Original Study| Volume 22, ISSUE 4, P251-256, August 2009

Download started.


Pap Smear Knowledge Among Young Women Following the Introduction of the HPV Vaccine


      Study Objective

      Investigate sexually active young women's knowledge of the term Pap smear since development of the HPV vaccine.


      Cross-sectional study conducted January–May 2007.


      University health services clinic at a university in southern United States.


      Sexually active women, age 18–24, presenting for a Pap smear or STD testing (N=145).

      Main Outcome Measures

      Pap smear knowledge was assessed by participants' written definition of the term Pap smear and by multiple choice responses indicating Pap smear as a test for cervical cancer/ HPV and not a pelvic exam, STD test, or pregnancy test.


      9.7% provided accurate definitions; 12.4% checked appropriate Pap smear synonyms. 68.5% incorrectly responded that Pap smear was the same as “pelvic exam”; 42.5% indicated “STD test”; 11.7% indicated “pregnancy test.” Indicators of HPV risk (age of sexual debut, previous abnormal Pap smear, previous STD diagnosis) were not associated with knowledge. Never using condoms, increasing age, and lower depression scores predicted accurate Pap smear definition rating (R2=0.08). Never using condoms, Caucasian race, and decreased lifetime number of sex partners predicted accurate identification of Pap smear synonyms (R2=0.15).


      Few participants understood the meaning of the term Pap smear; there does not appear to be improvement in women's knowledge after development of the HPV vaccine. Poor Pap smear knowledge may affect young women's understanding of their overall sexual health.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dunne E.F.
        • Unger E.R.
        • Sternberg M.
        • et al.
        Prevalence of HPV infection among females in the United States.
        JAMA. 2007; 297: 813
        • Moscicki A.B.
        • Shiboski S.
        • Broering J.
        • et al.
        The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women.
        J Pediatr. 1998; 132: 277
        • Franco E.L.
        • Villa L.L.
        • Sobrinho J.P.
        • et al.
        Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer.
        J Infect Dis. 1999; 180: 1415
        • Munoz N.
        • Bosch F.X.
        • de Sanjose S.
        • et al.
        Epidemiologic classification of human papillomavirus types associated with cervical cancer.
        N Engl J Med. 2003; 348: 518
        • Walboomers J.M.
        • Jacobs M.V.
        • Manos M.M.
        • et al.
        Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.
        J Pathol. 1999; 189: 12
        • Schiffman M.H.
        • Castle P.
        Epidemiologic studies of a necessary causal risk factor: human papillomavirus infection and cervical neoplasia.
        J Natl Cancer Inst. 2003; 95: E2
      1. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2004 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2007. Available at: “” Accessed on: June 10, 2008.

        • Shew M.L.
        • Fortenberry J.D.
        • Miles P.
        • et al.
        Interval between menarche and first sexual intercourse, related to risk of human papillomavirus infection.
        J Pediatr. 1994; 125: 661
        • Ho G.Y.
        • Bierman R.
        • Beardsley L.
        • et al.
        Natural history of cervicovaginal papillomavirus infection in young women.
        N Engl J Med. 1998; 338: 423
        • Burk R.D.
        • Ho G.Y.
        • Beardsley L.
        • et al.
        Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women.
        J Infect Dis. 1996; 174: 679
        • Moscicki A.B.
        • Winkler B.
        • Irwin Jr., C.E.
        • et al.
        Differences in biologic maturation, sexual behavior, and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia.
        J Pediatr. 1989; 115: 487
      2. FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus. Available at:, 2008. Accessed on: April 16, 2008.

        • Markowitz L.E.
        • Dunne E.F.
        • Saraiya M.
        • et al.
        Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2007; 56: 1
      3. Merck Launches National Advertising Campaign For GARDASIL®, Merck's New Cervical Cancer Vaccine. Available at: Accessed on: April 4, 2008.

        • Ramirez J.E.
        • Ramos D.M.
        • Clayton L.
        • et al.
        Genital human papillomavirus infections: knowledge, perception of risk, and actual risk in a nonclinic population of young women.
        J Womens Health. 1997; 6: 113
        • Mays R.M.
        • Zimet G.D.
        • Winston Y.
        • et al.
        Human papillomavirus, genital warts, Pap smears, and cervical cancer: knowledge and beliefs of adolescent and adult women.
        Health Care Women Intl. 2000; 21: 361
        • Massad L.S.
        • Meyer P.
        • Hobbs J.
        Knowledge of cervical cancer screening among women attending urban colposcopy clinics.
        Cancer Detect Prev. 1997; 21: 103
        • Jubelirer S.J.
        • Blanton M.F.
        • Blanton P.D.
        • et al.
        Assessment of knowledge, attitudes, and behaviors relative to cervical cancer and the Pap smear among adolescent girls in West Virginia.
        J Cancer Educ. 1996; 11: 230
        • Hasenyager C.
        Knowledge of cervical cancer screening among women attending a university health center.
        J Am Coll Health. 1999; 47: 221
        • Dell D.L.
        • Chen H.
        • Ahmad F.
        • et al.
        Knowledge about human papillomavirus among adolescents.
        Obstet Gynecol. 2000; 96: 653
        • Blake D.R.
        • Weber B.M.
        • Fletcher K.E.
        Adolescent and young adult women's misunderstanding of the term Pap smear.
        Arch Pediatr Adolesc Med. 2004; 158: 966
        • Kahn J.A.
        • Chiou V.
        • Allen J.D.
        • Goodman E.
        • Perlman S.E.
        • Emans S.J.
        Beliefs about Papanicolaou smears and compliance with Papanicolaou smear follow-up in adolescents.
        Arch Pediatr Adolesc Med. 1999; 153: 1046
        • Melchior L.A.H.G.
        • Brown V.B.
        • Reback C.J.
        A short depression index for women.
        Educ Psychol Meas. 1993; 53: 1117
        • Kahn J.A.
        • Rosenthal S.L.
        • Succop P.A.
        • Ho G.Y.
        • Burk R.D.
        Mediators of the association between age of first sexual intercourse and subsequent human papillomavirus infection.
        Pediatr. 2002; 109: E5
        • Head S.K.
        • Crosby R.A.
        • Shrier L.A.
        • Moore G.R.
        Young women's misperceptions about sexually transmissible infection testing: a ‘clean and clear’ misunderstanding.
        Sex Health. 2007; 4: 273