Latina Farmworkers: Relationships Between Pap Screening Behaviors, Acculturation, and Cultural Cancer Screening Scales
Background: Latinas are disproportionately burdened with cervical cancer, with incidence rates of 11.5 per 100,000 and the second highest mortality rates of 4 per 100,000, yet they have the lowest participation rates in national cervical cancer screening programs. Psychosocial factors have been identified as one of the main barriers for low cancer screening rates among Latinas. In this study, we explored cultural cancer screening beliefs (CCSB), acculturation levels, past Pap screening behavior and intent to undergo Pap tests among Mexican farmworker women in South Georgia.
Methods: We screened 252 Latinas using our eligibility criteria which specified 1) Mexican immigrant, 2) no Pap test in over 2 years, 3) 20 women who lived >10 years in the U.S. and 20 women who lived ≤10 years in the U.S, and 4) had a farmworker background. We recruited a quota sample of 40 Mexican immigrant women meeting eligibility criteria. We administered questionnaires to collect demographic information and Pap screening behaviors. We also used the Acculturation Scale for Mexican Americans (ASMA) to measure acculturation behaviors and the Cultural Cancer Screening Scale (CCSS) scale (20-item scale with 5 constructs).We assessed the internal consistency of the scales and constructs using Cronbach's alphas. Differences between the groups of women given their prior screening behaviors or intent to undergo screening with respect to each of cultural cancer screening or acculturation scale measures, respectively, were assessed using the Kruskal-Wallis rank test. When the test was statistically significant, post-hoc pairwise comparisons were performed.
Results: Out of 40 women, 7(18%) never had a Pap; 2 (5%) had it less than 3 years ago, and 31 (78%) had it more than three years ago. Thirty-two (80%) women expected to have their next Pap smear 1 yr. or less; 4 women (10%) >1 not more than 3 years; 1 (3%) woman reported that it was their first time getting a Pap smear, and 3 (8%) women did not respond. With the exception of sociocultural deterrents (alpha = 0.67), internal consistency of cancer screening fatalism (alpha = 0.94), symptomatic deterrents (alpha = 0.95), catastrophic disease expectations (alpha = 0.87), and negative beliefs about health professionals (alpha = 0.77) were high. Internal consistency of CCSS was 0.91. The estimated mean score for acculturation was 0.98 (SD =0.77; range: 0 – 2). Women who reported never having a Pap test compared to women who reported having their Pap test more than three years ago were more likely to consider health professionals performing screening examinations to not be trustworthy (mean ranks=32 and 18 respectively, p= 0.003). Women who reported never having a Pap test compared to women who reported having their Pap test more than three years ago were more likely to believe that health professionals inappropriately touch their patients during screening examinations (mean ranks 33 and 18, respectively; p = 0.001). Other associations were not statistically significant. The difference between the groups of women based on their intent to undergo future Pap tests and each of cultural cancer screening scale measures was not significant. No statistically significant associations were found between acculturation measures and past or intended screening behavior of women, respectively.
Conclusions: The two psychosocial factors associated with lack of past screening behavior reflect the negative beliefs about health professionals among Mexican immigrant farmworker women. Despite variability in time spent living in the U.S. and scores on an acculturation scale, these variables were not related to past screening or intent to screen. Other factors, such as access to health care, discrimination, and transportation issues need to be explored in future studies to understand their relationship with low screening rates in Latina subpopulations such as low-income Mexican farmworkers.
American Association for Cancer Research Annual Conference (AACR)
Watson, Lisa C., Yelena Tarasenko, Moya L. Alfonso, Claudia Reyes-Garcia, John S. Luque.
"Latina Farmworkers: Relationships Between Pap Screening Behaviors, Acculturation, and Cultural Cancer Screening Scales."
Community Health Faculty Presentations.