Disparities in vaccinations and cancer screening among non-Hispanic White women: US- and foreign-born Arab and European Americans

Background: Disparities in cancer screenings and vaccinations exist when comparing foreign-born and US-born women collectively and disaggregated by race and ethnicity. The purpose of this study is to estimate and compare the age-adjusted prevalence of not receiving a flu or pneumonia vaccine, clinical breast exam, mammogram or pap smear among US- and foreign-born white women by region of birth and examine associations while controlling for potential confounders.

Methods: We pooled 12 years of NHIS data (N=117,893). To approximate an “Arab American” ethnicity, we identified 15 “Arab” countries from the Middle East region that comprise the Arab Nations. Data was requested from the NCHS Research Data Center. Chi-squares were used to compare descriptive statistics and odds ratios (95% confidence intervals) were used for inferential statistics.  

Results: Foreign-born whites from the Arab Nations had higher estimates of not receiving recommended cancer screenings and vaccinations. In crude and adjusted analyses, foreign-born Arab American women were less likely to report receiving a flu vaccine (OR=0.34; 95% CI=0.21, 0.58), pneumonia vaccine (OR=0.14; 95% CI=0.06, 0.32), pap smear (OR=0.13; 95% CI=0.05, 0.31), or clinical breast exam (OR=0.16; 95% CI=0.07, 0.37) compared to US-born white women. There were no statistically significant differences for mammogram.

Conclusions: This national study examining preventive cancer screenings and uptake of flu and pneumonia vaccines suggests estimates are lower for foreign-born Arab American women compared to US-born white women. Future studies should collect qualitative data that assesses the cultural context surrounding prevention and screening behaviors among Arab American women.