Cervical cancer screening in hospitals: The effficacy of legislation in Maryland

Objectives. The purpose of the study was to examine the efficacy of a Maryland law requiring Pap testing to be offered during hospital admissions. 'In-reach' strategies emphasize cancer screening within existing health care contacts (such as inpatient stays) rather than additional visits solely for screening. Methods. Data from a 1986 telephone survey of Maryland women were used to examine the effect of hospitalization on self-reported Pap testing in a 3-year period. The effect of hospitalization on screening was examined by age and income to assess whether inpatient screening was more prevalent among certain subgroups of women. Results. For the group as a whole, the odds of Pap screening did not vary with hospitalization. However, among women aged 45 to 54 years with annual household incomes over $20 000, hospitalized women were more likely than nonhospitalized women to report recent Pap tests. For low-income women aged 75 years and older, hospitalization actually decreased the likelihood of reporting Pap tests. Conclusions. Despite legislation, inpatient cervical cancer screening appears to mirror outpatient patterns, leaving elderly and low-income women unscreened. Methods for increasing inpatient Pap testing for underscreened women are discussed.