Hello, I am Amela Boukouic, a medical student from the Rowan Virtual School of Osteopathic Medicine. Firstly, on behalf of myself and my co-authors, I would like to thank you all for the opportunity to allow us to present an important preliminary study we have done on the New Jersey Muslim community. Our project determined the religious and non-religious factors that impact pap smear compliance amongst Muslim women in New Jersey. Cervical cancer is the leading cause of cancer in women worldwide, with the number one risk factor being HPV infection. Approximately 80% of women will contract HPV within their lifetime, most often though they will be asymptomatic. With the implementation of pap smear guidelines starting at the age of 21 years old, and HPV vaccination starting at the age of 9 years old, cervical cancer rates have decreased significantly. However, screening rates are lower among Muslim women compared to non-Hispanic white women. Previous studies that have investigated this have determined that this may be due to discomfort and cultural influences, especially considering the stigma related to HPV infections and the sensitivity of a pap smear exam. We believe this project to be especially important to the New Jersey community since it is home to the largest Muslim population percentage wise in the United States. So to confirm previous studies, the question we have posed to understand further why the Muslim community has significantly lower pap smear compliance rates was, how do Islamic ideology and non-religious factors influence the understanding and compliance of cervical cancer screening in Muslim women in New Jersey? We carried out this study using a questionnaire created in Qualtrics that was distributed via social media platforms and flyers in New Jersey communities. Chai Square and Fisher's exact tests were used to analyze relationships between religious values and non-religious values with pap smear compliance. In the second column here, you can see our results. We have received 136 self-reported responses from New Jersey Muslim women between the ages of 21 years old to 65 years old. 43% from our respondents received a pap smear within the past two to three years of taking the survey, with 94% exhibiting basic understanding of the use of pap smears. The central question we asked was concerning the impact of Islamic practice and belief on medical decision making, with only 13% answering yes, it did have an impact on their medical decision making. 60% answered no, with 27% answering sometimes. So what are the significant correlating factors with pap smear compliance in New Jersey Muslim women? Firstly, the consideration of accommodation by a health care provider, particularly amongst those who consider Islamic practice to be a factor in decision making, with a PS value of 0.00378. Additionally, being young and unmarried was associated with low compliance, with a P value of less than 0.001. Virginity status was also a significant factor, with a P score value of being less than 0.00001. Additionally, reliance on cervical cancer screening, referral, and testing from their primary care providers, that had a P value of less than 0.00001. English proficiency, comprehension, and also insurance coverage was also a significant factor, but had a weaker correlation with pap smear compliance, with a P value of 0.01, as well as a patient attending their physical exams on a regular basis, with a P value of 0.04. We also inquired about stigma and feelings related to pap smear testing, and the top three perceptions were, quote unquote, my doctor will refer me or give me a pap smear at my regular checkup, indicating that they're relying on their primary care provider, as well as, quote unquote, having a pap smear is embarrassing, and lastly, quote unquote, I am a virgin or abstaining from sex, so I do not need a pap smear. So what do these results tell us? Based on our analysis, we have seen that our results show a lower compliance rate than the general population, despite the screening target being 79.2%. In regards to virginity status being a significant factor, about half of our participants reported being unmarried. Additionally, there is a great emphasis placed on virginity in Islamic tradition, with pap smears being viewed as a threat to one's virginity, according to previous studies. This is consistent with our findings of single unmarried women reporting, quote, I am a virgin and do not need a pap smear, end quote. This is also consistent, like I said, with previous studies, so it was an expected finding. Previous studies have also reported strong associations between screening and acculturation, socioeconomic status, and health literacy. While still statistically significant in our study, like I mentioned, there is a weaker correlation. Over half of the women in our study reported that they would get their pap smears if they knew other women in the community had as well. While we did not find a statistically significant value related to this, we believe this still indicates the presence of a stigma related to screening for sexually transmitted infections within the community. Our findings have also confirmed the importance of the role of a primary care provider in the community members' lives. Forty-six percent of participants are referred by their providers or have had a pap smear done in office, while 39 percent have reported that their providers did not refer them to do a pap smear. So in conclusion, health care providers play a crucial role in influencing and improving compliance rates. We have concluded that overall New Jersey Muslim women demonstrated higher pap smear noncompliance rate compared to the general population of women in New Jersey. Reasons for noncompliance are multifactorial and may be influenced by lack of access, cultural norms, and health perception and literacy. Although Islamic ideology does not significantly impact pap smear compliance among Muslims according to our study, it remains important for health care professionals to recognize and respect the values and beliefs held by this community. Thank you all for listening, and I hope that you all learned something. Thank you.

pap smear compliance

Muslim women

culturally sensitive healthcare

New Jersey

HPV stigma