward cervical cancer risk factors, screening programs and available treatment facilities. Approximately 5 FGDs will be conducted.

5.  Study Population:

The population groups selected for this study from within the province of New Brunswick are as follows:

  • (i). Female members from age group (16-19) representing the selected high school populations of New Brunswick.
  • (ii). Female members from age group (20-25) drawn primarily from university  population of New Brunswick.

6. Results:

The results from questionnaires and interviews are presented as follows: 

High School Data: Based on questionnaire surveys.

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7. Acknowledgements: 

This study was supported by a research grant from New Brunswick Regional Research Development Program. We thank all the participants including Principals, teachers and District Superintendents for their support. We would also like to acknowledge the research assistance provided by Monica Ott and Lisa Atkinson.