title: Impact of U.S. citizenship status on cancer screening among immigrant women.
abstract: OBJECTIVE
  We evaluated the relationship between U.S. citizenship status and the receipt of Pap smears and mammograms among immigrant women in California.
  
  
  METHODS
  Cross-sectional study using data from the 2001 California Health Interview Survey.
  
  
  METHODS
  Noninstitutionalized, civilian women, aged 18 years and older living in California.
  
  
  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.
authors.affiliation: Division of General Internal Medicine and Primary Care, Department of Medicine, University of California, Irvine, CA, USA. idealba@uci.edu <idealba@uci.edu>
authors.forename: Israel
authors.initials: I
authors.lastname: De Alba
authors.forename: F Allan
authors.initials: FA
authors.lastname: Hubbell
authors.forename: Juliet M
authors.initials: JM
authors.lastname: McMullin
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Sweningson
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D004522:Educational Status; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D065006:Papanicolaou Test; D012959:Socioeconomic Factors; D014481:United States; D014626:Vaginal Smears / Q000706:statistics & numerical data*