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To explore the rate and predictors of Papanicolaou (Pap) smear use among American Samoans, we conducted a survey of 986 randomly selected adult, self-identified Samoan women in American Samoa (n = 323), Hawaii (n = 325), and Los Angeles (n = 338). Only 46% of the women reported having a Pap smears within the past 3 years. These women were more likely than others to reside in Hawaii (odds ratio [OR], 1.7), be less than 40 years of age (OR, 2.2), be married (OR, 1.9), have more than 12 years of formal education (OR, 2.1), have an income of more than $20,000 per year (OR, 1.6), have health insurance (OR, 1.6), and have higher acculturation levels (OR, 1.9). Knowledge and attitudes about cervical cancer did not predict Pap smear screening. It is likely that the low rate of Pap smear screening contributes to the high site-specific incidence of cervical cancer among American Samoan women.