in mortality is a discrepancy in the rate of follow-up of abnormal Pap smears among African ± American women. The objective of this study is to determine the demographic factors associated with a delay to follow-up of abnormal pap smears. METHODS: Eligible subjects were a sample of women aged 18 years and older with an abnormal cervical cytology report between February 1999 ± April 2000 screened at an academic medical center or one of three neighborhood health centers. We obtained information on subjects from a registration database and a pathology database. We excluded subjects who did not have a race category specified (17%). We defined adequate follow-up conservatively, as cytology or pathology within 4 months for dysplasia (low or high grade squamous intraepithelial lesion or carcinoma in-situ) and within 7 months for atypia (atypical squamous or glandular cells of unknown significance). We analyzed differences in follow-up rates by race, age, insurance status, source of care (academic medical center or neighborhood health center), and type of pap abnormality (dysplasia or atypia). RESULTS: Of the 345 subjects, 57%were African American, 16%were Caucasian, and 26%were from other racial/ethnic groups. 49%of the subjects were under the age of 30. 62%were screened at the medical center and 38%at the neighborhood health centers. Only 18%of the subjects had private insurance. Overall, only 53%of the subjects had follow-up for an abnormal pap smear either by additional cytology or pathology within 4 months for dysplasia (50%) or 7 months for atypia (56%). 55%of African ± American women, 55%of Caucasian women, and 48%of women from other racial/ethnic groups received follow-up (not significant). The follow-up rate of 45%for subjects less than 30 was significantly lower than that of subjects aged 30 or older (61%, p-value 0.003). No differences in follow-up rates were seen according to the subject's race, insurance status, source of care, or type of pap abnormality. CONCLUSION: In a low income, predominantly minority population, the rate of follow-up for abnormal pap smears was low, only 53%. This may explain the higher mortality rate seen in African ± American women. Younger women were less likely to receive adequate follow-up. Race, source of referral, insurance status, and type of pap abnormality were not associated with follow-up rates in this cohort. Patients were also asked to express their preferences regarding physician involvement in their religious/spiritual life. Descriptive statistics were tabulated. Associations between patient characterisitics and patients' preferences for specific physician spiritual behaviors were assessed using bivariate and multivariate techniques. RESULTS: Two hundred-ninety nine patients were surveyed. Patients' ages ranged from 19 to 86 years. Fifty six percent were male, 46%were African American, 51%white, and 63%belonged to Protestant denominations. Fifty three percent had annual incomes of $20,000 or less. Fifty nine percent of African American patients (AA) felt it was important that their physician have strong spiritual beliefs compared with 40%of whites (W)(p < .001); 45%of AA vs 32%of W would want a different physician if their doctor did not believe in God or a higher power (p < .001). Forty five percent of AA felt their health would improve if their physician prayed for them vs 32%of W (p = .03). Fifteen percent of AA were willing to give up time spent on medical problems to discuss spiritual issues with their physicians while only 4%of W agreed with this viewpoint (p = .001). In bivariate analysis, significant associations with patient desires for more physician religious involvement in medical encounters (p < .05) were AA race,older age, education less than college, and higher score on the SWB scale. In logistic regression, only AA race remained significantly associated with willingness to give up time spent on medical care in exchange for spiritual discussion (OR 3.8, 95%CI 1.3 ± 11) . AA race (OR 1.9, 95%CI 1.1 ± 3.4) and higher SWB score (OR 1.8, 95%CI 1.3 ± 2.4) were associated with patients' desire for physicians to have strong religious beliefs. Patients who would change physicians if theirs did not believe in God/higher power were more likely to be AA (OR 2.1, 95%CI 1.1 ± 3.9), have higher SWB score (OR 1.5, 95%CI 1.0 ± 2.1) and education less than college (OR 1.9, 95%CI 1.1 ± 3.4). AA race (OR 2.0, 95%CI 1.1 ± 3.5) and being married (OR 2.1, 95%CI 1.2 ± 3.7) were associated with the belief that physician prayer would improve patients' health. Age, sex and physical function had no significant associations. CONCLUSION: Physician religious beliefs and behaviors are more important to AA patients than to white patients. Physicians should be aware that religious discussions might be important for effective communication with AA patients in making medical decisions. PURPOSE: It has previously been reported that many patients would like their physicians to engage in prayer with them as part of their medical care. We studied the relationship of care settings to this preference and physicians' willingness to respond to patients' religious/spiritual needs.