Correlates of Cervical Cancer Screening Among Adult Latino Women: A 5‐Year Follow‐Up

• DOI: http://doi.org/10.1002/wmh3.230
• Date: 01 June 2017
• Published date: 01 June 2017

Correlates of Cervical Cancer Screening Among Adult

Latino Women: A 5-Year Follow-Up

Patria Rojas, Tan Li, Gira J. Ravelo, Christyl Dawson, Mariana Sanchez,

Alicia Sneij, Weize Wang, Mariano Kanamori, Elena Cyrus,

and Mario R. De La Rosa

Background: Latinas have the highest incidence rates of cervical cancer in the United States, and

Latinas in the United States are less likely to utilize cervical cancer screening. We used secondary

data analysis of a nonclinical convenience sample (n¼316 women at baseline; n ¼285 at 5-year

follow-up) to examine correlates of cervical cancer screening among adult Latina women. Univariate

and multiple logistic regression models using generalized estimated equations (GEE) algorithm were

utilized to assess the inf‌luence of the independent variables. Women who reported their main health-

care source as community health clinics, women who were sexually active, and women who reported

that a health-care provider discussed HIV prevention with them were more likely to report having

had a cervical cancer screening (aOR ¼2.06; CI ¼1.20, 3.52). The results suggest a need for

continued efforts to ensure that medically underserved women (e.g., Latina women) receive

counseling and education about the importance of preventive cervical cancer screening.

KEY WORDS: cervical cancer screening, drug and alcohol use, Latinas/Hispanics

Introduction

Background

In the United States, Latinas are disproportionately affected by cervical

cancer (Corcoran, Dattalo, & Crowley, 2012; Martnez-Donate et al., 2013;

McDougall, Madeleine, Daling, & Li, 2007). According to the Centers for

Disease Control and Prevention (CDC, 2016), Latinas have the highest

incidence rates of cervical cancer compared to other racial/ethnic groups. The

age-adjusted incidence rate for cervical cancer among Latinas is 11.8 per

100,000, compared to 7.8 per 100,000 among non-Latina White women (Jemal

et al., 2013; Martnez-Donate et al., 2013). Additionally, the mortality rate for

cervical cancer among Latinas is 24.2 per 100,000 (McDougall et al., 2007),

which is the highest in the United States after African Americans (CDC, 2015).

World Medical & Health Policy, Vol. 9, No. 2, 2017

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doi: 10.1002/wmh3.230

#2017 Policy Studies Organization

The high incidence and mortality rates of cervical cancer among Latinas has

been largely attributed to the low rates of cervical cancer screening within this

population (Corcoran et al., 2012; Martnez-Donate et al., 2013, McDougall

et al., 2007). CDC (2016) guidelines recommend that women should be

screened regularly for potentially cancerous or pre-cancerous cells in the

cervix, thereby increasing the likelihood of prevention and effective treatment.

However, Latinas have been found to have lower rates of recent cervical

cancer screening (75 percent) than non-Latina White women (80 percent)

(Jemal et al., 2013; Martnez-Donate et al., 2013). Furthermore, some studies

have shown that approximately 18.9 percent of U.S.-born Latinas and 16.8

percent of Latina immigrants have never had a cervical cancer screening

(Corcoran et al., 2012; Owusu et al., 2005). Gaining an understanding of the

factors associated with the lack of screening among Latinas is imperative to

reducing cervical cancer disparities in this population.

Factors Associated with Cervical Cancer Screening among Latinas

In addition to demographic characteristics (e.g., age, income, education,

access to healthcare) that decrease a woman’s likelihood of being screened for

cervical cancer, unique sociocultural factors impact screening among Latinas

compared to other racial/ethnic groups (Calle, Flanders, Thun, & Martin, 1993;

Chilton, Gor, Hajek, & Jones, 2005; Garbers & Chiasson, 2004; Leyden et al., 2005;

Norman et al., 1991; Sung, Alema-Mensah, & Blumenthal, 2002). Some of these

factors include a lack of trust in the health-care system, fear of deportation, low

self-perceived risk, failing to follow-up with abnormal cervical test results, stigma,

and language barriers (Byrd, Chavez, & Wilson, 2007; Coronado, Thompson,

Koepsell, Schwartz, & McLerran, 2004; Pinto, McKay, & Escobar, 2008; Scarinci,

Beech, Kovach, & Bailey, 2003; Scarinci et al., 2010; Sheppard et al., 2008;

Sheppard, Zambrana, & O’Malley, 2004). Previous studies indicate that Latinas

often do not seek preventive healthcare due to limited access to screening

facilities in their communities and lack of knowledge about cancer susceptibility.

They are also less likely to have a primary care physician (Soneji & Fukui, 2013).

U.S.-born Latinas with higher levels of acculturation are more likely to be

screened than those who are foreign-born and are less acculturated (Shah, Zhu,

Wu, & Potter, 2006). Lower screening rates among less acculturated Latinas could

be attributed to language, economic, and cultural barriers faced by this popula-

tion in accessing and utilizing health-care services (Shah et al., 2006). For instance,

existing research suggests that certain Latino cultural beliefs and social norms

lead to lower cervical cancer screening rates (Mann, Foley, Tanner, Sun, &

Rhodes, 2014; Suarez, 1994). These include traditional gender roles such as

marianismo—encouraging women to abstain from premarital sex and remain

obedient to men and sexually naı

¨ve—which may make Latinas less likely to

discuss sexual health issues with their physicians, thereby decreasing cervical

cancer screening (Ayala et al., 2009; Rhodes et al., 2009; Rothenberg, 1995;

Royster, Richmond, Eng, & Margolis, 2006). Additionally, cultural concerns about

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