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In 2000 and 2003, women were asked when they had their
most recent Pap smear (give month and year). Women who
did not respond were given a follow-up question that used
the 1999 wording, and women who did not respond to the
follow-up question were asked a second follow-up question
that used the 1998 wording. Estimates for 2000 and 2003
may be slightly overestimated in comparison with years
prior to 1999 due to the inclusion of women who responded
‘‘3 years ago’’ (less than 1% of women), which could have
included more than 3 years but less than 4 years.
In 2005, women were asked the same series of questions
about Pap smear use as in the 2000 and 2003 surveys, but
the questionnaire skip pattern was modified so that more
women were asked the follow-up question using the 1998
wording, and these women were not uniformly coded as
having had a Pap smear within the past 3 years. Thus,
estimates for 2005 are more precise than estimates for 1999,
2000, and 2003. SAS code to categorize Pap smear data for
2000 and beyond is available from: http://www.cdc.gov/
nchs/nhis/nhis_2005_data_release.htm.
In 2008, 2010, and 2013, Pap smear questions were similar to
those asked in 2005.
All women aged 18 and over are asked the Pap smear
question(s). Women who reported having had a
hysterectomy (removal of the uterus, with or without
removal of the ovaries and cervix) were still asked the Pap
smear questions because a woman who has had a
hysterectomy may still have Pap smear testing.
The current recommendation, made by the U.S. Preventive
Services Task Force in 2012, is the use of Pap smears for cervical
cancer every 3 years in women aged 21–65. In Health, United
States, 2014, additional age groups (18–20, 21–24, and 21–44)
were added to account for the new recommendation. For more
information on the change in recommendations, see:
http://www.uspreventiveservicestaskforce.org/Page/
Document/RecommendationStatementFinal/cervical-cancerscreening#update-of-previous-uspstf-recommendation.
The U.S. Preventive Services Task Force recommends against
routine Pap smear screening in women who have had a total
hysterectomy for benign disease. Therefore, two measures of
Pap smear screening are presented in Health, United States:
one among all women and one among women who did not
report having a hysterectomy, although it is not known from
NHIS data whether the hysterectomy was for benign disease.
Questions about whether the respondent had a
hysterectomy were not asked in 2003. For other survey
years, questions about hysterectomy in NHIS differed
slightly, as follows.
In 1987, women who reported that they had not had a
recent Pap smear were asked the most important reason
they had not had a Pap smear; one reason women could
select was because they had had a hysterectomy. In 1993,
1994, 1998, 1999, and 2013 women were asked, ‘‘Have you
had a hysterectomy?’’ In 2000, 2005, 2008, and 2010, two
questions were used to determine whether women had had
a hysterectomy. Women were asked, ‘‘Have you had a
hysterectomy?’’ In addition, women who reported that they
had not had a recent Pap smear were asked the most
important reason they had not had a Pap smear; one reason
women could select was because they had had a
hysterectomy. Women indicating in either of these questions
that they had had a hysterectomy were excluded from the
Pap smear screening estimates.
Pap smear screening recommendations have changed
over time and vary in the recommended age to begin
and end screening and the interval for screening. For a
summary of current and historic recommendations, see:
U.S. Preventive Services Task Force. Cervical cancer:
Screening [Recommendation summary]. Release date,
March 2012. Rockville, MD: Agency for Healthcare
Research and Quality; 2013. Available from:
http://www.uspreventiveservicestaskforce.org/uspstf/
uspscerv.htm.
Patient—See Appendix II, Inpatient; Office visit; Outpatient
visit.
Percent change/percentage change—See Appendix II,
Average annual rate of change (percent change).
Perinatal mortality rate; ratio—See Appendix II, Rate:
Death and related rates.
Personal care home with or without nursing—See
Appendix II, Nursing home.
Personal health care expenditures—See Appendix II,
Health expenditures, national.
Physical activity, leisure-time—Starting with Health,
United States, 2010, estimates on leisure-time physical
activity changed to reflect the federal 2008 Physical
Activity Guidelines for Americans (available from:
http://www.health.gov/PAGuidelines/guidelines/
default.aspx). Adults who met the 2008 guidelines reported
at least 150 minutes per week of moderate-intensity or
75 minutes per week of vigorous-intensity aerobic physical
activity (or an equivalent combination of moderate- and
vigorous-intensity aerobic activity) and muscle
strengthening activities at least twice a week. The estimates
for the percentage of Americans who met the 2008
guidelines for aerobic and muscle strengthening are not
comparable with estimates in previous editions of Health,
United States that showed the percentage of Americans with
regular leisure-time physical activity. For more information,
see: Carlson SA, Fulton JE, Schoenborn CA, Loustalot F. Trend
and prevalence estimates based on the 2008 Physical
Activity Guidelines for Americans. Am J Prev Med
2010;39(4)305–13.
Starting with 1998 data, leisure-time physical activity has
been assessed in the National Health Interview Survey
(NHIS) by asking adults a series of questions about how
often they do vigorous or light/moderate physical activity of
Health, United States, 2014 Appendix II. Definitions and Methods 433