Immigration and sexual partner risk among Latino adolescents in San Francisco

Sexual partner characteristics increase risk for adverse reproductive health outcomes. Evidence is limited regarding whether choice of sexual partners among Latino adolescents changes with U.S. acculturation/adaptation. We used generalized estimating equations to assess the associations between immigrant generation (recent immigrant, 1.5 [immigrated prior to adolescence], 2nd and 3rd) and sexual partner risk in a prospective cohort study of 411 Latino adolescents aged 14-19. We examined three measures of partner risk and mediating effects of family influence (familism and parental monitoring). The odds of reporting a partner with frequent substance use increased with increasing immigrant generation (odds ratios (OR) [reference = recent immigrants]: 2.3, 3.4, and 5.6) as did having a partner who was in a gang/incarcerated (OR [reference = recent immigrants]: 2.4, 3.6, and 5.7). Though the odds of having high-risk partners decreased with higher parental monitoring, neither family influence measure mediated these relationships. Findings underscore the need for a prevention focus on partner choice with attention to increased risk with increasing U.S. generation.

Correlates of breast cancer screening among low-income, low-education Latinas

INTRODUCTION

This paper discusses the factors associated with breast cancer screening among low-education, low-income Latinas.

BACKGROUND

These data were collected as part of a breast cancer educational intervention study aimed at this population. The objective of the larger study was to evaluate multimedia methods as an appropriate medium for educating this population of Latinas about breast cancer.

METHODS

The study was designed as a field experiment with a pre and posttest design. A total of 1,197 individuals participated in the study, and these were all self-identified Latinas above the age of 40 years who fit the screening criteria of low income and education levels. Of these, 583 individuals provided the baseline (pretest) data on mammogram attitudes, knowledge, and intentions analyzed in this paper.

RESULTS

Our results indicate that breast cancer screening knowledge and having a regular doctor were significant factors in ever having had a mammogram and having had a recent mammogram in this sample of low-income, low-education Latinas. Age affected the odds of ever having had a mammogram, but not a recent mammogram.

CONCLUSION

Attitudes toward mammography, insurance status, and demographic factors such as foreign birth were not significant predictors of mammography screening in this study.

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.

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.

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.

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.

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.

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.