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This study is a secondary analysis of survey data collected in fall 2000 from patients of a safety-net hospital and its eight community health outreach clinics in Fort Worth, Texas. The study examined three objectives. These include explaining the utilization of Pap smear tests among the sample who were low-income women, by ascertaining the determinants of using these services. Using binary logistic regressions analyses primarily, the study tested 10 hypotheses. The main hypothesis tested the race/ethnicity/immigration status effect on Pap smear screening. The remaining hypotheses examined the effects of other independent/control variables on having a Pap smear. Results from the data provide support for the existence of a race/ethnicity/immigration status effect. Anglos were more likely to have had a Pap smear, followed by African Americans, Hispanic immigrants, and finally, by Hispanic Americans. The persistence of the race/ethnicity/immigration status effect, even when the effects of other independent/control variables are taken into account, may be explained by several factors. These include cultural differences between the different groups studied. The race/ethnicity/immigration status effect on Pap smear screening changed with the introduction of age, usual source of care, check-up for current pregnancy, and having multiple competing needs for food, clothing and housing into the models studied. Other variables, such as marital status, employment status and health insurance coverage had no statistically significant effects on Pap smear screening. The findings of this study are unique, probably due to the hospital-based sample who has regular access to subsidized health insurance from a publicly funded safety-net healthcare network and its healthcare providers. Given the importance of race/ethnicity/immigration status for preventive Pap smear screening, public education efforts to promote appropriate Pap smear tests among vulnerable populations should target specific race/ethnicity/immigration status groups in the U.S. within the cultural context of each group. Furthermore, publicly funded health programs for underserved populations such as the John Peter Smith Connections and Medicaid should be maintained and strengthened.