Exploring the role of acculturation on mammography utilization among Hispanic women in the United States Open Access

Abstract

Breast cancer is the leading cause of cancer-related death among Hispanic women in the U.S. While Hispanic women have lower mortality rates than non-Hispanic white women, Hispanic women are more likely to get diagnosed at later stages. Disparities in stage at diagnosis may be explained, in part, by lower levels of mammography use among Hispanic women.  In order to develop interventions, there is interest in understanding if acculturation impacts mammography use among Hispanic women. This dissertation conducted a systematic literature review and two quantitative studies to explore the association between acculturation and mammography use among Hispanic women in the U.S.

The systematic review indicated that while research has been conducted to assess the role of acculturation on mammography utilization among Hispanic women, this research has almost exclusively focused on proxy measures of acculturation on immigration status and language utilization. While these studies have provided limited evidence, results suggest that among foreign-born women, non-U.S. citizens are less likely to be up-to-date with mammography screening. Quantitative exploration of the role of immigration status on mammography use among a national sample of Hispanic women indicated that while immigration status was not a significant predictor of recent mammography use, foreign-born non-U.S. citizens faced significantly greater odds of being rarely or never screened for breast cancer. Results also indicated that these same women were more likely to face significant barriers in accessing health care and had lower socioeconomic status. 

An ecological study exploring mammography capacity in Hispanic communities in the U.S. found that counties with dense Hispanic communities and counties that have been traditional Hispanic settlement destinations have greater odds of having limited mammography capacity. In addition, these high Hispanic population density and limited mammography capacity counties tend to be rural, and have a larger proportion of their population who are non-U.S. citizens, uninsured, and are living below the poverty level than the average U.S. county.  Ensuring Hispanic women have adequate access to mammography screening in the U.S. will require policy and health system interventions to ensure access to health care services for non-citizens and those living in rural areas.

Table of Contents

Table of Contents

Chapter One – Introduction........................................................................................................ 1

I. Background................................................................................................................................... 1

A.    The Hispanic population of the United States................................................................................................................ 1

B. Hispanic Mortality Paradox........................................................................................................................................................... 4

C. Cancer Burden of the Hispanic Population........................................................................................................................... 6

D. Breast Cancer among Hispanic women.................................................................................................................................. 7

II. Literature Review...................................................................................................................... 10

A. Mammography use among Hispanic women in the U.S............................................................................................. 10

B. Hispanics as homogeneous population............................................................................................................................... 15

C. Conceptualization and measurement of acculturation.............................................................................................. 16

D. Contextual factors and mammography use....................................................................................................................... 18

III. Theoretical Approach.............................................................................................................. 22

IV. Significance and Aims of Research.......................................................................................... 36

V. References................................................................................................................................. 41

Chapter Two................................................................................................................................ 62

Exploring acculturation as a multi-dimensional measure in research on mammography utilization among Hispanic/Latina women in the U.S........................................................................................................................................................ 62

I. Introduction................................................................................................................................ 62

II. Methods.................................................................................................................................... 64

III. Results..................................................................................................................................... 67

IV. Discussion............................................................................................................................... 77

V. Tables and Figures.................................................................................................................... 84

VI. References.............................................................................................................................. 101

VII. Supplementary Materials..................................................................................................... 113

Chapter Three........................................................................................................................... 118

The role of immigration status on mammography use among Hispanic women in the U.S. 118

I. Introduction.............................................................................................................................. 118

II. Methods.................................................................................................................................. 122

III. Statistical Analysis................................................................................................................ 132

IV. Results................................................................................................................................... 136

V. Discussion............................................................................................................................... 146

VI. Tables and Figures................................................................................................................. 158

VII. References............................................................................................................................ 173

VIII. Supplementary Materials................................................................................................... 183

Chapter Four............................................................................................................................. 185

Mammography capacity in primarily Hispanic communities in the U.S........................... 185

I. Introduction.............................................................................................................................. 185

II. Methods.................................................................................................................................. 187

III. Statistical Analysis................................................................................................................ 191

IV. Results................................................................................................................................... 193

V. Discussion............................................................................................................................... 197

VI. Tables and Figures................................................................................................................. 203

VII. References............................................................................................................................ 215

VIII. Supplementary Materials................................................................................................... 224

Chapter Five - Conclusions..................................................................................................... 228

I. Main Findings.......................................................................................................................... 228

II. Evaluation of Research: Limitations and Strengths................................................................. 235

III. Implications for Public Health Research and Practice........................................................... 238

IV. Conclusions........................................................................................................................... 241

V. References............................................................................................................................... 242

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Keyword	Mammography Acculturation Cancer Screening
Committee Chair / Thesis Advisor	Cam Escoffery, Emory University
Committee Members	Regine Haardoerfer, Emory University Kimberly Jacob Arriola, Emory University Natalie Crawford, Emory University

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