Impact of health insurance as a mediator on the effect of foreign-born status on Pap test use among women living in the United States

Background: Mortality due to cervical cancer in the U.S. has been significantly reduced in the past fifty years, partly due to the early detection of that disease by Pap tests. Nevertheless, little is know how foreign-born status and health insurance status interact to influence Pap test use.

Objectives: To investigate the direct effect and indirect effect via health insurance status of foreign-born status on Pap test use among women living in the United States.

Method: The total effect of foreign-born status by duration on Pap test use is decomposed into the direct effect and the indirect effect via health insurance coverage. The outcome of interest is having a Pap test in the preceding three years. The data source is National Health Interview Survey (NHIS) for women ages 18 and older in 2000, 2003, and 2005.

Results: Comparing the population of foreign-born women living in the US for 10 to 14 years with the US-born population shows that the indirect effect via health insurance is about 76 percent of the total effect.

Concussion: Using a mediational model that treats health insurance as a mediator between foreign-born status by duration and Pap test use suggests that nearly 40 percent of the total effect of foreign-born status by duration on Pap test use is due to whether the woman has health insurance. This finding suggests that increasing health insurance coverage for foreign-born women now living in the U.S. will increase their use of Pap tests.