Dr. Juan luque Department of public health sciences Survey of Latina Immigrant Women on Recency of Cervical Cancer Screening in the Lowcountry Dr. Juan luque Department of public health sciences SCTR Health Disparities Retreat

Introduction In 2013, 54 million Hispanics in the U.S., 17.1% of population Expected to reach 128.8 million or 31% of population by 2060 64% has Mexican origin, 35% is foreign-born 68% speaks English at least very well, 66% identify as white Younger population than non-Hispanic population In SC, 148% growth in period 2000 to 2010

Cervical Cancer NHW Hispanic Hispanic Subgroups Incidence and mortality rates among Hispanic women are higher than Non-Hispanic White women Health disparities with mortality are associated with lower screening rates and low adherence to follow- up recommendations after abnormal Pap test Cervical cancer screening rates*: women 21–65 yrs. who had a Pap test within the past 3 years NHW Non-Hispanic White Hispanic Hispanic Subgroups All Uninsured Mexican Puerto Rican Cuban Central & South American Dominican 82.8 57.3 77 64.1 76.9 82.7 73.3 75.6 80.4 There is a disparity in mortality rates: the rate of cervical cancer deaths is highest among Hispanics. This disparity is associated with lower screening rates. . *Siegel et al. CA Cancer J Clin 2015;65:457-480

Common Barriers to Cervical Cancer Screening in Hispanic Women in the U.S. Limited knowledge of screening and places to go Lack of health insurance High costs of health services Lack of Spanish speaking providers and medical interpretation Transportation challenges Low health literacy Family obligations, cultural factors (preference for female providers) Low formal education Perceived affordability of follow-up tests following abnormal screening tests

Study Aim Examine foreign-born Hispanic women’s utilization and adherence to cervical cancer screening guidelines and explore factors associated with this outcome. Ladson flea market vegetable stand

Charleston Tri County Area/Zip Codes Community-based survey sample of 196 foreign-born Latina women 21-64 years in Tri-County Charleston area of South Carolina. Survey administered in Spanish by two female interviewers (one native) Response rate = 55% Survey sites: Flea market, church after Spanish mass, Free Clinics, schools after ESL class Incentive: $10 Walmart card and an educational brochure with Cervical cancer facts, HPV vaccine and a list of free and low cost clinics.

Methods Survey questions from NCI HINTS and 4 validated scales on language acculturation, cervical cancer screening self-efficacy, cervical cancer screening barriers, and trust in physicians Descriptive statistics calculated for sociodemographic and health characteristics. Bivariate tests for associations Multiple ordinal logistic regression with forward variable selection and significance level of 0.05 Adjusted prevalences of recency of Pap test as average predictive margins

Results – Sociodemographics Characteristic Women (n=196), % or Mean ±SD Age, y 38.7 ±9.3 Years in the United States 13.4 ±7.0 Married or living with a partner 82% Education < 11 years 42% Employed 29% Speak English very well or well Have a regular healthcare provider 50% Household income <$20,000/yr. 51% Country of origin = Mexico 70% Spent <25% of life in the US 19%

Cervical Cancer Screening Frequency Almost 50% of women reported having had their Pap test in the last year. CDC and ACS guidelines of 3 years interval are not the same as guidelines in many Latin American countries Habit of yearly check up Only chance for many to have a personal encounter with a health professional Almost 50% of women reported having had their Pap test in the last year. This high frequency could be due to cultural reasons: in South and Central America a yearly check up that includes a pap smear is customary It could also be due to the fact that this is the only free exam that uninsured women have found that they can access under the provision of family planning.

Cervical Cancer Screening Barriers and Cervical Cancer Screening Note. CC Barriers ranges from 1-5. Based on a 15-item Likert-type scale. 1 = Low barriers 5 = High barriers F = 5.0, df (2, 179), p = .008 Barriers

Recency of Pap Test by Selected Characteristics   Characteristics Pap ≤1, % (±SD) Pap >1-≤3, Pap ≥3 or no Pap, Have a regular provider Yes 60.8 (18.6)a 30.6 (12.0)b 8.6 (8.1)c No 36.2 (18.5)a 42.4 (9.0)b 21.4 (14.4)c Current chronic health condition 39.8 (20.3)a 40.3 (9.6)b 20.0 (15.6)c 55.0 (21.1)a 33.4 (12.2)b 11.6 (21.1)c Note. Same superscripts mark statistically significant differences in adjusted prevalence of Pap test use by selected characteristics. P< 0.05 based on paired t-tests. In the adjusted analyses, having a regular medical provider, having a chronic medical condition, having more barriers to screening, having lower cervical cancer screening self-efficacy, and not wanting to know their chance of getting cancer were each significant risk factors for forgoing a Pap test. More specifically, almost 13 percentage points (pp) more women without a regular healthcare provider had their last Pap test more than 3 years ago or never than women with a regular healthcare provider (21.4% vs. 8.6%, P < 0.001). The adjusted prevalence of guideline-adherent screening was 30.6% among women with a regular healthcare provider compared to 42.4% among women without a regular healthcare provider (P < 0.001).

Collaboration Opportunities Increase dissemination of health education and resource accessibility within the Latino community. Mobile technologies and social media Media (newspaper, radio, TV) Working with researchers who have expertise in scale development and psychometrics to ensure validity of scales or measures for Spanish- speaking populations. Working with HCC outreach staff to coordinate screening events for the Latino community (e.g., mobile mammograms and Pap tests).

Acknowledgements Supported in part by the Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina (P30 CA 138313) and by the South Carolina Clinical and Translational Research Institute, Biomedical Informatics Center (BMIC) (UL1 TR 001450) which supports REDCap.