Latinas: Impact of Citizenship on Access to Pap Smears

University Of California Los Angeles, Los Angeles CA

Investigators

Abstract

Some studies have found Latina women to be a particularly vulnerable population as regards underutilization of preventive services (Anderson and May, 1995, Kirkman-Liff and Kronenfeld, 1992). Given the importance of preventive services, including cancer-screening services to reduce morbidity and mortality, it is important to identify predictors of this under-utilization of services. Barriers specific to immigrant women have been investigated including issues of acculturation, language, and country of origin. However, one factor that has not been explored is the impact of citizenship status. The Expanded Andersen Behavioral Model of Health Services Use is a highly regarded model for explaining health care services utilization. To date, citizenship status has not been included in this model. Citizenship may increase the predictive ability of this model and should be considered for inclusion. The purpose of this research is to test, through applied research, the appropriateness of including a citizenship variable in the Andersen paradigm. This research is designed to examine utilization of preventive services by Latina women living in Los Angeles County with the intent of determining whether citizenship plays a significant role in access, especially for the large Latina immigrant population. Access/ utilization will be measured by appropriate use of the specific cancer-screening test for cancer of the cervix, the Pap smear. A cross-sectional study design using a secondary data source will examine the impact of citizenship on a sample of 1784 Latina women, ages 18 years or older, living in Los Angeles County. The data are from the 1997 Los Angeles County Health Survey which is a population-based, random digit dialing telephone survey of 8,004 households in Los Angeles County. Logistic regression will be performed separately for each of the empirical models. Stepwise regression will facilitate variables being added (forced in) according to the expansion of the initial, simple model. This modeling methodology allows for analysis of changes in the results as the conceptual model is expanded to include additional predictors of Pap smear utilization. The final model will control for approximately 40+ separate factors derived from the Andersen Model that might impact on access/utilization of this preventive service.