To identify access, attitudes, and health practices of Latina women undergoing regular mammography and Pap smear screening, 977 Latinas aged 40 to 74, residing in four California cities, answered a telephone interview. Forty-one percent of women had regular mammography, and 73% had regular Pap smear screening. Cancer screening maintenance was associated with having health insurance, a regular place of care, and fewer fatalistic attitudes about cancer. Regular mammography and Pap smear screening were also associated with ever being married, attending church, and having taken hormone replacement therapy. Being older than 50, residing in the United States a long time, and having had a hysterectomy predicted mammography maintenance. Pap smear screening maintenance was negatively associated with poverty, old age, and negative attitudes toward physicians. There are structural and attitudinal barriers to regular cancer screening among Latinas. Interventions that increase access to care and address women's attitudes about cancer are needed.
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References
1.
1. Anderson LM, May DS: Has the use of cervical, breast, and colorectal cancer screening increased in the United States? Am J Public Health85(6):840-842, 1995.
2.
2. Healthy People 2000 Review 1997. Hyattsville, MD, Public Health Service, 1997.
3.
3. National Center for Health Statistics: Health, United States, With Socioeconomic Status and Health Chartbook. Hyattsville, MD, National Center for Health Statistics, 1998.
4.
4. Morris CR, Wright WE: Breast Cancer in California. Sacramento, California Department of Health Services, Cancer Surveillance Section, Cancer Control Branch, Chronic Disease and Injury Control Divison, 1996.
5.
5. Wells BL, Horm JW: Targeting the underserved for breast and cervical cancer screening: The utility of ecological analysis using the National Health Interview Survey. Am J Public Health88(10):1484-1489, 1998.
6.
6. Vincent AL, Greene JN, Hoercherl S, McTague D: Women at risk: Papanicolaou smear screening in Florida. J Fla Med Assoc84(5):302-307, 1997.
7.
7. California Department of Health Services: BCCCP Agency Report. Institute for Health & Aging, University of California, San Francisco, 1999.
8.
8. Bastani R, Kaplan CP, Maxwell AE, Nisenbaum R, Pearce J, Marcus AC: Initial and repeat mammography screening in a low income multi-ethnic population in Los Angeles. Cancer Epidemiol Biomarkers Prev4(2):161-167, 1995.
9.
9. Woloshin S, Bickell NA, Schwartz LM, Gany F, Welch HG: Language barriers in medicine in the United States. JAMA273(9):724-728, 1995.
10.
10. Stein JA, Fox SA: Language preference as an indicator of mammography use among Hispanic women. J Natl Cancer Inst82(21):1715-1716, 1990.
11.
11. Solis JM, Marks G, Garcia M, Shelton D: Acculturation, access to care, and use of preventive services by Hispanics: Findings from HHANES 1982-84. Am J Public Health80(suppl.):11-19, 1990.
12.
12. Harmon MP, Castro FG, Coe K: Acculturation and cervical cancer: Knowledge, beliefs, and behaviors of Hispanic women. Women Health24(3):37-57, 1996.
13.
13. Kaplan RM, Navarro AM, Castro FG, Elder JP, Mishra SI, Hubbell A, et al.: Increased use of mammography among Hispanic women: Baseline results from the NCI Cooperative Group on Cancer Prevention in Hispanic Communities. Am J Prev Med12(6):467-471, 1996.
14.
14. Valdini A, Cargill LC: Access and barriers to mammography in New England community health centers. J Fam Pract45(3):243-249, 1997.
15.
15. Chavez LR, Hubbell FA, Mishra SI, Valdez RB: The influence of fatalism on self-reported use of Papanicolaou smears. Am J Prev Med13(6):418-424, 1997.
16.
16. California Women's Health Survey. Data Points, 1997. California State Department of Health Services, Sacramento, CA. Issue 1, Volume 1, Fall 1998.
17.
17. Zambrana RE, Dorrington C, Hayes-Bautista D: Family and child health: A neglected vision, in Zambrana RE (ed.): Understanding Latino Families: Scholarship, Policy, and Practice. Thousand Oaks, CA, Sage, 1995, pp. 157-176.
18.
18. Giachello AL: Hispanics' access to health care: Issues for the 1990's, in Molina C, Aguirre-Molina M (eds.): Latina Health: America's Growing Challenge for the 21st Century. Washington, DC, American Public Health Association, 1994, pp. 83-114.
19.
19. Zambrana RE, Breen N, Fox SA, Gutierrez-Mohamed ML: Use of cancer screening practices by Hispanic women: Analyses by subgroup. Prev Med29(6 Pt 1):466-477, 1999.
20.
20. UCLA Center for Health Policy research and the Women's Health Collaborative: Women at Risk in California: A Chartbook on Health Insurance Coverage and Access to Care. Los Angeles, the Regents of the University of California, 1998.
21.
21. Brown E, Wyn R, Levan R: The Uninsured in California: Causes, Consequences, and Solutions. Final Report to the California HealthCare Foundation. Los Angeles, UCLA Center for Health Policy Research, 1997.
22.
22. Haynes MO: Geriatric gynecologic care of minorities. Clin Obstet Gynecol39(4):946-958, 1996.
23.
23. Peragallo NP, Fox PG, Alba ML: Breast care among Latino immigrant women in the U.S. Health Care Women Int19(2):165-172, 1998.
24.
24. Suarez L, Roche RA, Nichols D, Simpson DM: Knowledge, behavior, and fears concerning breast and cervical cancer among older low-income Mexican-American women. Am J Prev Med13(2):137-142, 1997.
25.
25. Jennings KM: Getting a Pap smear: Focus group responses of African American and Latina women. Oncol Nurs Forum24(5):827-835, 1997.
26.
26. Chavez LR, Hubbell FA, McMullin JM, Martinez RG, Mishra SI: Structure and meaning in models of breast and cervical cancer risk factors: A comparison of perceptions among Latinas, Anglo women, and physicians. Med Anthropol Q9(1):40-74, 1995.
27.
27. Chavez LR, Hubbell FA, McMullin JM, Martinez RG, Mishra SI: Understanding knowledge and attitudes about breast cancer. A cultural analysis. Arch Fam Med4(2):145-152, 1995.
28.
28. Hubbell FA, Chavez LR, Mishra SI, Valdez RB: Differing beliefs about breast cancer among Latinas and Anglo women. West J Med164(5):405-409, 1996.
29.
29. Perez-Stable EJ, Sabogal F, Otero-Sabogal R, Hiatt RA, McPhee SJ: Misconceptions about cancer among Latinos and Anglos. JAMA268(22):3219-3223, 1992.
30.
30. Fernandez MA, Tortolero-Luna G, Gold RS: Mammography and Pap test screening among low-income foreign-born Hispanic women in USA. Cad Saude Publica14(suppl. 3):133-147, 1998.
31.
31. Lobell M, Bay RC, Rhoads KV, Keske B: Barriers to cancer screening in Mexican-American women. Mayo Clin Proc73(4):301-308, 1998.
32.
32. Perez-Stable EJ, Otero-Sabogal R,Sabogal F, McPhee SJ, Hiatt RA: Self-reported use of cancer screening tests among Latinos and Anglos in a prepaid health plan. Arch Intern Med154(10):1073-1081, 1994.
33.
33. Laws MB, Mayo SJ: The Latina Breast Cancer Control Study, year one: Factors predicting screening mammography utilization by urban Latina women in Massachusetts. J Community Health23(4):251-267, 1998.
34.
34. Facione NC, Dodd MJ, Holzemer W, Meleis AI: Helpseeking for self-discovered breast symptoms. Implications for early detection. Cancer Pract5(4):220-227, 1997.
35.
35. Fulton JP, Rakowski W, Jones AC: Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women. Public Health Rep110(4):476-482, 1995.
36.
36. Powe BD: Cancer fatalism among elderly Caucasians and African Americans. Oncol Nurs Forum22(9):1355-1359, 1995.
37.
37. Powe BD: Cancer fatalism among African-Americans: A review of the literature. Nurs Outlook44(1):18-21, 1996.
38.
38. Powe BD, Weinrich S: An intervention to decrease cancer fatalism among rural elders. Oncol Nurs Forum26(3):583-588, 1999.
39.
39. Hubbell FA, Chavez LR, Mishra SI, Valdez RB: Beliefs about sexual behavior and other predictors of Papanicolaou smear screening among Latinas and Anglo women. Arch Intern Med156(20):2353-2358, 1996.
40.
40. Bastani R, Marcus AC, Hollatz-Brown A: Screening mammography rates and barriers to use: A Los Angeles County survey. Prev Med20(3):350-363, 1991.
41.
41. Delgado DJ, Lin WY, Coffey M: The role of Hispanic race/ethnicity and poverty in breast cancer survival. P R Health Sci J14(2):103-116, 1995.
42.
42. Fox SA, Roetzheim RG: Screening mammography and older Hispanic women. Current status and issues. Cancer74(7 suppl.):2028-2033, 1994.
43.
43. Perez-Stable EJ, Otero-Sabogal R, Sabogal F, Napoles-Springer A: Pathways to early cancer detection for Latinas: En Accion Contra el Cancer. Health Educ Q23(suppl.):S41-S59, 1996.
44.
44. Wu ZH, Black SA, Markides KS: Prevalence and associated factors of cancer screening: Why are so many older Mexican American women never screened? Prev Med33(4):268-273, 2001.
45.
45. Bindman AB, Grumbach K, Osmond D, Vranizan K, Stewart AL: Primary care and receipt of preventive services. J Gen Intern Med11(5):269-276, 1996.
46.
46. Derose KP, Baker DW: Limited English proficiency and Latinos' use of physician services. Med Care Res Rev57(1):76-91, 2000.
47.
47. Hickson GB, Clayton EW, Entman SS, Miller CS, Githens PB, Whetten-Goldstein K, et al: Obstetricians' prior malpractice experience and patients' satisfaction with care. JAMA272(20):1583-1587, 1994.
48.
48. Larkey LK, Hecht ML, Miller K, Alatorre C: Hispanic cultural norms for health-seeking behaviors in the face of symptoms. Health Educ Behav28(1):65-80, 2001.
49.
49. MacLennan AH, Wilson DH, Taylor A: Hormone replacement therapy—Prevalence, compliance and the “healthy woman” notion. Climacteric1(1):42-49, 1998.
50.
50. Suarez L: Pap smear and mammogram screening in Mexican-American women: The effects of acculturation. Am J Public Health84(5):742-746, 1994.
51.
51. Sabogal F, Marin G, Otero-Sabogal R, Marin BV, et al: Hispanic familism and acculturation: What changes and what doesn't? 9(4):397-412, 1987.
52.
52. Suarez L, Ramirez AG, Villarreal R, Marti J, McAlister A, Talavera GA, et al: Social networks and cancer screening in four U.S. Hispanic groups. Am J Prev Med19(1):47-52, 2000.
53.
53. Suarez L, Lloyd L, Weiss N, Rainbolt T, Pulley L: Effect of social networks on cancer-screening behavior of older Mexican-American women. J Natl Cancer Inst86(10):775-779, 1994.
54.
54. Mayo RM, Ureda JR, Parker VG: Importance of fatalism in understanding mammography screening in rural elderly women. J Women Aging13(1):57-72, 2001.
55.
55. Prochaska JO, DiClemente CC: The transtheoretical approach: Crossing traditional boundaries of therapy. Homewood, IL, Irwin, 1984.
56.
56. Hulka BS, Zyzanski SJ, Cassel JC, Thompson SJ: Scale for the measurement of attitudes toward physicians and primary medical care. Med Care8(5):429-436, 1970.
57.
57. Hubbell FA, Chavez LR, Mishra SI, Magana JR, Burciaga Valdez R: From ethnography to intervention: Developing a breast cancer control program for Latinas. J Natl Cancer Inst Monogr (18):109-115, 1995.
58.
58. Perez-Stable EJ, Sabogal F, Otero-Sabogal R: Use of cancer-screening tests in the San Francisco Bay area: Comparison of Latinos and Anglos. J Natl Cancer Inst Monogr (18):147-153, 1995.
59.
59. Waksberg J: Sampling methods for random digit dialing. J Am Stat Assoc73:40-46, 1978.
60.
60. Marin G, Vanoss Marin B, Perez-Stable EJ: Feasibility of a telephone survey to study a minority community: Hispanics in San Francisco. Am J Public Health80(3):323-326, 1990.
61.
61. Valdes MI, Seoane MH: Hispanic Market Handbook: The Definitive Source for Reaching This Lucrative Segment of American Consumers. New York, Gale Research, 1995.
62.
62. Brislin RW: The wording and translation of research instruments, in Lonner WJ, Berry JW (eds.): Field Methods in Cross Cultural Research. Beverly Hills, CA, Sage, 1986, pp. 137-164.
63.
63. Napoles-Springer A: The Effects of Cultural Factors on the Health Screening Behaviors of Latina Women. Berkeley, University of California, 1998.
64.
64. Group Health Association of America, Davies AR, Ware J: The Group Health Association of America Patient Satisfaction Questionnaire: Measuring and Managing Health Care Quality. Gaithersburg, MD, Aspen, 1992.
65.
65. Marin G, Sabogal F, Marin BV, Otero-Sabogal R, et al: Development of a short acculturation scale for Hispanics. Hisp J Behav Sci9(2):183-205, 1987.
66.
66. Triandis HC, Marin G, Betancourt H, Lisansky J, Chang B: Dimensions of Familism Among Hispanic and Mainstream Navy Recruits. Technical Report No. 14. Champaign, University of Illinois, Department of Psychology, 1982.
67.
67. Rakowski W, Fulton JP, Feldman JP: Women's decision making about mammography: A replication of the relationship between stages of adoption and decisional balance. Health Psychol12(3):209-214, 1993.
68.
68. Screening mammography: A missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey Studies. JAMA264(1):54-58, 1990.
69.
69. Hiatt RA, Pasick RJ, Stewart S, Bloom J, Davis P, Gardiner P, et al: Community-based cancer screening for underserved women: Design and baseline findings from the breast and cervical cancer intervention study. Prev Med33(3):190-203, 2001.
70.
70. California Department of Health Services CCR: The Year 2000 Objectives, Measured by California's Behavioral Risk Factor Survey. Sacramento, California Department of Health Services, 1998.
71.
71. U.S. Department of Health and Human Services: Healthy People 2010: Tracking Healthy people 2010. Washington, DC, U.S. Department of Health and Human Services, 2000.
72.
72. Otero-Sabogal R, Arnsberger P, Nussey B, Brown B, Fox PJ: Factors associated with low income Latinas adherence to breast cancer rescreening. Women Cancer1(5):35-41, 1999-2000.
73.
73. Guralnik JM, Leveille SG: Race, ethnicity, and health outcomes—Unraveling the mediating role of socioeconomic status. Am J Public Health87(5):728-730, 1997.
74.
74. Ramirez AG, Suarez L, Laufman L, Barroso C, Chalela P: Hispanic women's breast and cervical cancer knowledge, attitudes, and screening behaviors. Am J Health Promot14(5):292-300, 2000.
75.
75. Sabogal F, Merrill SS, Packel L: Mammography rescreening among older California women. Health Care Fin Rev22(4):63-75, 2001.
76.
76. Pincus T, Esther R, DeWalt DA, Callahan LF: Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med129(5):406-411, 1998.
77.
77. Blaxter M: Evidence on inequality in health from a national survey. Lancet2(8549):30-33, 1987.
78.
78. Bastani R, Marcus AC, Maxwell AE, Das IP, Yan KX: Evaluation of an intervention to increase mammography screening in Los Angeles. Prev Med23(1):83-90, 1994.
79.
79. Calle EE, Miracle-McMahill HL, Moss RE, Heath CW, Jr: Personal contact from friends to increase mammography usage. Am J Prev Med10(6):361-366, 1994.
80.
80. Suarez L, Nichols DC, Pulley L, Brady CA, McAlister A: Local health departments implement a theory-based model to increase breast and cervical cancer screening. Public Health Rep108(4):477-482, 1993.
81.
81. Breen N, Kessler L: Changes in the use of screening mammography: Evidence from the 1987 and 1990 National Health Interview Surveys. Am J Public Health84(1):62-67, 1994.
82.
82. Otero-Sabogal R, Fox PJ: Predictors of Repeat Breast Cancer Screening Among Low Income BCCCP and BCEDP Women. San Francisco, University of California, 1999.
83.
83. Huerta EE, Macario E: Communicating health risk to ethnic groups: Reaching Hispanics as a case study. J Natl Cancer Inst Monogr25:23-26, 1999.
84.
84. Zhang P, Tao G, Anderson LA: Prevalence of and factors associated with hormone replacement therapy counseling: Results from the 1994 National Health Interview Survey. Am J Public Health89(10):1575-1577, 1999.
85.
85. Haynes MA, Smedley BD, Institute of Medicine (U.S.), Committee on Cancer Research Among Minorities and the Medically Underserved: The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. Washington, DC, National Academy Press, 1999.
86.
86. Phillips JM, Cohen MZ, Moses G: Breast cancer screening and African American women: Fear, fatalism, and silence. Oncol Nurs Forum26(3):561-571, 1999.
87.
87. Carpenter V, Colwell B: Cancer knowledge, self-efficacy, and cancer screening behaviors among Mexican-American women. J Cancer Educ10(4):217-222, 1995.
88.
88. Fox SA, Pitkin K, Paul C, Carson S, Duan N: Breast cancer screening adherence: Does church attendance matter? Health Educ Behav25(6):742-758, 1998.
89.
89. Magna A, Clark NM: Examining a paradox: Does religiosity contribute to positive birth outcomes in Mexican American populations? Health Educ Q22(1):96-109, 1995.
90.
90. Etzi S, Lane DS, Grimson R: The use of mammography vans by low-income women: The accuracy of self-reports. Am J Public Health84(1):107-109, 1994.
91.
91. Degnan D, Harris R, Ranney J, Quade D, Earp JA, Gonzalez J: Measuring the use of mammography: Two methods compared. Am J Public Health82(10):1386-1388, 1992.
92.
92. Mandelblatt J, Kanetsky PA: Effectiveness of interventions to enhance physician screening for breast cancer. J Fam Pract40(2):162-171, 1995.
93.
93. Stoddard AM, Rimer BK, Lane D, Fox SA, Lipkus I, Luckmann R, et al: Underusers of mammogram screening: Stage of adoption in five U.S. subpopulations. The NCI Breast Cancer Screening Consortium. Prev Med27(3):478-487, 1998.
94.
94. Collins KS, Hughes DL, Doty MD, Ives BL, Edwards JN, Tenney K: Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans: Findings From the Commonwealth Fund 2001 Health Care Quality Survey. New York, The Commonwealth Fund, 2002, p. 68.
95.
95. Fox SA, Stein JA: The effect of physician-patient communication on mammography utilization by different ethnic groups. Med Care29(11):1065-1082, 1991.
96.
96. Campinha-Bacote J: How do we achieve cultural competence in the health professions? Paper presented at the Second National Conference on Quality Health Care for Culturally Diverse Populations. Strategy and Action for Communities, Providers, and a Changing Health System, Los Angeles, October 11-14, 2000.
97.
97. Sabogal F, Binson D, Catania JA: Researching sexual behavior—Methodological issues for Hispanics, in Bancroft J (ed.): Researching Sexual Behavior: Methodological Issues. Bloomington, Indiana University Press, 1998, pp. 114-133.
98.
98. Freeman HP: Cancer in the economically disadvantaged. Cancer64(1 suppl.):324-334: discussion 42-45, 1989.
99.
99. Sabogal F, Otero-Sabogal R, Pasick RJ, Jenkins CNH, Perez-Stable EJ: Printed health education materials for diverse coummunities: Suggestions learned from the field. Health Educ Q23(suppl.):S123-S141, 1996.
100.
100. Giorgianni SJ(ed.): Responding to the challenge of health literacy. Pfizer J2(1):1-40, 1998.
101.
101. Barsky AJ: Forgetting, fabricating, and telescoping: The instability of the medical history. Arch Intern Med162(9):981-984, 2002.
102.
102. Rand Corporation: Evidence Report and Evidence-Based Recommendations: Interventions That Increase the Utilization of Medicare-Funded Preventive Services for Persons Age 65 and Older. Santa Monica, CA, U.S. Department of Health & Human Services, Health Care Financing Administration, 1998.
