The relationship between religiosity and cancer screening among Vietnamese women in the United States: the moderating role of acculturation

In this study the authors explore the relationship between intrinsic, personal extrinsic, and social extrinsic religiosity to breast and cervical cancer screening efficacy and behavior among Vietnamese women recruited from a Catholic Vietnamese church and a Buddhist temple in the Richmond, Virginia metropolitan area. The potential moderating effect of acculturation was of interest. Participants were 111 Vietnamese women who participated in a larger cancer screening intervention. Data collection began early fall of 2010 and ended in late spring 2011. High levels of acculturation were associated with increased self-efficacy for Pap tests and having received a Pap test. Acculturation moderated the relationships between religiosity and self-efficacy for breast and cervical cancer screening. Higher levels of social extrinsic religiosity were associated with increased efficacy for cancer screening among less acculturated women. Acculturation also moderated the relationship between religiosity and breast cancer screening. Specifically, for less acculturated women, increasing levels of intrinsic religiosity and personal extrinsic religiosity were associated with lower likelihood probability of Pap testing. For highly acculturated women, increasing levels of intrinsic religiosity and personal extrinsic religiosity were associated with higher likelihood probability of Pap testing. The authors' findings demonstrate the need for further investigation of the dynamic interplay of multi-level factors that influence cancer screening.     

The Relationship Between Religiosity and Cancer Screening Among Vietnamese Women in the United States: The Moderating Role of Acculturation

In this study the authors explore the relationship between intrinsic, personal extrinsic, and social extrinsic religiosity to breast and cervical cancer screening efficacy and behavior among Vietnamese women recruited from a Catholic Vietnamese church and a Buddhist temple in the Richmond, Virginia metropolitan area. The potential moderating effect of acculturation was of interest. Participants were 111 Vietnamese women who participated in a larger cancer screening intervention. Data collection began early fall of 2010 and ended in late spring 2011. High levels of acculturation were associated with increased self-efficacy for Pap tests and having received a Pap test. Acculturation moderated the relationships between religiosity and self-efficacy for breast and cervical cancer screening. Higher levels of social extrinsic religiosity were associated with increased efficacy for cancer screening among less acculturated women. Acculturation also moderated the relationship between religiosity and breast cancer screening. Specifically, for less acculturated women, increasing levels of intrinsic religiosity and personal extrinsic religiosity were associated with lower likelihood probability of Pap testing. For highly acculturated women, increasing levels of intrinsic religiosity and personal extrinsic religiosity were associated with higher likelihood probability of Pap testing. The authors' findings demonstrate the need for further investigation of the dynamic interplay of multi-level factors that influence cancer screening.     

Health beliefs and practices related to cancer screening among Arab Muslim women in an urban community

In this exploratory study I investigated the participation status in breast and cervical cancer screening of a group of American immigrant Arab Muslim women (AMW). Perceived knowledge of and barriers to screening participation, relationships among demographic variables, health practice and beliefs, and self-reports of traditionalism and acculturation also are studied. Factors including religious and cultural beliefs, economic concerns, and modesty and embarrassment were considered. To reach the goals of Healthy People 2010 (HP 2010), an effective and meaningful educational initiative to raise awareness about breast and cervical cancer of AMW will require specific interventions consistent with their cultural and religious traditions.     

Cervical Cancer Screening Among Southeast Asian American Women

The incidence of cervical cancer is high among Southeast Asian American women, but their participation in preventive cervical cancer screening is alarmingly low. This paper reviews the literature on factors associated with participation in cervical cancer screening among women of Vietnamese, Cambodian and Hmong descent in the United States. These factors include acculturation, age, marital status, knowledge about cervical cancer, apprehension about cervical cancer screening, financial concerns, access to health care, and physician characteristics and recommendation. Suggestions for future research include the need to investigate the role of physicians treating Southeast Asian American women, the need for more extensive up-to-date studies on the current generation of young Southeast Asian American women, and the use of more advanced assessments of acculturation. Overall, much more work is needed in order to deepen our understanding of the various ways to improve the rate of cervical cancer screening among Southeast Asian American women.     

What Factors Explain Disparities in Mammography Rates Among Asian-American Immigrant Women? A Population-Based Study in California

BackgroundThe purpose of this study was to compare rates of screening mammography among immigrant women in five Asian-American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening.MethodsUsing 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, sociodemographic characteristics, access to health care, and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors.FindingsParticipation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past 2 years) screening. These differences decreased substantially after adjusting for acculturation, sociodemographic factors, and risk factors of breast cancer, but differences remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors.ConclusionsThis analysis draws attention to low mammography screening rates among Asian-American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is important to increase regular mammography screening in these groups.     

Pap smear and mammogram screening in Mexican-American women: the effects of acculturation.

OBJECTIVES. For Mexican Americans, acculturation is a multidimensional process of adopting attitudes, values, and behavior from the non-Hispanic White culture. This study examines the effects of different dimensions of acculturation on the cancer screening behavior of Mexican-American women. METHODS. Subjects were 450 randomly selected Mexican-American women age 40 years and older living in El Paso, Texas. Personal interviews solicited information on age, income, education, health insurance, Pap smear and mammogram use, and acculturation. Acculturation was measured with five scales that assessed English proficiency, English use, value placed on culture, traditional family attitudes, and social interaction. RESULTS. The 2-year prevalence of Pap smear and mammogram screening increased with each gain in acculturation on English proficiency and use. These associations disappeared when adjusted for age, income, insurance, and education. After adjusting for sociodemographic factors and other acculturation dimensions, a strong traditional Mexican attitude toward family was positively related to mammography use. CONCLUSIONS. Taking advantage of the positive influence of Hispanic familism on cancer screening behavior may increase the effectiveness of cancer control interventions in Mexican Americans.     

Acculturation and Cancer Screening Among Asian Americans: Role of Health Insurance and Having a Regular Physician

Cancer is the leading cause of death among Asian Americans, but screening rates are significantly lower in Asians than in non-Hispanic Whites. This study examined associations between acculturation and three types of cancer screening (colorectal, cervical, and breast), focusing on the role of health insurance and having a regular physician. A cross-sectional study of 851 Chinese, Korean, and Vietnamese Americans was conducted in Maryland. Acculturation was measured using an abridged version of the Suinn–Lew Asian Self-Identity Acculturation Scale, acculturation clusters, language preference, length of residency in the US, and age at arrival. Age, health insurance, regular physician, gender, ethnicity, income, marital status, and health status were adjusted in the multivariate analysis. Logistic regression analysis showed that various measures of acculturation were positively associated with the odds of having all cancer screenings. Those lived for more than 20 years in the US were about 2–4 times [odds ratio (OR) and 95 % confidence interval (CI) colorectal: 2.41 (1.52–3.82); cervical: 1.79 (1.07–3.01); and breast: 2.11 (1.25–3.57)] more likely than those who lived for less than 10 years to have had cancer screening. When health insurance and having a regular physician were adjusted, the associations between length of residency and colorectal cancer [OR 1.72 (1.05–2.81)] was reduced and the association between length of residency and cervical and breast cancer became no longer significant. Findings from this study provide a robust and comprehensive picture of AA cancer screening behavior. They will provide helpful information on future target groups for promoting cancer screening.     

Cervical cancer screening among Latinas: the importance of referral and participation in parallel cancer screening behaviors

Low cancer screening participation among medically underserved Latinas is largely due to lack of active referral to screening procedures by health care providers. We explored how physicians' referral and instruction on parallel screening procedures discriminates Latinas' cervical cancer screening practices in the context of relevant variables such as sociodemographic characteristics, health insurance, history of cancer, and level of acculturation. Of 153 women surveyed, 100 were compliant with yearly Pap smear while 53 were not compliant. Discriminant function analysis revealed that health care provider interventions and parallel breast cancer screening behaviors were significant discriminators between women who obtained a Pap smear within a year and those who were less compliant. A change in public health policy that facilitates to medically underserved Latinas access to reliable sources of health care referrals and services might increase their regular use of cervical cancer screening, which could potentially result in a reduction in cancer treatment costs and in lives lost to cervical cancer among these women.     

Breast and cervical cancer screening: Knowledge, attitudes and behaviour among schoolteachers in Italy

The study explores knowledge, attitudes and behavior regarding screening for breast and cervical cancers. All female teachers in primary and secondary schools in Crotone and in Cassino (Italy) received a questionnaire on demographic and socioeconomic characteristics, clinical history, knowledge, behavior and attitudes about breast and cervical cancer and related screening procedures. A response rate of 65% was achieved. Knowledge on effectiveness of mammography and pap test in finding related cancers was widely spread in the sample. Only about 30% and 50% had respectively undergone their last mammogram and pap test according to the recommended time interval. Having been examined by a physician in the previous year and having had a screening CBE or a screening pap smear in the past three years were significantly more likely in women who underwent mammography for screening purposes in the past two years. Pap smear in the previous three years was significantly more likely in women in their forties, with a higher family income and in those who had been examined by a physician in the previous year. The results strongly recommend continued emphasis of physicians on education of women regarding mammography and pap smear.     

Acculturation and breast cancer screening among Hispanic women in New York City.

OBJECTIVES: This study investigated whether acculturation was associated with the receipt of clinical breast examinations and mammograms among Colombian, Ecuadorian, Dominican, and Puerto Rican women aged 18 to 74 years in New York City in 1992. METHODS: A bilingual, targeted, random-digit-dialed telephone survey was conducted among 908 Hispanic women from a population-based quota sample. Outcome measures included ever and recent use of clinical breast examinations and mammograms. Multivariate logistic regression models were used to assess the effect of acculturation on screening use. RESULTS: When demographic, socioeconomic, and health system characteristics and cancer attitudes and beliefs were controlled for, women who were more acculturated had significantly higher odds of ever and recently receiving a clinical breast examination (P < or = .01) and of ever (P < or = .01) and recently (P < or = .05) receiving a mammogram than did less acculturated women. For all screening measures, there was a linear increase in the adjusted probability of being screened as a function of acculturation. CONCLUSIONS: Neighborhood and health system interventions to increase screening among Hispanic women should target the less acculturated.     

Acculturation, access to care and use preventive health services by Vietnamese women

PURPOSE OF THE PAPER. The purposes of this study were to examine the relationships between acculturation and (1) access to health services and (2) use of preventive services among Vietnamese women in western Massachusetts. METHODS. The telephone survey method was conducted with 141 Vietnamese women ages 18 years or over. PRINCIPAL FINDINGS. Of the acculturation variables, language acculturation was significantly related to having a routine place for health care and a regular provider. Women tended to have better access to health service with an increase in the length of residence in the US. Length of residence in the US was an independent predictor of prior use of Pap test and clinical breast examination. CONCLUSIONS. Utilization level of preventive health services among study group participants was low. The findings indicate that length of residence and increase in language capacity (more English usage) lead to more adequate access to health care. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. This study is particularly relevant to Vietnamese American women in the U.S. KEY WORDS. Vietnamese women; acculturation; preventive heaslth services; Massachusetts.     

Does HPV vaccination affect women's attitudes to cervical cancer screening and safe sexual behaviour?

The Human Papillomavirus (HPV) vaccine has the potential to greatly reduce the incidence of cervical cancer by protecting against HPV infections responsible for 70% of cervical cancer diagnoses. However, preliminary research has indicated that women vaccinated against HPV may be less likely to undergo cervical cancer screening and engage in safe sexual behaviour. The aim of the current study was to investigate whether vaccinated and unvaccinated women differ in their (i) knowledge of cervical screening guidelines, (ii) perceived vulnerability to cervical cancer, (iii) cervical screening intentions and uptake, and (iv) attitudes to and engagement in safe sexual behaviour. Participants were 193 female university students (119 vaccine recipients and 74 vaccine non-recipients) who completed online self-report questionnaires. Of all the assessed outcomes, attitudes to safe sexual behaviour were the only significant findings related to vaccination status (p<.001), such that vaccinated women held more positive attitudes to practicing safe sexual behaviour. Less than 5% of participants correctly identified screening guidelines. These findings do not support previous research concluding vaccination could have a detrimental impact on screening and sexual behaviour. Importantly, results highlight poor awareness of screening guidelines, poor levels of consistent condom use (50%) amongst those sexually active, and low uptake of screening (42%) amongst those eligible to be screened. Further research needs to specifically address young women's gaps in knowledge by developing initiatives promoting cervical screening.     

Correlates of mammography screening among Hispanic women living in lower Rio Grande Valley farmworker communities.

Factors contributing to the underuse of mammography screening by female Hispanic farmworkers aged 50 years and older in the Lower Rio Grande Valley were determined through home-based, Spanish-language personal interviews (N = 200). Questions covered adherence to screening mammography guidelines (mammogram within 2 years), healthcare access, sociodemographic characteristics, and theoretical constructs related to breast cancer screening in the literature. Multivariate findings indicated that adherent women were 3.6 times more likely to have health insurance. Self-efficacy for obtaining a mammogram and decisional balance were also significantly related to adherence; age, income, and education variables were not associated, perhaps because of restricted variation. Results indicate continuing efforts are needed to ensure that medically underserved migrant farmworker women have access to health care services. In addition, efforts to increase their self-efficacy in obtaining a mammogram and to counter negative attitudes and opinions by stressing the positive prognosis associated with early detection are warranted.     

Health beliefs and illness attitudes as predictors of breast cancer screening attendance

BACKGROUND: This paper considers the breast cancer screening programme in the autonomous community of Navarre, Northern Spain. Women from different areas of Northern, Central and Southern Navarre are involved. METHODS: A sample of 512 women participants and 196 non-participants was taken from a total of 60,908 women between 45 and 65 years of age who received an invitation to attend the breast cancer screening programme. The participants were asked to fill in an individual structured questionnaire in their local Health Centre and the non-participants in their homes. This was done retrospectively. RESULTS: The response rate was 100% for participants and 83.9% for non-participants. This study investigates the attitude profiles of the women attending mammography mass screening, with non-attending women (matched in educational and occupational levels) as controls. Subjects were assessed on dimensions such as attitudes towards health and illness. The results support Rosenstock's 1974 model that perceived severity of breast cancer and perceived susceptibility to breast cancer are related to participation in screening. Furthermore, results demonstrated that hypochondriacal beliefs, disease phobia and feared effects of symptoms were related to decreased participation levels. CONCLUSION: This study has explored the implication of health belief attitudes and the attitudes toward illness variables with women's participation in a breast cancer screening programme. It assesses the relative contribution of these variables to levels of participation, and the results of the study indicate that belief sets and attitudes are important components of women's cancer prevention behaviours.     

Hispanic acculturation and utilization of cervical cancer screening in the US

BACKGROUND: Hispanic women have an incidence rate of invasive cervical cancer that is twice as high as that of non-Hispanic White women. Previous investigations have reported that Hispanics are less likely to utilize cancer screening services. Using data from the 2000 National Health Interview Survey, this study examined whether acculturation of Hispanic women was associated with cervical cancer screening. METHODS: The subjects included 2307 Hispanic women aged 21-70 who did not have a history of cervical cancer or a hysterectomy. Women were analyzed by acculturation level according to whether or not they ever had a Pap smear and had one in the previous year and previous 3 years. RESULTS: Acculturation levels tended to be inversely correlated with no Pap smear. Compared to lower acculturated women, women who were more acculturated were less likely to never had a Pap smear (OR = 0.86; 95% CI = 0.58-1.27 for moderate acculturated women and OR = 0.51; 95% CI = 0.29-0.89 for higher acculturated women). Similar results were found for having no Pap smear within the past 3 years (OR = 0.83; 95% CI = 0.61-1.13 for moderate acculturated women and OR = 0.73; 95% CI = 0.49-1.08 for higher acculturated women). CONCLUSION: The findings show that lower acculturation was associated with the under use of cervical cancer screening and suggest that these women might have barriers in accessing and utilizing Pap smears.     

Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older

BACKGROUND: This study examined screening utilization at least once and regular adherence to mammography, clinical breast exam, and breast self-exam among older Chinese-American women. METHOD: One hundred women were recruited from senior centers in two metropolitan cities. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, breast cancer screening, common and cultural barriers to screening, and acculturation. RESULTS: Logistic regression models found insurance coverage for mammography and acculturation to be significant predictors of having had a mammogram at least once. Low perceived need/lack of physician recommendation and recency of physical examination were significant predictors of having had a mammogram in the past year. Acculturation and modesty were significant predictors of having had a clinical breast exam at least once, while recency of physical examination was a significant predictor of having had a clinical breast exam in the past year. Reliance on medial professionals for screening and forgetting were significant predictors of having performed breast self-exam at least once, and forgetting was a significant predictor of regular performance of breast self-exam. CONCLUSIONS: These findings suggest that both common and cultural barriers play a role in breast cancer screening among older Chinese-American women, with cultural factors being more influential in the initiation of cancer screening behavior.     

Acculturation,Acculturative Stress,and Depressive Symptoms in International Migrants: A Study with Vietnamese Women in South Korea

Globally, there have been increasing numbers of migrant women; these women are at an increased risk for depressive symptoms. The purpose of this study was to examine the associations among acculturation, acculturative stress and depressive symptoms in Vietnamese women who migrated to South Korea through marriages. We hypothesized that acculturative stress would serve as a mediator in the relationship between acculturation and depressive symptoms. Our findings from surveys with 217 Vietnamese immigrant women showed that the indirect effect of acculturation on depressive symptoms, mediated through acculturative stress [??.15 (.04)], was significant (bias corrected 95% confidence interval for the indirect effect?=???.25, ??.08). Low levels of acculturation increased acculturative stress, which in turn led to the elevated symptoms of depression. Our findings not only illuminate the adaptation processes of international, female migrants but also suggest avenues to protect and promote their mental well-being.     

Beliefs, recommendations and intentions are important explanatory factors of mammography screening behavior among Muslim Arab women in Israel

The rates of mammography screening by Muslim Arab women in Israel are lower compared with the general population. The current study aimed to examine factors related to screening mammography behavior among Arab women by employing components from the Health Belief Model and the Theory of Reasoned Action. Sociodemographic factors, knowledge, beliefs about breast cancer and mammography, self-efficacy, cues to action, norms and intention to perform mammography were examined as explanatory variables for mammography use. Face-to-face interviews with a random sample of 510 Muslim Arab women, aged 50-69 years, were conducted. The women had limited knowledge about breast cancer and mammography, and the rate of mammography screening behavior (at the recommended interval) was only 20%. The women who were significantly more likely to undergo mammography were those who received a recommendation from a health professional or from family/friends, perceived themselves as vulnerable to getting breast cancer, believed in the efficacy of the test, perceived it as not painful, were younger, were more educated and were only of borderline significance among those who expressed an intention to undergo mammography. The findings indicate that professional recommendation and beliefs sets are essential factors for developing effective mammography screening interventions in this unique population.     

Vietnamese American women: breast cancer knowledge, attitudes, and screening adherence

Breast cancer screening behavior and attitudes was measured among a convenience sample of 275 Vietnamese American women as part of a cancer education program evaluation. Follow-up interviews were completed with 178. Only 36% reported having adequate knowledge on this topic, and 87% indicated an interest in receiving more information. Rates of receiving a mammogram were below recommended levels.