The roles of citizenship status, acculturation, and health insurance in breast and cervical cancer screening among immigrant women

Background: Immigrant women are less likely to undergo cancer screening. However, few national studies have examined the role of citizenship status or acculturation. Objective: The objective of this study was to examine differences in Papanicolaou. (Pap) smear and mammography screening among U.S.-born women and immigrants who are naturalized citizens or remained noncitizens. Among Latinas, we also determined if acculturation is related to screening after adjusting for covariates. Research Design: The authors conducted a cross-sectional analysis of the Adult Section of the 2000 National Health Interview Survey, a nationally representative sample. Subjects: A total of 18,342 women completed the survey, including 1445 who were not citizens. Measures: For Pap smears, women age 18-65 were appropriately screened if they reported testing within the past 3 years. For mammograms, women age 50-70 were considered appropriately screened if they reported testing within the past 2 years. We determined acculturation using a modified version of the Marin scale. Results: After adjusting for age, education, family income, and marital status, noncitizens remained significantly less likely to report having a mammogram than U.S.-bom women (14 percentage point difference; P < 0.01). However, after adjusting for health insurance coverage and a usual source of care, these disparities were markedly attenuated. For Pap smears, after adjusting for sociodemographics and access to care, disparities persisted (11 percentage points, P < 0.01). Among Latinas, differences in Pap smears between noncitizens and the U.S.-bom disappeared after further controlling for acculturation. Conclusions: Our study suggests that initiatives to diminish disparities in screening should prioritize improving access to care for noncitizens. Our study also lends support to culturally sensitive interventions aimed at improving Pap smear screening among noncitizens.