1. Dr. Juan luque Department of public health sciences
Survey of Latina Immigrant Women on Recency of Cervical Cancer Screening in the Lowcountry
Dr. Juan luque
Department of public health sciences
SCTR Health Disparities Retreat

2. Introduction
In 2013, 54 million Hispanics in the U.S., 17.1% of population
Expected to reach million or 31% of population by 2060
64% has Mexican origin, 35% is foreign-born
68% speaks English at least very well, 66% identify as white
Younger population than non-Hispanic population
In SC, 148% growth in period 2000 to 2010

3. Cervical Cancer NHW Hispanic Hispanic Subgroups
Incidence and mortality rates among Hispanic women are higher than Non-Hispanic White women
Health disparities with mortality are associated with lower screening rates and low adherence to follow- up recommendations after abnormal Pap test
Cervical cancer screening rates*:
women 21–65 yrs. who had a Pap test within the past 3 years
NHW
Non-Hispanic White
Hispanic
Hispanic Subgroups
All
Uninsured
Mexican
Puerto Rican
Cuban
Central
& South American
Dominican
82.8
57.3 77
64.1
76.9
82.7
73.3
75.6
80.4
There is a disparity in mortality rates: the rate of cervical cancer deaths is highest among Hispanics.
This disparity is associated with lower screening rates. .
*Siegel et al. CA Cancer J Clin 2015;65:

4. Common Barriers to Cervical Cancer Screening in Hispanic Women in the U.S.
Limited knowledge of screening and places to go
Lack of health insurance
High costs of health services
Lack of Spanish speaking providers and medical interpretation
Transportation challenges
Low health literacy
Family obligations, cultural factors (preference for female providers)
Low formal education
Perceived affordability of follow-up tests following abnormal screening tests

5. Study Aim
Examine foreign-born Hispanic women’s utilization and adherence to cervical cancer screening guidelines and explore factors associated with this outcome.
Ladson flea market vegetable stand

6. Charleston Tri County Area/Zip Codes
Community-based survey sample of 196 foreign-born Latina women years in Tri-County Charleston area of South Carolina.
Survey administered in Spanish by two female interviewers (one native)
Response rate = 55%
Survey sites: Flea market, church after Spanish mass, Free Clinics, schools after ESL class
Incentive: $10 Walmart card and an educational brochure with Cervical cancer facts, HPV vaccine and a list of free and low cost clinics.

7. Methods
Survey questions from NCI HINTS and 4 validated scales on language acculturation, cervical cancer screening self-efficacy, cervical cancer screening barriers, and trust in physicians
Descriptive statistics calculated for sociodemographic and health characteristics. Bivariate tests for associations
Multiple ordinal logistic regression with forward variable selection and significance level of 0.05
Adjusted prevalences of recency of Pap test as average predictive margins

8. Results – Sociodemographics
Characteristic
Women (n=196), % or Mean ±SD
Age, y
38.7 ±9.3
Years in the United States
13.4 ±7.0
Married or living with a partner
82%
Education < 11 years
42%
Employed
29%
Speak English very well or well
Have a regular healthcare provider
50%
Household income <$20,000/yr.
51%
Country of origin = Mexico
70%
Spent <25% of life in the US
19%

9. Cervical Cancer Screening Frequency
Almost 50% of women reported having had their Pap test in the last year.
CDC and ACS guidelines of 3 years interval are not the same as guidelines in many Latin American countries
Habit of yearly check up
Only chance for many to have a personal encounter with a health professional
Almost 50% of women reported having had their Pap test in the last year.
This high frequency could be due to cultural reasons: in South and Central America a yearly check up that includes a pap smear is customary
It could also be due to the fact that this is the only free exam that uninsured women have found that they can access under the provision of family planning.

10. Cervical Cancer Screening Barriers and Cervical Cancer Screening
Note. CC Barriers
ranges from 1-5.
Based on a 15-item
Likert-type scale.
1 = Low barriers
5 = High barriers
F = 5.0, df (2, 179), p = .008
Barriers

11. Recency of Pap Test by Selected Characteristics
Characteristics
Pap ≤1,
% (±SD)
Pap >1-≤3,
Pap ≥3 or no Pap,
Have a regular provider
Yes
60.8 (18.6)a
30.6 (12.0)b
8.6 (8.1)c No
36.2 (18.5)a
42.4 (9.0)b
21.4 (14.4)c
Current chronic health condition
39.8 (20.3)a
40.3 (9.6)b
20.0 (15.6)c
55.0 (21.1)a
33.4 (12.2)b
11.6 (21.1)c
Note. Same superscripts mark statistically significant differences in adjusted prevalence of Pap test use by selected characteristics. P< 0.05 based on paired t-tests.
In the adjusted analyses, having a regular medical provider, having a chronic medical condition, having more barriers to screening, having lower cervical cancer screening self-efficacy, and not wanting to know their chance of getting cancer were each significant risk factors for forgoing a Pap test. More specifically, almost 13 percentage points (pp) more women without a regular healthcare provider had their last Pap test more than 3 years ago or never than women with a regular healthcare provider (21.4% vs. 8.6%, P < 0.001). The adjusted prevalence of guideline-adherent screening was 30.6% among women with a regular healthcare provider compared to 42.4% among women without a regular healthcare provider (P < 0.001).

12. Collaboration Opportunities
Increase dissemination of health education and resource accessibility within the Latino community.
Mobile technologies and social media
Media (newspaper, radio, TV)
Working with researchers who have expertise in scale development and psychometrics to ensure validity of scales or measures for Spanish- speaking populations.
Working with HCC outreach staff to coordinate screening events for the Latino community (e.g., mobile mammograms and Pap tests).

13. Acknowledgements
Supported in part by the Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina (P30 CA ) and by the South Carolina Clinical and Translational Research Institute, Biomedical Informatics Center (BMIC) (UL1 TR ) which supports REDCap.