Chronic comorbidities and cervical cancer screening and adherence among US-born and foreign-born women
Whereas chronic conditions and foreign-birth have an inverse relationship with cervical cancer screening, the combined effect of these factors on screening is unknown. This study examined the associations between chronic comorbidities and Pap screening recommendations and adherence, and whether these associations vary between foreign- and US-born women.
In 2017, data from 2013 and 2015 National Health Interview Survey on women aged 21–65 years (N = 20,080) were analyzed. Bivariate associations between chronic comorbidities (hypertension, diabetes, and obesity) and cervical cancer screening recommendation and adherence (screened in the last 3 years) were examined using Chi-square analysis. Multivariate binary logistic regression was used to examine the association between foreign-born status and participant Pap test adherence, adjusting for physician Pap test recommendation and chronic comorbidities.
Obesity, hypertension, and diabetes were positively associated with Pap screening recommendation. Hypertension and diabetes were negatively associated with screening adherence. Pap screening recommendation (60% vs. 57%, p < 0.05) and adherence (85% vs. 78%, p < 0.001) were higher among foreign-born than US-born women. After adjusting for chronic conditions, foreign-born women had significantly lower odds of receiving Pap tests compared with US-born women (OR 0.8, 95% CI 0.6–0.9). In stratified analysis, only obesity was associated with Pap testing among US-born and foreign-born women. Among foreign-born women, the association between obesity and Pap testing was attenuated after controlling for years lived in the US and citizenship.
Public health intervention efforts must improve regular access to preventive care and encourage Pap screening among women diagnosed with chronic conditions. Future research should further identify additional factors driving the cervical cancer screening practices of both US- and foreign-born women with and without chronic conditions.
KeywordsCervical cancer screening Obesity Diabetes Hypertension Foreign-born women
This research was supported by an institutional training grant (National Research Service Award T32HD055163, Berenson, PI) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at NIH, and from the Office of Research on Women’s Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to disclose.
- 1.Howlader N, Noone A, Krapcho M et al (eds) (2017) SEER cancer statistics review, 1975-2014. National Cancer Institute, BethesdaGoogle Scholar
- 3.US Department of Health and Human Services Office of Disease Prevention and Health Promotion (2010) Healthy people 2020. US Department of Health and Human Services Office of Disease Prevention and Health Promotion, Washington, DCGoogle Scholar
- 11.Schleicher E (2007) Immigrant women and cervical cancer prevention in the United States. Women’s and Children’s Health Policy Center, Johns Hopkins Bloomberg School of Public Health, BaltimoreGoogle Scholar
- 20.Ogden CL, Lamb MM, Carroll MD, Flegal KM (2010) Obesity and socioeconomic status in adults: United States, 2005-2008. NCHS Data Brief 50:1–8Google Scholar
- 23.Lopez G, Radford J (2017) Statistical portrait of the foreign-born population in the United States, 2015. Pew Research Center, Washington, DCGoogle Scholar
- 25.Singh GK, Rodriguez-Lainz A, Kogan MD (2013) Immigrant health inequalities in the United States: use of eight major national data systems. Sci World J 2013:512313Google Scholar
- 30.Jasso G, Massey D, Rosenzweigh M, Smith J (2004) Immigrant health selectivity and acculturation. In: Anderson NB, Bulatao RA, Cohen B (eds) Critical perspectives on racial and ethnic differences in health in late life, chapter 7. Committee on Population, National Research Council, The National Academies Press, Washington DCGoogle Scholar
- 31.Le Grand J (1991) Equity and choice: an essay in economics and applied philosophy. Harper Collins Academic, LondonGoogle Scholar
- 32.Dey AN, Lucas JW (2006) Physical and mental health characteristics of U.S.- and foreign-born adults: United States, 1998-2003. Adv Data 369:1–19Google Scholar
- 33.Centers for Disease Control (CDC) National Center for Health Statistics National Health Interview Survey (NHIS) (2016) Questionnaires, datasets, and related documentation 2013–2015. CDC, Atlanta, GAGoogle Scholar
- 34.Czajka JL, Beyler A (2016) Declining response rates in federal surveys: trends and implications (background paper). Mathematica Policy ResearchGoogle Scholar