Race and Social Problems

, Volume 6, Issue 1, pp 4–14 | Cite as

Socio-demographic Factors and Cancer Screening Among Foreign-Born Chinese, Cambodian and Vietnamese Women

  • Karen E. Kim
  • Edwin Chandrasekar
  • Helen Y. LamEmail author


Asian Americans are now the most rapidly growing minority group in the USA. Over 60 % Asian Americans in the USA are immigrants. Cancer has been the leading cause of death among Asian American women since 1980. Understanding the barriers to screening is essential to reduce the unnecessary burden of cancer. Little is known about cancer screening behaviors among foreign-born Asian women and how socio-demographic factors may influence these behaviors. Even less is known about disaggregated Asian subgroups. Using data from the Chicago Asian Community Survey, a local health assessment survey of three Asian subgroups in Chicago, Chinese, Vietnamese and Cambodian, this study found that breast and cervical cancer screening rates were much lower among foreign-born Asian women, 48 and 49 %, respectively, than the national rates for the general population, 72 and 83 %, respectively. Furthermore, we studied disaggregated data to determine cancer screening differences between communities. Findings from this study provide a critical evidence base to inform future research, policy and targeted interventions for Asian ethnic-specific populations.


Socio-demographic Asian immigrants Cervical cancer screening Breast cancer screening 



The CACS project was funded by the Illinois Department of Public Health, Chicago Community Trust, and Research Retirement Foundation. We thank Chinese American Services league, Cambodian Association of Illinois and Chinese Mutual Aid Association for their cooperation and feedback in developing the survey instrument, their recruitment of participants, and their assistance with survey interviews. We also thank the Sinai Urban Health institute (SUHI) Institutional Review Board for ensuring ethical review of the project. We thank all participants for their time and sharing personal information about their health and well-being.


  1. Aday, L. A. (2001). At risk in America: The health and health care needs of vulnerable populations in the United States. San Francisco, CA: Jossey-Bass.Google Scholar
  2. Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., et al. (1994). Socioeconomic status and health: the challenge of the gradient. American Psychologist, 49, 15–24.CrossRefGoogle Scholar
  3. American Cancer Society. (2007). Breast cancer facts and figures 20072008. Retrieved on October 9, 2013, from
  4. American Cancer Society. (2013a). Cancer facts and figures 2013. Retrieved on October 9, 2013, from
  5. American Cancer Society. (2013b). Breast cancer facts and figures 20132014. Retrieved on October 9, 2013, from
  6. American Community Survey. (2010). Retrieved on July 14, 2013, from
  7. Anderson, N., Bulatao, R., & Cohen, B. (2004). Critical perspectives on racial and ethnic differences in health in late life. Washington, DC: National Academies press.Google Scholar
  8. Asian Health Coalition. (2010). The Chicago Asian Community Survey. Retrieved on December 24, 2012, from
  9. Center for Disease Control. (2012a). CDC press release: January 26, 2012. Study finds racial and ethnic disparities in US cancer screening rates. Retrieved on May 16, 2013, from
  10. Center for Disease Control. (2012b). Cancer screening—United States 2010. MMWR, 61, 43–51.Google Scholar
  11. Chen, M. S. (2005). Cancer health disparities among Asian Americans: What we know and what we need to do. Cancer, 104, 2895–2902.CrossRefGoogle Scholar
  12. Chen, J. Y., Diamant, A. L., Kagawa-Singer, M., Pourat, N., & Word, C. (2004). Disaggregating data on Asian and Pacific Islander women to assess cancer screening. American Journal of Preventive Medicine, 27, 139–145.CrossRefGoogle Scholar
  13. Chen, J., Vargas-Bustamante, A., & Ortega, A. N. (2012). Health care expenditures among Asian American Subgroups. Medical Care Research and Review. doi: 10.1177/107755872465773.
  14. Curry, S. J., Byers, T., Hewitt, M., et al. (2003). Fulfilling the potential of cancer prevention and early detection. Washington, DC: The national Academics Press.Google Scholar
  15. Czaja, R., Blaire, J., & Sebestik, J. P. (1982). Respondent selection in a telephone survey; a comparison of three techniques. Journal of Marketing Research, 19, 381–385.CrossRefGoogle Scholar
  16. Derose, K. P., & Baker, D. W. (2000). Limited English proficiency and Latinos’ use of physician services. Medical care Research and Review, 57, 76–91.CrossRefGoogle Scholar
  17. Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and health care: sources of vulnerability. Health Affairs, 26, 1258–1268.CrossRefGoogle Scholar
  18. Dunlop, S., Coyte, P. C., & McIsaac, W. (2000). Socioeconomic status and the utilization of physicians’ service: results from the Canadian National Population Health Survey. Social Science and Medicine, 51, 123–133.CrossRefGoogle Scholar
  19. Feinstein, J. S. (1993). The relationship between socioeconomic status and health. Milbank Quarterly, 71, 279–322.CrossRefGoogle Scholar
  20. Ferlay, J., Shin, H. R., Bray, F., Forman, D., Mathers, C., & Parkin, D. M. (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International Journal of Cancer, 127, 2893–2917.CrossRefGoogle Scholar
  21. Flaskerud, J. H., & Winslow, B. J. (1998). Conceptualizing vulnerable populations health-related research. Nursing Research, 47, 69–78.CrossRefGoogle Scholar
  22. Frisbie, W. P., Cho, Y., & Hummer, R. A. (2001). Immigration and the health of Asian and Pacific Islander adults in the United States. American Journal of Epidemiology, 153, 372–380.CrossRefGoogle Scholar
  23. Ghosh, C. (2003). Healthy People 2010 and Asian Americans/Pacific Islanders: Defining a baseline of information. American Journal of Public Health, 93, 2093–2098.CrossRefGoogle Scholar
  24. Goddard, M., & Smith, P. (2001). Equity of access to health care services: Theory and evidence from the UK. Social Science and Medicine, 53, 1149–1162.CrossRefGoogle Scholar
  25. Goel, M. S., Wee, C. C., McCathy, E. P., Darris, R. B., Ngo-Metzer, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening. Journal of General Internal Medicine, 18, 1028–1035.CrossRefGoogle Scholar
  26. Goldman, D. P., Smith, J. P., & Sood, N. (2006). Immigrants and the cost of medical care. Health Affairs, 25, 1700–1711.CrossRefGoogle Scholar
  27. Gomez, S. L., Kelsey, J. L., Glaser, S. L., Lee, M. M., & Sidney, S. (2004). Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organization. American Journal of Public Health, 94, 1977–1984.CrossRefGoogle Scholar
  28. Grieco, E. M., Acosta, Y. D., Petricia de la Cruz, G., Gambino, G., Gryn, T. et al. (2012). The foreign-born population in the United States 2010: American Community Survey Reports. Retrieved on October 16, 2013, from
  29. Heckathorn, D. D. (1997). Respondent-driven sampling: a new approach to the study of “hidden” population. Social Problems, 44, 174–199.CrossRefGoogle Scholar
  30. Heckathorn, D. D. (2002). Respondent-driven sampling II: Deriving valid population estimate from chain-referral samples of hidden populations. Social Problems, 49, 11–34.CrossRefGoogle Scholar
  31. Hedeen, A. N., White, E., & Taylor, V. (1999). Ethnicity and birthplace in relation to tumor size and stage in Asian American women with breast cancer. American Journal of Public Health, 89, 1248–1252.CrossRefGoogle Scholar
  32. Homeland Security. (2012). Yearbook of immigration statistics 2012. Retrieved on March 21, 2013, from
  33. Howlader, N., Noone, A. M., Krapcho, M., Garshell, J., Neyman, N., Altekruse, S. F., et al. (Eds.). (2012). SEER cancer statistics review, 19752010. Bethesda, MD: National Cancer Institute.
  34. Humes, K. R., Jones, N. A., & Ramirez, R. R. (2011). 2010 census briefs: overview of race and Hispanic origin: 2010. U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau. Retrieved on February 21, 2011, from
  35. Hyman, I. (2001). Immigration and Health. Health policy working paper Series. Working paper 01-05. Ottawa, ON: Health Canada.Google Scholar
  36. Jackson, J. C., Tayla, V. M., Chitnarong, K., et al. (2000). Development of a cervical cancer control intervention program for Cambodian American women. Journal of Community Health, 25, 359–375.CrossRefGoogle Scholar
  37. Jacobs, E. A., Karavolos, K., Rathouz, P. J., Ferris, T. G., & Powell, L. H. (2005). Limited English proficiency and breast and cervical cancer screening in a multiethnic population. American Journal of Public Health, 95, 1410–1416.CrossRefGoogle Scholar
  38. Jemal, A., Clegg, E., Ward, L., et al. (2004). Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer, 101, 3–27.CrossRefGoogle Scholar
  39. Jemal, A., Siegel, R., Ward, E., Yongping, H., et al. (2008). Cancer statistics. CA, A Cancer Journal for Clinician, 58, 71–96.CrossRefGoogle Scholar
  40. Jerant, A. F., & Fenton, J. J. (2008). Determinants of racial/ethnic colorectal cancer screening disparities. Archives of Internal Medicine, 168, 1317–1324.CrossRefGoogle Scholar
  41. Kandula, N. R., Wen, M., Jacobs, E. A., & Lauderdale, D. E. (2006). Low rates of colorectal, cervical and breast cancer screening in Asian Americans compared with non-Hispanic whites: Cultural influences or access to care? Cancer, 107, 184–192.CrossRefGoogle Scholar
  42. Krieger, N., & Fee, E. (1994). Social class: the missing link in U.S. health data. International Journal of Health Services, 24, 25–44.CrossRefGoogle Scholar
  43. Krieger, N., Rowley, D. L., Herman, A. A., Avery, B., & Phillips, M. T. (1993). Racism, sexism, and social class: implications for studies of health disease, and well-being. American Journal of Preventive Medicine, 9, 82–122.Google Scholar
  44. Lillie-Blanton, M., Martinez, R. M., Taylor, A. K., & Robinson, B. G. (1993). Latina and African American women: continuing disparities in health. International Journal of Health Services, 23, 555–584.CrossRefGoogle Scholar
  45. Lin, S. S., Clarke, C. A., Preh, A. W., Glaser, S. L., West, D. W., & O’Malley, C. D. (2002). Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas. Cancer, 94, 1175–1182.CrossRefGoogle Scholar
  46. Marmot, M. G., Kogevinas, M., & Elston, M. A. (1987). Social/economic status and disease. Annual Review of Public Health, 8, 111–135.CrossRefGoogle Scholar
  47. McCracken, M., Olsen, M., Chen, M. S., et al. (2007). Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA: Cancer Journal for Clinician, 57, 190–205.Google Scholar
  48. Mock, J., Mcphee, S. J., Nguyen, T., et al. (2007). Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women. American Journal of Public Health, 97, 1693–1700.CrossRefGoogle Scholar
  49. National Center for Health Statistics. (1998). Health, United States, 1998 with socioeconomic status and health chart book. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  50. Pew Research Center. (2012). The rise of Asian American. Washington, DC: Pew Research center.Google Scholar
  51. Ponce, N., Hays, R. D., & Cunningham, W. E. (2006). Linguistic disparities in health care access and health status among older adults. Journal of General Internal Medicine, 21, 786–791.CrossRefGoogle Scholar
  52. Raffle, A. E., Alden, B., Quinn, M., Babb, P. J., & Bret, M. T. (2003). Outcomes of screening to prevent cancer: Analysis of cumulative incidence of cervical abnormality and modeling of cases and deaths prevented. British Medical Journal, 326, 901–905.CrossRefGoogle Scholar
  53. Singh, G. K., & Miler, B. A. (2004). Health, life expectancy, and mortality patterns among immigrant populations in the United States. Canadian Journal of Public Health, 95, I14–I21.Google Scholar
  54. Swam, J., Breen, N., Coates, R. J., Rimer, B. K., & Lee, N. C. (2003). Progress in cancer screening practices in the United States: Results from the 2000 National Health Interview Survey. Cancer, 97, 1528–1540.CrossRefGoogle Scholar
  55. Takaki, R. (1989). Strangers from a different shore: A history of Asian Americans. New York, NY: Penguin Books.Google Scholar
  56. Tang, T. S., Solomon, L. J., & MaCracken, L. M. (2000). Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older. Preventive Medicine, 31, 575–583.CrossRefGoogle Scholar
  57. Taylor, V. M., Jackson, J. C., Tu, S. P., et al. (2002). Cervical cancer screening among Chinese Americans. Cancer Detection and Prevention, 26, 139–145.CrossRefGoogle Scholar
  58. Tseng, W., McDonald, D. D., Ho, W., Lee, C., & Wong, S. (2010). Ethnic Health Assessment for Asian Americans, Native Hawaiians and Pacific Islanders in California. Prepared for the California Program on Access to Care (CPAC). Berkeley, CA: UC Berkeley School of Public Health.Google Scholar
  59. U.S. Census Bureau. (2000). Summary file 1. U.S. Census Bureau. Retrieved on December 6, 2013, from
  60. U.S. Census Bureau. (2008). Retrieved on March 21, 2013, from
  61. U.S. Census Bureau. (2010). Retrieved on March 21, 2013, from
  62. Watters, J. K., & Bierbacki, P. (1989). Targeted sampling: options for the study of hidden populations. Social Problems, 36, 416–430.CrossRefGoogle Scholar
  63. Wen, M., Lauderdale, D. S., & Kandula, N. R. (2009). Ethnic neighborhoods in multi-ethnic America, 1990–2000: Resurgent ethnicity in the ethnoburbs? Social Forces, 68, 425–460.CrossRefGoogle Scholar
  64. Wilkinson, R. G. (1990). Income distribution and life expectancy. Sociology of Health & Illness, 12, 391–412.CrossRefGoogle Scholar
  65. William, D. R. (1990). Socioeconomic differentials in health: A review and redirection. Social Psychology Quarterly, 53, 81–99.CrossRefGoogle Scholar
  66. Williams, D. R., & Collins, C. (1995). US socioeconomic and racial differences in health: patterns and explanations. Annual Review of Sociology, 21, 349–386.CrossRefGoogle Scholar
  67. Wu, Z., Penning, M. J., & Schimmele, C. M. (2005). Immigrant status and unmet health care needs. Canadian Journal of Public Health, 96, 369–373.Google Scholar
  68. Yu, E. S., Kum, K. K., Chen, E. H., & Brintnall, R. A. (2001). Breast and cervical cancer screening among Chinese American women. Cancer Practice, 9, 81–91.CrossRefGoogle Scholar
  69. Yu, M. Y., Seetoo, A. D., Tsai, C. K., & Sun, C. (1998). Socio–demographic predictors of Papanicolaou smear test and mammography use among women of Chinese descent in southeastern Michigan. Women’s Health Issues, 8, 372–381.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Karen E. Kim
    • 1
  • Edwin Chandrasekar
    • 2
  • Helen Y. Lam
    • 1
    Email author
  1. 1.The University of Chicago Comprehensive Cancer CenterChicagoUSA
  2. 2.Asian Health CoalitionsChicagoUSA

Personalised recommendations