Predictors of Cervical Cancer Screening Awareness and Literacy Among Korean-American Women

  • Y. Joon ChoiEmail author
  • Hee Yun Lee
  • Soonok An
  • Young Ji Yoon
  • Jennifer Oh



Korean-American women experience a higher incidence of cervical cancer than non-Hispanic White women as well as other Asian-American women. A prominent cause of such a disproportional health risk among Korean-American women is a lack of awareness and knowledge of cervical cancer screening. Identifying factors related to cervical cancer screening awareness and literacy is critical for increasing cervical cancer screening among this population.


Researchers surveyed 230 Korean-American women in a metro area in a Southeastern state, USA. Based on Anderson’s Behavioral Model of Health Services Use, predisposing, enabling, and need factors were explored to predict cervical cancer screening awareness and literacy.


Monthly income, education, English proficiency, and annual checkups had significantly positive associations with cervical cancer screening awareness. Having an acquaintance giving support and receiving an annual checkup had significantly positive relationships with cervical cancer screening literacy.


This study recommends culture specific guidelines to promote annual checkups through primary care physicians and the transfer of information about cervical cancer screening through acquaintances giving support.


Cervical cancer Cancer screening literacy Korean-American women Annual checkups Acquaintance support 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Wang SS, Carreon JD, Gomez SL, Devesa SS. Cervical cancer incidence among six Asian ethnic groups in the United States, 1996 through 2004. Cancer. 2010;116(4):949–56.CrossRefGoogle Scholar
  2. 2.
    McCracken M, Olsen M, Jr C, Ahmedin J, et al. Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin. 2007;57(4):190–205.CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (CDC). Cervical cancer screening among women aged 18-30 years-United States, 2000-2010. MMWR Morb Mortal Wkly Rep. 2013;61(51-52):1038–42 [cited 2019 January 23]. Available from Scholar
  4. 4.
    Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2012, National Cancer Institute. Bethesda, MD,, based on November 2014 SEER data submission, posted to the SEER web site, April 2015.
  5. 5.
    Juon HS, Lee CS, Klassen AC. Predictors of regular Pap smears among Korean-American women. Prev Med. 2003;37(6 Pt 1):585–92.CrossRefGoogle Scholar
  6. 6.
    Kagawa-Singer M, Pourat N, Breen N, Coughlin S, Abend McLean T, McNeel TS, et al. Breast and cervical cancer screening rates of subgroups of Asian American women in California. Med Care Res Rev. 2007;64(6):706–30.CrossRefGoogle Scholar
  7. 7.
    Lee HY, Roh S, Vang S, Jin SW. The contribution of culture to Korean American women's cervical cancer screening behavior: the critical role of prevention orientation. Ethn Dis. 2011;21(4):399–405.Google Scholar
  8. 8.
    Lee HY, Ju E, Vang PD, Lundquist M. Breast and cervical cancer screening among Asian American women and Latinas: does race/ethnicity matter? J Women's Health. 2010;19(10):1877–84.CrossRefGoogle Scholar
  9. 9.
    U.S. Department of Health and Human Services. Healthy people 2020: cancer objectives. Washington, DC: U.S. Department of Health and Human Services; 2010.Google Scholar
  10. 10.
    Moskowitz JM, Kazinets G, Wong JM, Tager IB. Health is strength: a community health education program to improve breast and cervical cancer screening among Korean American women in Alameda County, California. Cancer Detect Prev. 2007;31(2):173–83.CrossRefGoogle Scholar
  11. 11.
    Gor BJ, Chilton JA, Camingue PT, Hajek RA. Young Asian Americans’ knowledge and perceptions of cervical cancer and the human papillomavirus. J Immigr Minor Health. 2011;13(1):81–6.CrossRefGoogle Scholar
  12. 12.
    Lee HY, Lee MH. Barriers to cervical cancer screening and prevention in young Korean immigrant women: implications for intervention development. J Transcult Nurs. 2017;28(4):353–62.CrossRefGoogle Scholar
  13. 13.
    Han HR, Song I, Kim M, et al. Breast and cervical cancer screening literacy among Korean American women: a community health worker-led intervention. Am J Public Health. 2017;107(1):159–65.CrossRefGoogle Scholar
  14. 14.
    Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.CrossRefGoogle Scholar
  15. 15.
    Lee HY, Choi JK, Park JH. The primary care physician and cancer literacy: reducing health disparities in an immigrant population. Health Educ J. 2014;73(4):435–45.CrossRefGoogle Scholar
  16. 16.
    Lee EE, Tripp-Reimer T, Miller AM, Sadler GR, Lee SY. Korean American women’s beliefs about breast and cervical cancer and associated symbolic meanings. Oncol Nurs Forum. 2007;34(3):713–20.CrossRefGoogle Scholar
  17. 17.
    Lee EE, Eun Y, Lee SY, Nandy K. Age-related differences in health beliefs regarding cervical cancer screening among Korean American women. J Transcult Nurs. 2012;23(3):237–45.CrossRefGoogle Scholar
  18. 18.
    Nguyen TT, McPhee SJ, Nguyen T, Lam T, Mock J. Predictors of cervical Pap smear screening awareness, intention, and receipt among Vietnamese-American women. Am J Prev Med. 2002;23(3):207–14.CrossRefGoogle Scholar
  19. 19.
    Lee HY, Choi JK, Lee MH. Health literacy in an underserved immigrant population: new implications toward achieving health equity. Asian Am J Psychol. 2015;6(1):97–105.CrossRefGoogle Scholar
  20. 20.
    Kim H, Lee KJ, Lee SO, Kim S. Cervical cancer screening in Korean American women: findings from focus group interviews. J Korean Acad Nurs. 2004;34(4):617–24.CrossRefGoogle Scholar
  21. 21.
    Abe-Kim J, Takeuchi DT, Hong SH, Zane N, Sue S, Spencer MS, et al. Use of mental health–related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study. Am J Public Health. 2007;97(1):91–8.CrossRefGoogle Scholar
  22. 22.
    Kung W. Chinese Americans’ help seeking for emotional distress. Soc Serv Rev. 2003;77:110–34.CrossRefGoogle Scholar
  23. 23.
    Wang P, Lane M, Olfson M, Pincus K, Kessler R. Twelve month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:629–40.CrossRefGoogle Scholar
  24. 24.
    Alegria M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G. Prevalence of psychiatric disorders across latino subgroups in the United States. Am J Public Health. 2007;97(1):68–75.CrossRefGoogle Scholar
  25. 25.
    Fung K, Wong Y. Factors influencing attitudes towards seeking professional help among East and Southeast Asian immigrant and refugee women. Int J Soc Psychiatry. 2007;53(3):216–31.CrossRefGoogle Scholar
  26. 26.
    Hwang WC, Myers HF, Abe-Kim J, Ting JY. A conceptual paradigm for understanding culture's impact on mental health: the cultural influences on mental health (CIMH) model. Clic Psychol Reb. 2008;28(2):211–27.CrossRefGoogle Scholar
  27. 27.
    Wang XC. Mental health and service utilization among Asian Americans: an analysis of influencing factors using U.S. national representative data. Athens, Georgia: U of Georgia. Accessed 15 Jan 2019.
  28. 28.
    American Cancer Society. American Cancer Society guidelines for the early detection of cancer. 2018. [cited 2018 October 23]. Available from
  29. 29.
    American Cancer Society. Cervical cancer prevention and early detection. 2018. [cited 2018 October 23]. Available from
  30. 30.
    Maxwell AE, Bastani R, Warda US. Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. Am J Am J Prev Med. 2000;18(1):62–8.CrossRefGoogle Scholar
  31. 31.
    Kim KC, Kim S. Korean immigrant churches in the U.S. In: Bedell K, editor. Yearbook of American Canadian churches. Nashville: Abingdon Press; 1995. p. 6–9.Google Scholar
  32. 32.
    Kim KC, Kim S. The ethnic roles of Korean immigrant churches in the United States. In: Kwon HY, Kim KC, Warner RS, editors. Korean Americans and their religions: pilgrims and missionaries from a different shore. University Park: The Pennsylvania State University Press; 2001. p. 71–95.Google Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.School of Social WorkUniversity of GeorgiaAthensUSA
  2. 2.School of Social WorkUniversity of AlabamaTuscaloosaUSA
  3. 3.Department of Social Work and SociologyNorth Carolina A&T State UniversityGreensboroUSA
  4. 4.School of Social WorkUniversity of MinnesotaSt PaulUSA
  5. 5.Department of Counseling PsychologyRadford UniversityRadfordUSA

Personalised recommendations