259736 Acculturation and Cancer Screening among Asian Americans: The Importance of Health Insurance and Having a Regular Physician as Mediators

Monday, October 29, 2012

Sunmin Lee, ScD, MPH , Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
Lu Chen , Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
Mary Jung, MPH , Department of Epidemiology and Biostatistics, University of Maryland Schoo of Public Health, College Park, MD
Hee-Soon Juon, PhD , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: Understanding cancer screening behaviors is important for cancer prevention among Asian Americans.

Objective: To examine the association between acculturation and receiving cancer screenings within two years (colon, pap smear, mammography, and prostate) among Asian Americans.

Methods: We used data from 851 Chinese, Korean and Vietnamese Americans in Maryland. Acculturation was measured using an abridged version of the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), acculturation clusters, language preference, length of stay in the U.S., and age at arrival. Age, education, income, ethnicity, and marital status were used as control variables. Health insurance and having a regular physician were included as mediators.

Results: Multiple logistic regression analysis showed that acculturation was positively associated with the likelihood of having all cancer screenings. Those lived for more than 20 years in the U.S. were about 2 times [odds ratio (OR) and 95% confidence interval (CI): colon cancer: 2.4 (1.5-4.0); pap smear: 2.1 (1.2-3.7); mammogram: 2.1 (1.2-3.7); prostate cancer: 3.3 (1.5-7.6)] more likely than those who lived for 10 years or less to have had cancer screening. Mediating effects of health insurance and having a regular physician were found between most cancer screening outcomes and length of stay and age at arrival. The association between length of stay and mammography was greatly reduced and became no longer significant after incorporating mediation of having a regular physician (OR=1.4 (0.8-2.6) compared to OR=2.1 (1.2-3.7)).

Conclusion: Acculturation is associated with cancer screening among Asian Americans. This association is mediated by health insurance and having a regular physician.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Learning objectives: 1. Describe the screening behaviors among Chinese, Korean and Vietnamese Americans in Maryland. 2. Discuss the relationship between acculturation and cancer screening behaviors using multiple acculturation indicators. 3. Assess the mediating effects of health insurance and having a regular physician.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceptualized and designed the study. I also interpreted findings and wrote manuscript.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3390.0: Social-ecologic context of API health