Self-reported use of cancer screening tests among Latinos and Anglos in a prepaid health plan.

OBJECTIVE: To evaluate self-reported use of cancer screening tests by Latino and Anglo prepaid health plan members, we conducted telephone interviews about the knowledge of, use of, and reason for Papanicolaou (Pap) smear, clinical breast examination, mammogram, rectal examination, fecal occult blood test, and sigmoidoscopy. METHODS: Cross-sectional telephone survey of randomly selected Kaiser Permanente Medical Care Program members in San Francisco and Alameda Counties, California. A total of 844 Latinos (432 men and 412 women) and 510 Anglos (208 men and 302 women), between 35 and 74 years of age, completed the interview. RESULTS: Overall, 97.4% of Latinas reported having had at least one Pap smear compared with 99.7% of Anglo women; 90% in each group reported a Pap smear within 3 years. A clinical breast examination within 2 years was reported by 87% of Latina and 90% of Anglo women. Seventy-six percent of Latina and 85% of Anglo women aged 35 years or more reported having had at least one mammogram; and 65% of Latina and 75% of Anglo women reported a mammogram within 2 years. Among members 40 to 74 years of age, a lower proportion of Latinos compared with Anglos reported having had at least one digital rectal examination (67% vs 80%) and one fecal occult blood test (46% vs 54%); among those 50 to 74 years of age, fewer Latinos reported at least one sigmoidoscopy (29% vs 41%). After adjusting for age, education, employment, perceived health status, marital status, and county of residence, Latinos were significantly less likely to report having had at least one digital rectal examination (odds ratio; 0.60, 95% confidence interval, 0.45, 0.79), fecal occult blood test (odds ratio, 0.77; 95% confidence interval, 0.59-1.01), and sigmoidoscopy (odds ratio, 0.70; 95% confidence interval, 0.52, 0.95). After adjusting for the same variables, Latinos were more likely than Anglos to claim forgetfulness/carelessness (75% vs 60%; odds ratio, 1.84; 95% confidence interval, 1.41-2.40) as a reason for not obtaining cancer screening tests. CONCLUSION: These data suggest that, within this prepaid health plan without direct financial barriers to cancer screening services, Latinos are less likely than Anglos to obtain selected recommended cancer screening tests.

Use of cancer-screening tests in the San Francisco Bay area: comparison of Latinos and Anglos.

BACKGROUND: Compared with Anglos (non-Latino whites), incidences of breast and colorectal cancers are lower for Latinos and incidences of cervical cancer are higher for Latinos. In regional and national studies, Latinos obtain fewer cancer screening tests for cervical, breast, and colorectal cancers when compared with Anglo populations. It remains unclear if these differences are due solely to socioeconomic status. PURPOSE: To evaluate self-reported use of these tests by ethnicity, we conducted telephone interviews about the use of the Pap smear, clinical breast examination, mammogram, rectal examination, fecal occult blood test, and sigmoidoscopy. METHODS: Cross-sectional, random-digit dialing telephone surveys of Latino and Anglo adults, 35-74 years of age, living in San Francisco and Alameda Counties, Calif. were used. A total of 798 Latinos (398 men and 408 women) and 436 Anglos (214 men and 222 women) completed the interview. RESULTS: Age-adjusted rates showed that 82.0% of Latinas reported a Pap smear within 3 years compared with 85.1% of Anglo women. A clinical breast examination within 2 years was reported by 82.1% of Latinas and by 88.9% of Anglo women. Screening mammograms within 2 years were reported by 57.8% of Latinas and by 72.3% of Anglo women (difference = -14.5%; 95% confidence interval [CI] = -21.5, -7.5). Compared with Anglos, fewer Latinos reported digital-rectal examinations within 2 years (44.6% versus 61.8%; difference = -17.2%; 95% CI = -22.6, -11.8). There were no significant differences by ethnicity in obtaining a fecal occult blood test within 2 years (32.3% versus 34.0%) and sigmoidoscopy within 5 years (18.9% versus 21.5%). After adjusting for age, education, health insurance, employment, marital status, county of residence, and self-perceived health status, Latino ethnicity was a significant predictor only for digital-rectal examination within 2 years (odds ratio [OR] = 0.65; 95% CI = 0.49-0.86) and digital-rectal examination ever (OR = 0.54; 95% CI = 0.40-0.74). Latinos were significantly more likely to cite forgetfulness, lack of transportation, long wait for appointments, and need for child care as reasons for not having cancer screening tests. CONCLUSION: We conclude that after accounting for socioeconomic factors, Latino ethnicity is a relatively minor predictor of use of cancer screening tests. Increasing the availability of culturally appropriate educational materials and providing universal health care coverage are more important priorities to promote appropriate use of cancer screening tests by Latinos.

Psychosocial correlates of smoking among immigrant Latina adolescents.

Young immigrant Latinas, compared with non-Latina white adolescents, are at greater risk to begin smoking and experimenting with other substances; yet little is known about the contributing factors that place them at this risk. To identify psychosocial predictors of smoking, a sample of 447 self-identified Latinas and 160 non-Latina white adolescents aged 13-18 years from San Francisco and San Mateo counties, Calif., answered a 30-minute face-to-face questionnaire. Significant predictors of smoking status for the entire sample were (a) self-efficacy to avoid smoking (odds ratio [OR] = 10; 95% confidence interval [CI] = 5-21; P < .001), (b) intention to smoke even if it is risky (OR = 10; 95% CI = 5-20; P < .001), (c) usage of free time (OR = 4; 95% CI = 2-8; P < .001), (d) personal approval of others' smoking (OR = 3; 95% CI = 1-5; P < .01), and (e) peer's smoking approval (OR = 2; 95% CI = 1-4; P < .05). The majority of the adolescent smokers in this study reported low levels of self-efficacy for avoiding smoking and believed that they would continue to smoke even if it was risky. They spent more of their free time with friends or alone, reported higher personal approval of significant others' smoking, and reported stronger perceived peer's approval of smoking than nonsmokers. For non-Latina whites, personal approval of others' smoking and having serious problems were associated with smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of Spanish surnames to identify Latinos: comparison to self-identification.

Difficulties in identification of Latinos from secondary datasets have often been addressed by the use of a Spanish surname list. To evaluate the sensitivity and specificity of the 1980 U.S. Census Spanish surname list in correctly identifying Latino ethnicity, we conducted a cross-sectional survey of adult members of a prepaid health plan in the San Francisco Bay Area. We compared a randomly selected list of 1345 Spanish surnames and 717 non-Spanish surnames from health plan membership lists with their self-identified race and ethnicity obtained by telephone interviews. The sample was stratified according to surname group (Spanish or non-Spanish), sex, age, and county. Compared with self-identified ethnicity, a Spanish surname was 88.4% sensitive in identifying Latino men and 70.4% sensitive in identifying Latina women. The non-Spanish surname list was 94.1% sensitive and 95.0% specific in correctly identifying non-Latinos. Although the overall negative predictive value was 97.8%, the positive predictive value of a Spanish surname was only 68.3% for men and 55.7% for women. The low positive predictive value was largely due to the 316 (61%) Filipinos among the 517 persons with Spanish surnames who were not Latinos. We conclude that the use of the Spanish surname list alone to ascertain race and ethnicity in the San Francisco Bay Area both falsely identifies a large number of non-Latino persons as Latino and fails to identify a small proportion of Latinos. Although the level of sensitivity and specificity for Spanish surnames will vary with the area under study, this source of inaccuracy must be considered in studies that plan to use data based on Spanish surnames.

Dietary practices, alcohol consumption, and smoking behavior: ethnic, sex, and acculturation differences.

Current knowledge is scarce on Latino dietary practices. This study compared the dietary practices, alcohol consumption, and smoking behavior of Latinos and non-Latino whites in two randomly selected samples. Telephone surveys of adults 35-74 years of age from the Kaiser Permanente Medical Care Program (Latinos = 844; non-Latino whites = 510) and from census tract-based areas (Latinos = 806; non-Latino whites = 436) were conducted in the San Francisco Bay Area. Latino ethnicity was a significant predictor of dietary and alcohol consumption practices in multivariate logistic regression models after adjustment for sex, education, age, employment, health insurance, martial status, county of residence, and self-perceived health status. Compared with non-Latino whites, Latinos were significantly less likely to report eating vegetables and more likely to eat rice, beans, and fried foods and to drink whole milk. Less acculturated Latinos were more likely to eat fruits, rice, beans, meat, and fried foods and to drink whole milk than more acculturated Latinos. Latino men were significantly more likely to be binge drinkers, and Latina women were significantly more likely to abstain from drinking alcohol during the month prior to the interview. As Latina women acculturate to the U.S. mainstream, they report more cigarette smoking and alcohol consumption. Although Latinos reported higher levels of selected high-fiber foods, the low consumption of vegetables, widespread use of saturated fat, and the heavy drinking and smoking among Latino men, which are associated with the level of acculturation, may increase the risk for cancer. Educational messages targeting less acculturated Latinos should focus on maintaining their current healthy dietary practices of eating fruits, rice, and beans and decreasing their fat consumption. For more acculturated Latinos, emphasis should be placed on resuming the traditional diet.

Mammography screening among California Medicare beneficiaries: 1993-1994.

BACKGROUND: Over half of all breast cancer deaths occur among women 65 years of age or older. However, mammography screening decreases with increasing age, despite better survival rates for tumors detected early. METHODS: Health Care Financing Administration data from 1993 and 1994, and 1990 United States Census data were used to assess the impact of race, age, Medicaid coverage, and community-level socioeconomic indices on mammography screening for over 800,000 California Medicare beneficiaries. RESULTS: Women who were African American, older, or had Medicaid coverage were significantly less likely to have a biennial mammogram than their counterparts. Women living in areas with fewer college educated residents, with a higher proportion of Mexican or Asian residents had lower use of mammography. However, African-American and Caucasian women with Medicaid coverage had equally low mammography rates (AOR = 1.01, 95% CI .97-1.04), while African-American women with and without Medicaid had similarly low mammography rates (AOR = .96, 95% CI .92-1.01). CONCLUSIONS: Despite dual coverage, Medicare beneficiaries enrolled in Medicaid had few mammograms. African-American Medicare beneficiaries, with and without Medicaid, had low mammography rates. Intervention efforts should be targeted toward these women.

Mammography rescreening among older California women.

This is the first study to focus on Medicare mammography rescreening using a relatively large population of older women over a long followup period. To assess correlates of regular mammography, we followed all women age 65 or over enrolled continuously in Medicare fee-for-service (FFS) (n = 515,746) over a 7-year period. Data were drawn from the CMS claims data for the period 1992-1998. Irregular mammography intervals were more commonly found among vulnerable Medicare subpopulations--women who were older, minority, living in low income and lower education areas, and who were enrolled in both Medicare and Medicaid. Health care providers must communicate clearly to older women the breast cancer rescreening message: Not just once, but for a lifetime.

The family and type 2 diabetes: a framework for intervention.

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

Evaluation of "Guia para Dejar de Fumar," a self-help guide in Spanish to quit smoking.

Because of the absence of culturally appropriate self-help smoking cessation materials for Latinos, a new Spanish language cessation guide, "Guia para Dejar de Fumar," was developed and evaluated. It was distributed as part of a community-wide intervention to decrease the prevalence of smoking. The "Guia" is an attractive full-color booklet written in universal Spanish that uses simple text and numerous photographs. Motivation to quit smoking is emphasized, and graphic demonstrations of the adverse health effects of smoking are included. A menu of quitting and maintenance techniques is presented. A total of 431 smokers were identified for evaluation at approximately 3, 6, and 12 months after receiving the "Guia." Self-reported quit rates declined from 21.1 percent at 2.5 months to 13.7 percent at 14 months; 8.4 percent of the sample had a validated quit status by saliva cotinine test at 1 year. Persons older than 44 years were more likely to remain nonsmokers, but sex, education, acculturation score, and cigarettes smoked per day did not predict smoking cessation. The components of the "Guia" most mentioned by those who were surveyed were the graphic photographs, the health emphasis, and the overall format. The authors concluded that the "Guia" is an appropriate self-help smoking cessation booklet for Spanish-speaking Latinos in the United States.

HIV risk factors, condom use, and HIV antibody testing among heterosexual Hispanics: the National AIDS Behavioral Surveys (NABS).

PIP: Although Hispanics comprise only 9% of the US population, they account for 16% of AIDS cases. This study used data from the 4390 heterosexual Hispanics interviewed as part of the 1990-91 National AIDS Behavioral Survey to determine the prevalence and demographic correlates of HIV antibody testing and condom use among Hispanics at risk for HIV. Overall, 16.4% of respondents reported an HIV risk factor, primarily two or more sexual partners in the last 12 months (64%) or a high-risk main sex partner (26%). Those at risk tended to be highly acculturated unmarried males aged 18-29 years of European Spanish, South American, or Caribbean origin, with more than 12 years of education, an annual income under US$10,000, and infrequent church attendance. 35.3% of these high-risk persons had been tested for HIV; male gender and middle-income status were the strongest predictors of testing. Condoms were used at least half the time with a primary partner by 22.4% and with secondary partners by 44.7%, with higher use rates among acculturated Hispanics. The low prevalence of condom use and HIV testing among high-risk Hispanics underscores the need for campaigns that reinforce the acceptability of condom use as a social norm. Because US Hispanics are a heterogeneous group, such campaigns should target specific subgroups, including different national origins and levels of acculturation.^ieng

Profile of latino health and implications for health education.

Latinos are the fastest growing population in the United States. Yet in spite of their growing numbers, the health needs of Latinos are not met, they lack adequate access to health care and lack appropriate health education interventions. This article discusses key factors to be considered in dealing effectively with the health education needs of Latinos. These factors include demographic characteristics of this population; acculturation and its relationship to health practices; major health issues among Latinos and beliefs and practices which influence Latino health. Communication strategies most widely used by Latinos and most credible sources of health information are discussed. Recommendations for effective communication strategies to reach Latinos with culturally appropriate health messages are presented.

Data from the National AIDS Behavioral Surveys. II. Multiple sexual partners among Hispanics in high-risk cities.

Data from a random sample of 4,658 heterosexual Hispanics from 23 high-risk cities in the 1990-1991 National AIDS Behavioral Surveys reveal that 11% of Hispanics have had multiple partners in the past year-17% of men and 4% of women. The study shows a higher proportion of multiple sexual partners in the past year among Hispanic men who are unmarried (31%), Cuban (28%), aged 18-29 (25%), better educated (21%), of lower income (23%) and highly acculturated (20%). Among Hispanic women, marital status, age, Hispanic subgroup and level of acculturation are significant predictors of having multiple partners. Among highly acculturated Hispanic men, income, Hispanic subgroup and marital status are significant predictors of having multiple partners; among less acculturated Hispanic men, marital status is the only significant predictor. Only 20% of Hispanics with multiple partners report using a condom regularly with their primary partner, and 29% report regular condom use with their secondary partner. Among men, condom use tends to decrease as the number of partners increases.

Relationship between earlier and later mammography screening--California Medicare, 1992 through 1994.

Regular screening mammography is recommended to reduce breast cancer mortality. Although predictors of mammography have been studied, factors that influence adherence to guidelines are less understood. We examined the relationship between an index mammogram and subsequent mammograms among California Medicare beneficiaries. Medicare billing data for 1992, 1993, and 1994 were used to estimate the association between screening mammography in 1992 and subsequent screening in 1993 or 1994. We found that women with a 1992 mammogram were more than twice as likely to have a mammogram in 1993 or 1994 than women without a 1992 mammogram (relative risk = 2.58; 95% confidence interval, 2.57-2.59). This relationship was somewhat stronger for black women compared with white women and increased with age. Although further study of regular screening patterns is needed, these findings provide some evidence that encouraging a single mammogram may lead to continued adherence.

Stereotypes of smokers held by Hispanic and white non-Hispanic smokers.

A group of Hispanic and White non-Hispanic smokers were asked to report the stereotypes they hold of smokers in general. All respondents tended to think that smokers were Nervous, Friendly, and Sociable; although White non-Hispanics felt more certain than Hispanics that smokers were Friendly, Aggressive, Sociable, Attractive, and Feminine. Factor analyses of the responses showed three common (across ethnicity) factors: Sociability, Self-Presentation, and Nervousness. Only the Self-Presentation factor showed statistically significant differences between the two ethnic groups. The amount of cigarettes smoked had no effect on the stereotypes but the more highly acculturated Hispanics showed stereotypes that resembled those of the White non-Hispanics.

Changes in information as a function of a culturally appropriate smoking cessation community intervention for Hispanics.

Tested a 7-month, media-based, community intervention among Hispanics in San Francisco designed to change levels of information on the damaging effects of cigarette smoking and on the availability of culturally appropriate cessation services. Three community-wide surveys of Hispanics were conducted with independent random samples, two as baselines (n = 1,660 and 2,053) and one postintervention (n = 1,965). Results showed that changes in the level of awareness of cessation services had taken place after implementation of the intervention. Furthermore, those changes took place primarily among the less acculturated Spanish-speaking Hispanics who were the target of the intervention. The changes in information reported here demonstrate that a culturally appropriate information dissemination campaign that utilizes multiple channels can produce changes in a community's level of information even when the campaign is implemented for a relatively short period.

Attitudes and behaviors of Hispanic smokers: implications for cessation interventions.

The smoking behavior of Hispanics, especially Mexican Americans, has been reported to differ from that of non-Hispanic whites, in both large gender differences in prevalence as well as a lower self-reported number of cigarettes smoked per day. This study compared the responses of a convenience sample of 263 Hispanic (44% Mexican American and 38% Central American) and 150 non-Hispanic white smokers, in order to identify other ethnic; gender, and acculturation differences in smoking behaviors. Hispanic women smoked fewer cigarettes and initiated smoking at a comparatively later age than Hispanic men; they were also less likely to smoke during pregnancy than non-Hispanic white women. Hispanics smoked more cigarettes on Saturday than other days, but this was not true for non-Hispanic whites. Will power (voluntad propia) and knowing the negative effects of smoking were considered the most helpful techniques for quitting by Hispanics. Considering that light smokers are able to quit with less intensive cessation techniques, these data suggest that a properly developed health education community intervention may have an impact on smoking rates among Hispanics.

Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in northern California.

BACKGROUND: Using the medical records of a large, prepaid health plan, our purpose was to assess the accuracy of self-reported data on cancer detection practices and to evaluate any differences in accuracy between Hispanics and non-Hispanic whites. METHODS: Data were collected on six procedures: mammography, clinical breast examination, Pap smear, sigmoidoscopy, fecal occult blood tests, and digital rectal examination. We audited the medical records of 815 randomly selected Hispanic and 483 non-Hispanic white members of the Kaiser Permanente Medical Care Program in Northern California. All responded to a telephone survey. Using a standardized form, we recorded any of the six target examinations that had been performed within 5 years of the telephone interview. We then compared the times of the most recent screening tests as reported in the telephone survey with those in the medical record. RESULTS: For the 2 years before the telephone interview, self-reports for screening tests overestimated the actual rates at which these tests were performed as documented in the medical records. Lack of agreement between self-report and medical record audits was substantial for all screening procedures except sigmoidoscopy. Hispanic members had fewer procedures done for most tests, but the differences were not statistically significant. Overestimates in self-reported screening rates did not differ substantially between Hispanics and non-Hispanic whites. CONCLUSIONS: Self-reported data on early cancer detection procedures can substantially overestimate their occurrence among both non-Hispanic white and Hispanic populations. These findings confirm earlier findings for Pap smear and affect decisions on cancer prevention procedures that rely on the accuracy of self-reported data.

Patterns of mass media use among Hispanic smokers: implications for community interventions.

A relatively large percentage of Hispanics in the United States smoke. Yet a large proportion of Hispanics are light smokers, smoking ten or fewer cigarettes per day. Previous research has shown that most light smokers quit smoking on their own and that health education and an environment conducive to non-smoking can have a significant impact in reducing smoking rates. Given the current smoking patterns of Hispanics, culturally appropriate media-based community intervention to promote smoking cessation can have a significant impact. This study identified patterns of media use and language preference among a sample of 263 Hispanic smokers from the San Francisco Bay Area. Based on this study, recommendations to reach Hispanic smokers with a series of communication strategies are suggested.

Misconceptions about cancer among Latinos and Anglos.

OBJECTIVE: To collect information regarding knowledge about and attitudes toward cancer in a sample of adult health plan members, self-identified as Latino or Anglo. DESIGN: Cross-sectional survey. SETTING: Prepaid health plan. RESPONDENTS: A random sample of 844 Latinos (mean age, 50.5 years) and 510 Anglos (51.8 years) completed the interview. MAIN OUTCOME MEASURES AND RESULTS: Latinos were significantly more likely than Anglos to think that sugar substitutes (58% vs 42%), bruises from being hit (53% vs 34%), microwave ovens (47% vs 23%), eating pork (31% vs 11%), eating spicy foods (15% vs 8%), breast-feeding (14% vs 6%), and antibiotics (32% vs 12%) could cause cancer (P < .001 for each). Compared with Anglos, Latinos more often misidentified constant dizziness (39% vs 25%) and arthralgias (35% vs 20%) as being symptoms of cancer. A higher proportion of Latinos believed that having cancer is like getting a death sentence (46% vs 26%), that cancer is God's punishment (7% vs 2%), that there is very little one can do to prevent getting cancer (26% vs 18%), that it is uncomfortable to touch someone with cancer (13% vs 8%), and that they would rather not know if they had incurable cancer (35% vs 23%; P < .001 for each). Latino ethnicity was a significant predictor of these knowledge and attitude items in multivariate logistic regression models adjusted for sex, education, age, employment, marital status, county of residence, and self-perceived health status. CONCLUSIONS: We conclude that misconceptions about cancer are more prevalent among Latinos than Anglos and that selected attitudes about cancer among Latinos fit a cultural theme of fatalismo. These data can enable development of culturally appropriate cancer control interventions for Latinos.