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APHA Scientific Session and Event Listing

Recorded presentation

Ninez Ponce, MPP, PhD, Department of Health Services, UCLA, 31-254B CHS, Los Angeles, CA 90095-1772, 310-206-4021, nponce@ucla.edu

The study focuses on ethnic enclaves in California and tests whether ethnic concentration in neighborhoods mitigates or promotes receipt of cancer screening tests at recommended intervals. We examined appropriately-aged adults, depending on type of cancer screening, residing in metropolitan areas from the population-based 2003 California Health Interview Survey (n=42,044). Area-level data was obtained from the 2003 CHIS, 2000 US Census, and Interstudy 1999-2000.

We estimated multilevel logit models, stratified by race/ethnicity, on likelihood of receipt of 1) Pap tests, 2) mammograms, and 3) any colorectal cancer (CRC) tests. At the census tract level we measured racial/ethnic concentration, social capital, neighborhood tenure, %population living below poverty, %non-citizen, and %limited English proficient; at the metropolitan-statistical area (MSA) level, we included HMO penetration, HMO competition, and %staff/group model HMO. We adjusted for individual characteristics: age, gender, household income, education, family composition, years lived in the US, citizenship, English proficiency, neighborhood tenure, individual social capital index, discrimination in medical care, usual source of care, and health insurance coverage.

After adjusting only for other area-level covariates, Latino concentration was associated with reduced likelihood of CRC screening. Asian concentration decreased the likelihood of receipt of Pap tests and mammograms among Asians. White concentration significantly improved the likelihood of screening for mammography and any CRC test.

In the multilevel models that included individual and area characteristics, Latino concentration was no longer significant in predicting any CRC screening, but neighborhood concentration of limited-English (LEP) proficient Latinos had a significant negative effect. Higher Asian concentration significantly predicted lower odds of cervical cancer screening among Asians (Odds Ratio: 0.53, p-value: 0.046). White concentration was positively associated with higher screening for any CRC test (Odds Ratio 1.49; p-value: 0.009). Black concentration was not significant for any of the area-level and multilevel models.

Ethnic enclaves confer differential effects by race/ethnicity and by type of cancer screening. We found a protective effect for CRC screening among whites living in mostly white neighborhoods. In contrast, Asians living in Asian enclaves are less likely to be screened for cervical cancer and Latinos residing in a concentrated neighborhood of LEP Latinos face a disadvantage in CRC screening. This finding is particularly important since in California, Asians have the lowest rate of Pap tests and Latinos the lowest rates of CRC tests. Large gains can be made in reducing cancer screening disparities if cancer control programs focus on high-density Asian and LEP Latino neighborhoods.

Learning Objectives: At the end of this session, the audience participant will be able to

• Discuss the conceptual pathways of how ethnic enclaves could lead to individual decisions in preventive cancer screening.
• List a set of variables associated with "social capital" and "concentrated disadvantage".
• Identify preventive cancer tests that denote access to care.
• List 3 health care market measures commonly used in depicting HMO markets.
• Recognize the limitations of definitions and measures of ethnic enclaves.
• Interpret area-level effects on individual cancer screening behavior.

Keywords: Cancer Screening, Ethnic Minorities

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation