Journal of General Internal Medicine

, Volume 20, Issue 3, pp 290–296 | Cite as

Impact of U.S. Citizenship status on cancer screening among immigrant women

  • Israel De Alba
  • F. Allan Hubbell
  • Juliet M. McMullin
  • Jamie M. Sweningson
  • Richard Saitz
Original Articles

Abstract

OBJECTIVE: We evaluated the relationship between U.S. citizenship status and the receipt of Pap smears and mammograms among immigrant women in California.

DESIGN: Cross-sectional study using data from the 2001 California Health Interview Survey.

PATIENTS/PARTICIPANTS: Noninstitutionalized, civilian women, aged 18 years and older living in California.

MEASUREMENTS AND MAIN RESULTS: We analyzed data from the 2001 California Health Interview Survey and used logistic regression models to adjust for sociodemographic factors and for access and utilization of health services. After adjusting we found that U.S. citizen immigrants were significantly more likely to report receiving a Pap smear ever (adjusted prevalence ratio [aPR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), a recent Pap smear (aPR, 1.07; 95% CI, 1.03 to 1.11), a mammogram ever (aPR, 1.17; 95% CI, 1.12 to 1.21), and a recent mammogram (aPR, 1.38; 95% CI, 1.26 to 1.49) as compared to immigrants who are not U.S. citizens. Also associated with receiving cancer screening were income, having a usual source of care, and having health insurance. Hispanic women were more likely to receive Pap smears as compared to whites and Asians.

CONCLUSIONS: Not being a U.S. citizen is a barrier to receiving cervical and breast cancer screening. Additional research is needed to explore causal factors for differences in cancer screening rates between citizens and noncitizens.

Keywords

citizenship immigrant Pap smear mammogram women 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97:1528–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Skaer TL, Robison LM, Sclar DA, Harding GH. Cancer-screening determinants among Hispanic women using migrant health clinics. J Health Care Poor Underserved. 1996;7:338–54.PubMedGoogle Scholar
  3. 3.
    Calle EE, Flanders WD, Thun MJ, Martin LM. Demographic predictors of mammography and Pap smear screening in US women. Am J Public Health. 1993;83:53–60.PubMedGoogle Scholar
  4. 4.
    Trapido EJ, Burciaga Valdez R, Obeso JL, Strickman-Stein N, Rotger A, Perez-Stable EJ. Epidemiology of cancer among Hispanics in the United States. J Natl Cancer Inst Monogr. 1995;18:17–28.PubMedGoogle Scholar
  5. 5.
    Seeff LC, McKenna MT. Cervical cancer mortality among foreign-born women living in the United States, 1985 to 1996. Cancer Detect Prev. 2003;27:203–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1975–2000. Bethesda, MD: National Cancer Instute. Available at: http://seer.cancer.gov/csr/1975_2000. Accessed May 2003.Google Scholar
  7. 7.
    Hedeen AN, White E. Breast cancer size and stage in Hispanic American women, by birthplace: 1992–1995. Am J Public Health. 2001;91:122–5.PubMedGoogle Scholar
  8. 8.
    Hedeen AN, White E, Taylor V. Ethnicity and birthplace in relation to tumor size and stage in Asian American women with breast cancer. Am J Public Health. 1999;89:1248–52.PubMedGoogle Scholar
  9. 9.
    Wu ZH, Black SA, Markides KS. Prevalence and associated factors of cancer screening: why are so many older Mexican American women never screened? Prev Med. 2001;33:268–73.PubMedCrossRefGoogle Scholar
  10. 10.
    Howe HL, Wingo PA, Thun MJ, et al. Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends. J Natl Cancer Inst. 2001;93:824–42.PubMedCrossRefGoogle Scholar
  11. 11.
    Roetzheim RG, Pal N, Tennant C, et al. Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst. 1999;91:1409–15.PubMedCrossRefGoogle Scholar
  12. 12.
    Powell-Griner E, Bolen J, Bland S. Health care coverage and use of preventive services among the near elderly in the United States. Am J Public Health. 1999;89:882–6.PubMedGoogle Scholar
  13. 13.
    O’Malley AS, Mandelblatt J. Delivery of preventive services for low-income persons over age 50: A comparison of community health clinics to private doctors’ offices. J Community Health. 2003;28:185–97.PubMedCrossRefGoogle Scholar
  14. 14.
    O’Malley AS, Forrest CB, Mandelblatt J. Adherence of low-income women to cancer screening recommendations. J Gen Intern Med. 2002;17:144–54.PubMedCrossRefGoogle Scholar
  15. 15.
    Mandelblatt JS, Gold K, O’Malley AS, et al. Breast and cervix cancer screening among multiethnic women: role of age, health, and source of care. Prev Med. 1999;28:418–25.PubMedCrossRefGoogle Scholar
  16. 16.
    O’Malley AS, Mandelblatt J, Gold K, Cagney KA, Kerner J. Continuity of care and the use of breast and cervical cancer screening services in a multiethnic community. Arch Intern Med. 1997;157:1462–70.PubMedCrossRefGoogle Scholar
  17. 17.
    O’Malley AS, Kerner J, Johnson AE, Mandelblatt J. Acculturation and breast cancer screening among Hispanic women in New York City. Am J Public Health. 1999;89:219–27.PubMedGoogle Scholar
  18. 18.
    Schur CL, Albers LA, Berk ML. Health care use by Hispanic adults: financial vs. non-financial determinants. Health Care Fianc Rev. 1995;17:71–88.Google Scholar
  19. 19.
    Janes GR, Blackman DK, Bolen JC, et al. Surveillance for use of preventive health-care services by older adults, 1995–1997. MMWR CDC Surveill Summ. 1999;48:51–88.PubMedGoogle Scholar
  20. 20.
    Hubbell FA, Chavez LR, Mishra SI, Valdez RB. Beliefs about sexual behavior and other predictors of Papanicolaou smear screening among Latinas and Anglo women. Arch Intern Med. 1996;156:2353–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Chavez L, McMullin J, Mishra S, Hubbell F. Beliefs matter: cultural beliefs and the use of cervical cancer screening tests. Am Anthropol. 2001;103:1–16.Google Scholar
  22. 22.
    Ramirez AG, Suarez L, Laufman L, Barroso C, Chalela P. Hispanic women’s breast and cervical cancer knowledge, attitudes, and screening behaviors. Am J Health Promot. 2000;14:292–300.PubMedGoogle Scholar
  23. 23.
    Tortolero-Luna G, Glober GA, Villarreal R, Palos G, Linares A. Screening practices and knowledge, attitudes, and beliefs about cancer among Hispanic and non-Hispanic white women 35 years old or older in Nueces County, Texas. J Natl Cancer Inst Monogr. 1995;18:49–56.PubMedGoogle Scholar
  24. 24.
    Perez-Stable EJ, Otero Sabogal R, Sabogal F, McPhee SJ, Hiatt RA. Self-reported use of cancer screening tests among Latinos and Anglos in a prepaid health plan. Arch Intern Med. 1994;154:1073–81.PubMedCrossRefGoogle Scholar
  25. 25.
    De Alba I, Sweningson JM, Chandy C, Hubbell FA. Impact of English language proficiency on receipt of Pap smears among Hispanics. J Gen Intern Med. 2004;19:967–70.PubMedGoogle Scholar
  26. 26.
    Goel M, Wee C, McCarthy E, Davis R, Ngo-Metzger Q, Phillips R. Racial and ethnic disparities in cancer screening: the importance of foreignbirth as a barrier of care. J Gen Intern Med. 2003;18:1028–35.PubMedCrossRefGoogle Scholar
  27. 27.
    Carrasquillo O, Carrasquillo AI, Shea S. Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Am J Public Health. 2000;90:917–23.PubMedGoogle Scholar
  28. 28.
    Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work. 1998;23:136–45.PubMedGoogle Scholar
  29. 29.
    Schmidley A. U.S. Census Bureau, Current Population Reports, Series P23-206, Profile of the Foreign-born Population in the United States: 2000. Washington, DC: U.S. Census Bureau, U.S. Government Printing Offic; 2001.Google Scholar
  30. 30.
    Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work. 1998;23:136–45.PubMedGoogle Scholar
  31. 31.
    Li A, Covinski K. Citizenship status in an important determinant of health care disparity. J Gen Intern Med. 2003;18(suppl. 1):179.Google Scholar
  32. 32.
    Katzburg J. Impact of citizenship on access to preventive services among Latina women. Paper presented at the 128th annual meeting of the American Public Health Association, November 4, 2000, Boston, MA.Google Scholar
  33. 33.
    Chaudhry S, Fink A, Gelberg L, Brook R. Utilization of Papanicolaou smears by South Asian women living in the United States. J Gen Intern Med. 2003;18:377–84.PubMedCrossRefGoogle Scholar
  34. 34.
    California Health Interview Surgery. CHIS 2001 Methodology Series: Report 4—Responses Rates. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  35. 35.
    United States Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality; 1996.Google Scholar
  36. 36.
    Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003;53:141–69.PubMedGoogle Scholar
  37. 37.
    Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1.PubMedCrossRefGoogle Scholar
  38. 38.
    Yang PQ. Explaining immigrant naturalization. Int Migr Rev. 1994;28:449–77.PubMedCrossRefGoogle Scholar
  39. 39.
    Taylor VM, Jackson JC, Yasui Y, et al. Pap testing stages of adoption among Cambodian immigrants. Asian Am Pac Isl J Health. 2000;8:58–68.PubMedGoogle Scholar
  40. 40.
    Hubbell FA, Waitzkin H, Mishra SI, Dombrink J, Chavez LR. Access to medical care for documented and undocumented Latinos in a southern California county. West J Med. 1991;154:414–7.PubMedGoogle Scholar
  41. 41.
    Chavez LR, Hubbell FA, Mishra SI, Valdez RB. Undocumented Latina immigrants in Orange County, CA: A comparative analysis. Int Migr Rev. 1997;31:88–107.PubMedCrossRefGoogle Scholar
  42. 42.
    Chavez LR, Cornelius WA, Jones OW. Utilization of health services by Mexican immigrant women in San Diego. Women Health. 1986;11:3–20.PubMedCrossRefGoogle Scholar
  43. 43.
    U.S. Department of Homeland Security. Yearbook of Immigration Statistics 2002. Washington, DC: U.S. Department of Homeland Security; 2003.Google Scholar
  44. 44.
    Fix M, Passel JS, Sucher K. Trends in naturalization. The Urban Institute. September 2003. Available at: http://www.urban.org/url.cfm?ID=310847. Accessed March 1, 2004.Google Scholar
  45. 45.
    Asch S, Leake B, Gelberg L. Does year of immigration authorities deter tuberculosis patients from seeking care? West J Med. 1994;161:373–6.PubMedGoogle Scholar
  46. 46.
    Crane LA, Kaplan CP, Bastani R, Scrimshaw SC. Determinants of adherence among health department patients referred for a mammogram. Women Health. 1996;24:43–64.PubMedCrossRefGoogle Scholar
  47. 47.
    Clark WA. Large-scale immigration and political response: popular reaction in California. Int J Popul Geogr. 1998;4:1–10.PubMedCrossRefGoogle Scholar
  48. 48.
    Fenton JJ, Catalano R, Hargreaves WA. Effect of Proposition 187 on mental health service use in California: A case study. Health Aff (Millwood). 1996;15:182–90.CrossRefGoogle Scholar
  49. 49.
    Fenton JJ, Moss N, Khalil HG, Asch S. Effect of California’s Proposition 187 on the use of primary care clinics. West J Med. 1997;166:16–20.PubMedGoogle Scholar
  50. 50.
    Freeman GP. Reform and retreat in United States immigration policy. People Place. 1998;6:1–11.PubMedGoogle Scholar
  51. 51.
    Marx JL, Thach AB, Grayson G, Lowry LP, Lopez PF, Lee PP. The effects of California Proposition 187 on ophthalmology clinic utilization at an inner-city urban hospital. Ophthalmology. 1996;103:847–51.PubMedGoogle Scholar
  52. 52.
    McBride MJ. Migrants and asylum seekers: policy responses in the United States to immigrants and refugees from Central America and the Caribbean. Int Migr. 1999;37:289–317.PubMedCrossRefGoogle Scholar
  53. 53.
    Ziv TA, Lo B. Denial of care to illegal immigrants. Proposition 187 in California. N Engl J Med. 1995;332:1095–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Lee YT, Ottati V. Attitudes toward U.S. immigration policy: the roles of in-group-out-group bias, economic concern, and obedience to law. J Soc Psychol. 2002;142:617–34.PubMedCrossRefGoogle Scholar
  55. 55.
    Halfon N, Wood DL, Valdez RB, Pereyra M, Duan N. Medicaid enrollment and health services access by Latino children in inner-city Los Angeles. JAMA. 1997;277:636–41.PubMedCrossRefGoogle Scholar
  56. 56.
    Kullgren JT. Restrictions on undocumented immigrants’ access to health services: the public health implications of welfare reform. Am J Public Health. 2003;93:1630–3.PubMedCrossRefGoogle Scholar
  57. 57.
    Fix M, Passel JS. Trends in noncitizens’ and citizen’ use of public benefits following Welfare reform: 1994–97. The Urban Institute, Available at: http://urban.org/url.cfm?ID=408086. Accessed October 12, 2003.Google Scholar
  58. 58.
    Ellwood MR, Ku L. Welfare and immigration reform: unintended side effects for Medicaid. Health Aff (Millwood). 1998;17:137–51.CrossRefGoogle Scholar
  59. 59.
    The Gallup Organization. Americans worried about immigration, oppose Bush plan; majority says immigrants hurt economy. The Gallup Organization. Available at: http://www.gallup.com/poll/content/login.aspx?ci=10195. Accessed March 1, 2004.Google Scholar
  60. 60.
    McPhee SJ, Stewart S, Brock KC, Bird JA, Jenkins CN, Pham GQ. Factors associated with breast and cervical cancer screening practices among Vietnamese American women. Cancer Detect Prev. 1997;21:510–21.PubMedGoogle Scholar
  61. 61.
    Tu SP, Yasui Y, Kuniyuki A, et al. Breast cancer screening among Cambodian American women. Cancer Detect Prev. 2000;24:549–63.PubMedGoogle Scholar
  62. 62.
    Yu SM, Huang ZJ, Singh GK. Health status and health services utilization among US Chinese, Asian Indian, Filipino, and other Asian/Pacific Islander children. Pediatrics. 2004;113(pt 1):101–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Hiatt RA, Perez-Stable EJ, Quesenberry C Jr, Sabogal F, Otero-Sabogal R, McPhee SJ. Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic while health plan members in northern California. Prev Med. 1995;24:278–85.PubMedCrossRefGoogle Scholar
  64. 64.
    Paskett ED, Tatum CM, Mack DW, Hoen H, Case LD, Velez R. Validation of self-reported breast and cervical cancer screening tests among low-income minority women. Cancer Epidemiol Biomarkers Prev. 1996;5:721–6.PubMedGoogle Scholar
  65. 65.
    McPhee SJ, Nguyen TT, Shema SJ, et al. Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med. 2002;35:463–73.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Israel De Alba
    • 1
    • 2
  • F. Allan Hubbell
    • 1
    • 2
  • Juliet M. McMullin
    • 1
    • 2
    • 3
  • Jamie M. Sweningson
    • 2
  • Richard Saitz
    • 4
    • 5
  1. 1.Division of General Internal Medicine and Primary Care, Department of MedicineUniversity of CaliforniaIrvineUSA
  2. 2.Center for Health Policy and ResearchUniversity of CaliforniaIrvineUSA
  3. 3.Department of Anthropology, School of Social EcologyUniversity of CaliforniaIrvineUSA
  4. 4.Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of MedicineBoston University School of Medicine and Boston Medical CenterBostonUSA
  5. 5.Department of EpidemiologyBoston University School of Public HealthBostonUSA

Personalised recommendations