Impact of U.S. Citizenship Status on Cancer Screening Among Immigrant Women

Authors

  • Israel De Alba MD, MPH,

    1. Division of General Internal Medicine and Primary Care, Department of Medicine,
    2. Center for Health Policy and Research, and
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  • F. Allan Hubbell MD, MSPH,

    1. Division of General Internal Medicine and Primary Care, Department of Medicine,
    2. Center for Health Policy and Research, and
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  • Juliet M. McMullin PhD,

    1. Division of General Internal Medicine and Primary Care, Department of Medicine,
    2. Center for Health Policy and Research, and
    3. Department of Anthropology, School of Social Ecology, University of California, Irvine, CA, USA
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  • Jamie M. Sweningson MPH,

    1. Center for Health Policy and Research, and
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  • Richard Saitz MD, MPH

    1. Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
    2. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
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  • None of authors affiliated with this manuscript had any conflicts of interest related to the research conducted for this paper.

Address correspondence and requests for reprints to Dr. De Alba: 111 Academy Way, Suite 220, Irvine, CA 92697-5800 (e-mail idealba@uci.edu).

Abstract

Objectives: 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.

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