title: Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California.
abstract: OBJECTIVE
  Empirical evidence regarding cancer screening and health literacy is mixed. Cancer is the leading cause of death in Asian Americans, yet screening rates are notably low. Using a population-based sample, we determined if health literacy: (1) was associated with breast and cervical cancer screening, and (2) helped to explain Asian cancer screening disparities.
  
  
  METHODS
  We analyzed the 2007 California Health Interview Survey for Asian (Japanese, Chinese, Filipino, Korean, Vietnamese, other Asian) and white women within age groups relevant to US Preventive Services Task Force (USPSTF) screening guidelines: cervical: ages 21-65 (n = 15,210) and breast: ages 50-74 (n = 11,163). Multilevel logistic regression models predicted meeting USPSTF screening guidelines both with and without self-reported health literacy controlling for individual-level and contextual-level factors.
  
  
  RESULTS
  Low health literacy significantly (p < 0.05) predicted lower cancer screening in final models for both cancer types. In unadjusted models, Asians were significantly less likely than whites to receive both screening types and significantly more likely to report low health literacy. However, in multivariable models, the addition of the low health literacy variable did not diminish Asian vs. white cancer screening disparities.
  
  
  CONCLUSIONS
  Self-reported health literacy predicted cervical and breast cancer screening, but was not able to explain Asian cancer screening disparities. We provide new evidence to support a relationship between health literacy and cancer screening. Health literacy is likely a useful focus for interventions to improve cancer screening and ultimately reduce the burden of cancer. To specifically reduce Asian cancer disparities, additional areas of focus should be considered.
authors: Office of Public Health Studies, University of Hawai'i, 1960 East-West Road, Biomed, D-104, Honolulu, HI 96822 USA.
authors: Tetine
authors: T
authors: Sentell
authors: Office of Public Health Studies, University of Hawai'i, 1960 East-West Road, Biomed, D-104, Honolulu, HI 96822 USA ; 'Imi Hale Native Hawaiian Cancer Network (U54CA153459), Papa Ola Lōkahi, 894 Queen Street, Honolulu, HI 96813 USA.
authors: Kathryn L
authors: KL
authors: Braun
authors: Biostatistics Core, John A. Burns School of Medicine, Medical Education Building, Suite 401, 651 Ilalo Street, Honolulu, HI 96813 USA.
authors: James
authors: J
authors: Davis
authors: Section of General Medicine, School of Medicine, Shreveport, Louisiana State University Health Sciences Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932 USA.
authors: Terry
authors: T
authors: Davis
keywords: Asian American; Cancer screening; Health literacy