title: The roles of citizenship status, acculturation, and health insurance in breast and cervical cancer screening among immigrant women.
abstract: BACKGROUND
  Immigrant women are less likely to undergo cancer screening. However, few national studies have examined the role of citizenship status or acculturation.
  
  
  OBJECTIVE
  The objective of this study was to examine differences in Papanicolaou (Pap) smear and mammography screening among U.S.-born women and immigrants who are naturalized citizens or remained noncitizens. Among Latinas, we also determined if acculturation is related to screening after adjusting for covariates.
  
  
  METHODS
  The authors conducted a cross-sectional analysis of the Adult Section of the 2000 National Health Interview Survey, a nationally representative sample.
  
  
  METHODS
  A total of 18,342 women completed the survey, including 1445 who were not citizens.
  
  
  METHODS
  For Pap smears, women age 18-65 were appropriately screened if they reported testing within the past 3 years. For mammograms, women age 50-70 were considered appropriately screened if they reported testing within the past 2 years. We determined acculturation using a modified version of the Marin scale.
  
  
  RESULTS
  After adjusting for age, education, family income, and marital status, noncitizens remained significantly less likely to report having a mammogram than U.S.-born women (14 percentage point difference; P < 0.01). However, after adjusting for health insurance coverage and a usual source of care, these disparities were markedly attenuated. For Pap smears, after adjusting for sociodemographics and access to care, disparities persisted (11 percentage points, P < 0.01). Among Latinas, differences in Pap smears between noncitizens and the U.S.-born disappeared after further controlling for acculturation.
  
  
  CONCLUSIONS
  Our study suggests that initiatives to diminish disparities in screening should prioritize improving access to care for noncitizens. Our study also lends support to culturally sensitive interventions aimed at improving Pap smear screening among noncitizens.
authors.affiliation: Division of General Medicine, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Echeverria
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D004641:Emigration and Immigration / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D065006:Papanicolaou Test; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*