Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #107600

Ninez Alafriz Ponce, MPP, PhD¹, Melissa Gatchell², Jan T. Liu, MHS³, Juanita Dimas, PhD⁴, and Kelvin Quan, JD, MPH⁴. (1) UCLA Center for Health Policy Research, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, 310/206-4021, nponce@ucla.edu, (2) Center for Health Policy Research, University of California, Los Angeles, 10911 Weyburn Ave., Suite 300, Los Angeles, CA 90024, (3) Policy Division, Asian & Pacific Islander American Health Forum, 942 Market St., Suite 200, San Francisco, CA 94102, (4) Alameda Alliance for Health, 1240 South Loop Road, Alameda, CA 94502

Objective: This study examines the impact of cultural concordance, measured by language, racial and gender matches between patients and their providers on cervical cancer screening rates.

Design: Logistic regressions of language, ethnic, and/or gender match on Pap tests for the most commonly spoken beneficiary languages (Vietnamese, Spanish, Farsi and English), adjusting for beneficiary and practitioner characteristics. Relative risks and predicted probabilities were computed to evaluate effect sizes.

Population: Female members of Alameda County's local Medicaid managed care plan, ages 25-64 with at least 11 months coverage in 1999 and 2000, whose primary care physicians (PCPs) were office-based (n=1140 individual observations, 21 PCPs).

Findings: A language match improved the likelihood of receiving a Pap test among Spanish speaking women (RR 2.17; 95%CI 1.93, 2.43) and decreased the likelihood for Vietnamese speakers (RR 0.88; 95%CI 0.84, 0.93). Having a female doctor was important for Spanish speaking women only if that doctor also spoke Spanish: the predicted probability increased from 50% (gender match) to 85% (gender and language match). Racial concordance had the strongest effect for African-American women (RR 1.36; 95%CI 1.30, 1.41).

Conclusions: Our findings suggest that contracting with Spanish bilingual providers benefits Spanish-speaking women. While language match conferred a negative or nil benefit to Vietnamese and Farsi speakers, a majority of these women had PCPs who spoke their primary languages. Racial concordance had the most profound effect for African-American women. The lack of an effect on racial concordance for Latino women resulted from the scarcity of Latino providers in the sample.

Learning Objectives: Learning Objectives

At the end of the presentation, the audience will
• Understand the utilization patterns of Pap tests using administrative data,
• Differentiate the effects of physician-patient concordance by language, race/ethnicity and gender,
• Learn about measures of language proficiency in non-English languages among providers, and
• See an example of how to translate research findings into formulation of language access policies for immigrants.

Presenting author's disclosure statement:


I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Policy on Immigrant Health: Reviewing the Evidence

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA