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

Abstract #108730

Ninez Alafriz Ponce, MPP, PhD¹, Neetu Chawla, MPH², Susan Babey, PhD², Melissa Gatchell, MPH³, E. Richard Brown, PhD², David Etzioni, MD⁴, Benjamin Spencer, MD⁵, and Nancy Breen, PhD⁶. (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) UCLA Center for Health Policy Research, 10911 Weyburn Avenue, Los Angeles, CA 90024, (3) Health Services, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, (4) Department of Surgery, David Geffen School of Medicine UCLA, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA 90095, (5) Urology, Memorial Slaon Kettering, 1275 York Avenue, New York, NY 10022, (6) Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd MSC 7344, Suite 4005, Bethesda, MD 20892-7344

Though use of cervical cancer screening is widespread in the US, Asian and Latino women are less likely to use it. Using population-based data from the 2001 California Health Interview Survey (CHIS 2001), we examined whether primary language use, as measured by language of interview, contributes to these disparities. CHIS 2001 was conducted in six languages: English, Spanish, Chinese (Cantonese and Mandarin dialects), Korean, Vietnamese, and Khmer. We constructed mutually exclusive race and ethnic categories to create indicator variables such as Latinas who interviewed in English, Latinas who interviewed in Spanish, Asians who interviewed in Cantonese, Asians who interviewed in Vietnamese, etc. Multivariate logistic regression analyses were used to determine factors associated with three-year Pap test use. Factors studied include race/ethnicity and language of interview, marital status, income, educational attainment, level of acculturation, insurance status, usual source of care, smoking status, area of residence, and health status

Adjusting for all other covariates, we found that Asian women speaking English (RR 0.91; 95% CI 0.87, 0.95), Cantonese (RR 0.82; 95% CI 0.67, 0.93), Mandarin (RR 0.78; 95% CI 0.62, 0.91), Khmer (RR 0.73; 0.33, 0.99), and Korean (RR 0.92; 0.81, 1.00) were less likely to have had a Pap test in the past three years than English-speaking white women. In addition, multivariate results showed that Spanish-speaking White women (RR 1.09; 95% CI 1.04, 1.10) and Spanish-speaking Latinas (RR 1.06; 95% CI 1.05, 1.07) were the most likely to be screened.

Large language disparities in cervical cancer screening are present in California, where Asian women speaking Cantonese, Mandarin, Khmer, and Korean had the lowest rates of Pap tests compared to English-speaking non-Latino Whites. But even English-speaking Asians also had considerably lower screening rates, suggesting that in addition to language barriers, cultural barriers exist. Encouragingly, Spanish-speaking women are the most likely to report three-year Pap test use and Vietnamese-speakers had screening rates comparable to English-speaking White women. Although Federal civil rights law and policy require that health care providers make interpretation services available to patients who need it, such laws and policies are difficult to enforce so that barriers due to language may still exist. Our findings suggest that in addition to English and Spanish, cancer screening services in California should be available in Asian languages. Successful outreach and awareness efforts among Spanish-speaking and possibly, Vietnamese-speaking women could serve as a model for improving screening rates among Asian-language speakers in California and nationally.

Learning Objectives:

• To understand how language barriers contribute to racial/ethnic disparities in Pap test use in an ethnically diverse population-based sample.
• To identify which languages policymakers should address to increase efforts for targeting media, provider awareness, outreach and community-based intervention programs that aim to raise cervical cancer screening participation.

Keywords: Cancer Screening, Asian Women

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.