title: The Association of English Functional Health Literacy and the Receipt of Mammography among Hispanic Women Compared to Non-Hispanic U.S.-Born White Women.
abstract: BACKGROUND
  Breast cancer is a leading cause of cancer death among Hispanic women in the U.S., and mammography is the recommended screening for early diagnosing and preventing breast cancer. Several barriers exist to influence mammography utilization including poor health literacy. However, it is unclear whether the effect of health literacy on mammography utilization is consistent between Hispanic women and non-Hispanic White women. The main objective of this study was to examine association between functional health literacy and the receipt of mammography among Hispanic women compared to non-Hispanic White women in the U.S.
  
  
  METHODS
  A cross-sectional design using participants engaged in the National Assessment of Adult Literacy. Study sample comprised of 4,249 Hispanic and non-Hispanic U.S.-born White women ≥ 40 years of age who completed the functional health literacy assessment. Regression analyses were performed to test the association between health literacy and receipt of mammography. Among Hispanic women, analyses considered the influence of language-preference acculturation.
  
  
  RESULTS
  Equal percentages of Hispanic (59.3%) and non-Hispanic White (60.6%) women received mammography. After adjusting for covariates, health literacy was positively associated with receiving mammography among U.S.-born White women (β = 0.14, p<0.001), but negatively associated with mammography among Hispanic women (β = -0.13, p<0.001). Analyses stratified by acculturation status revealed that higher health literacy was associated with lower mammography among language-preference acculturated Hispanic women (β = -0.48, p<0.001), yet an opposite result among less acculturated Hispanic women (β = 0.08, p<0.001).
  
  
  CONCLUSIONS
  Functional health literacy has different associations with mammography depending upon ethnicity. Language-preference acculturation may explain the differing association.
authors.affiliation: Department of Community Health and Family Medicine, University of Florida, Gainesville, FL.|Department of Health Outcomes and Policy, University of Florida, Gainesville, FL.
authors.forename: Hajar
authors.initials: H
authors.lastname: Kadivar
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama-Birmingham, Birmingham, AL.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Kenzik
authors.affiliation: Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Darren A
authors.initials: DA
authors.lastname: Dewalt
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: I-Chan
authors.initials: IC
authors.lastname: Huang
mesh_terms: D000069:Acculturation; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D057220:Health Literacy; D006630:Hispanic or Latino / Q000193:education; D006801:Humans; D007802:Language; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D014481:United States; D044465:White People / Q000193:education