{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:51:06Z","timestamp":1791899466249,"version":"4.3.4"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi251563-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>While home-based self-sampling for cervical cancer screening is an evidence-based strategy proven to increase screening access and uptake, it is not currently recommended in the US despite recent Food and Drug Administration approval of the first at-home self-sampling device. Little nationally representative research has examined preference for and drivers of home-based self-sampling over clinic-based testing (the standard of care).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251563-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess women\u2019s perspectives about, reasons for considering, and factors associated with preferring at-home self-sampling for cervical cancer screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251563-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This population-based cross-sectional study used data from the 2024 Health Interview National Trends Survey (HINTS 7), a nationally representative survey of the civilian, noninstitutionalized US adult population offered between March and September 2024. Respondents included in this study were individuals aged between 21 and 65 years who were eligible for cervical cancer screening per the US Preventive Services Task Force guidelines and who self-reported their gender identity. Respondents who indicated not needing cervical cancer screening or who did not report their preference for any screening modality (home-based self-sampling or clinician-collected sampling) were excluded. Data were analyzed from May 12 to 25, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251563-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Age, race and ethnicity, income, educational level, sexual orientation, marital status, health insurance, urbanicity of residence, trust in the health care system, past-year number of visits to a health care practitioner, and prior experience of discrimination or prejudice when getting medical care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251563-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The main outcome was preference for at-home vaginal self-sampling over clinic-based testing, measured using the HINTS 7 question, \u201cIf you had choice, how would you prefer to do the cervical cancer screening test?\u201d Responses were: preference to have a health care practitioner do the test in his or her office, preference to self-collect specimen for the test at home, not knowing which option to choose, and not applicable. Weights were assigned to improve representativeness of the general US adult population. The proportion of individuals who reported preferring either screening modality was estimated using weighted percentages. Survey-weighted odds ratios (ORs), adjusted for covariates, were calculated to identify factors associated with preference for at-home self-sampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251563-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 2300 women included (mean [SD] age, 45.5 [29.2] years), most were married or living as married (weighted percentage, 58.2% [95% CI, 56.5%-60.0%]), health insured (91.9%; 95% CI, 90.7%-93.1%), and educated up to some college (61.6%; 95% CI, 60.1%-63.0%). Overall, 462 (20.4%; 95% CI, 17.4%-23.4%) preferred at-home self-sampling, 1402 (60.8%; 95% CI, 57.2%-64.4%) preferred clinic-based testing, and 436 (18.8%; 95% CI, 15.5%-22.1%) were uncertain about their choice. Non-Hispanic Black respondents (adjusted OR [AOR], 0.45; 95% CI, 0.21-0.96) had lower odds of preferring at-home self-sampling compared with non-Hispanic White individuals. Women who had experienced prejudice or discrimination when getting medical care had higher odds (AOR, 1.94; 95% CI, 1.16-3.22) of preferring at-home self-sampling. The most commonly self-reported reasons for preferring at-home self-sampling were privacy (54.9%; 95% CI, 49.8%-60.0%), time constraints (35.1%; 95% CI, 29.0%-41.2%), and fear of embarrassment (33.4%; 95% CI, 28.0%-38.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi251563-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cross-sectional study, marginalized populations, individuals with low income, and individuals who do not trust the health care system were more likely to prefer at-home self-sampling for cervical cancer screening or not know which option to choose. To address cervical cancer inequities and increase screening uptake, the findings suggest US guidelines should incorporate home-based self-sampling as an alternative to clinic-based testing, women\u2019s education and empowerment should be enhanced, and tailored interventions focusing on high-risk groups are needed to increase awareness and self-confidence in performing home-based self-sampling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.58841","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T16:30:34Z","timestamp":1770395434000},"page":"e2558841","source":"Crossref","is-referenced-by-count":3,"title":["Women\u2019s Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening"],"prefix":"10.1001","volume":"9","author":[{"given":"Jo\u00ebl","family":"Fokom Domgue","sequence":"first","affiliation":[{"name":"Division of Cancer Prevention and Population Sciences, The University of 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Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manali","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston"},{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Shete","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston"},{"name":"Department of Epidemiology, The University of Texas MD Anderson Cancer Center, 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Accessed May 15, 2025. https:\/\/www.getteal.com\/news\/fda-approves-teal-healths-teal-wand-tm---the-first-and-only-at-home-self-collection-device-for-cervical-cancer-screening-introducing-a-comfortable-alternative-to-in-person-screening"},{"key":"zoi251563r25","unstructured":"Health Information National Trends Survey 7 (HINTS 7) methodology report. Accessed November 30, 2025. https:\/\/hints.cancer.gov\/docs\/methodologyreports\/HINTS_7_MethodologyReport.pdf"},{"key":"zoi251563r26","unstructured":"Office for Human Research Protections. Regulations, policy & guidance. US Department of Health and Human Services 2022. Accessed March 3, 2024. https:\/\/www.hhs.gov\/ohrp\/regulations-and-policy\/index.html"},{"key":"zoi251563r27","unstructured":"EQUATOR (Enhancing the Quality and Transparency of Health Research) Network. Reporting guidelines for main study types. Accessed May 12, 2025. https:\/\/www.equator-network.org\/"},{"key":"zoi251563r29","unstructured":"Herman? JL, Flores? AR. 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