title: Acculturation and colorectal cancer screening among older Latino adults: differential associations by national origin.
abstract: BACKGROUND
  Although modest improvements in colorectal cancer (CRC) screening utilization have occurred, rates remain low among Latinos. It is unclear whether acculturation plays a role in the utilization of CRC screening.
  
  
  OBJECTIVE
  This study aimed to examine the relationships between acculturation and CRC screening among older Mexican, Puerto-Rican and Cuban adults.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Latinos 50 years and older, never diagnosed with CRC, and who were surveyed in the 2000, 2003 and 2005 National Health Interview Survey (NHIS).
  
  
  METHODS
  We measured acculturation with US nativity and language of interview, and examined three different CRC screening outcomes: fecal occult blood test (FOBT) in the past year, up-to-date endoscopy and any up-to-date CRC screening. Logistic regression models were adjusted for predisposing, enabling and health-care need factors consistent with the behavioral model of health-care utilization.
  
  
  RESULTS
  In adjusted analyses, US nativity was positively associated with up-to-date endoscopy among Mexicans (OR: 1.5; 95% CI: 1.1, 2.2), but negatively associated with FOBT in the past year among Puerto Ricans (OR: 0.3; 95% CI: 0.2, 0.7). In contrast to this latter finding among Puerto Ricans, English language interview was positively associated with FOBT in the past year (OR: 2.5; 95% CI: 1.1, 5.4).
  
  
  CONCLUSIONS
  Results underscore the importance of stratification by national origin in studies of acculturation and cancer screening and of targeting less acculturated adults to promote CRC screening. Clinicians, however, should consider the complexity of acculturation and treat US nativity and language preference as independent dimensions among their Latino patients.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California, 3333 California Street, Box 0856, San Francisco, CA 94143, USA. aafable-munsuz@ucsf.edu
authors.forename: Aimee
authors.initials: A
authors.lastname: Afable-Munsuz
authors.forename: Su-Ying
authors.initials: SY
authors.lastname: Liang
authors.forename: Ninez A
authors.initials: NA
authors.lastname: Ponce
authors.forename: Judith M E
authors.initials: JM
authors.lastname: Walsh
mesh_terms: D000069:Acculturation; D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003462:Cuba / Q000208:ethnology; D055088:Early Detection of Cancer; D005260:Female; D006306:Health Surveys; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D019303:Multilingualism; D044382:Population Groups / Q000208:ethnology; D011647:Puerto Rico / Q000208:ethnology