Cervical Cancer Screening Among African Immigrant Women in the United States

Purpose: This research explored cervical cancer screening among Sub-Saharan and North African/Middle Eastern immigrant women. Informed by the Cancer Screening Health Promotion Model (CSHP) by Alberta Health Services (2010), four groups of factors associated with cancer screening behaviors were evaluated, and these are 1) Genetic and non-modifiable characteristics (age and national origins), 2) Behavior, circumstance and personal history (education level and marital status), 3) Socioeconomic and environmental conditions (employment status), and 4) Enabling factors (having a regular source of health care and recent physician contact). The study focused on this population because little is known regarding cancer screening behaviors of African immigrant women. Given that cancer incidence patterns for first-generation immigrants may mirror those of their native country, available statistics suggest an elevated risk for cervical cancer among first-generation African immigrant women. Cervical cancer incidences in Africa show high levels of up to 40 per 100,000 women comparable to 1940s U.S. where a rate of 38 per 100,000 females was recorded in the Second U.S. National Cancer Survey of 1947. Understanding the use of the pap test by African immigrant women is integral to guide efforts towards the achievement of Healthy People 2020 cervical cancer screening objectives.

Methods: The sample consisted of women from Sub-Saharan Africa (n = 167) and North Africa/Middle East (n = 143) who participated in the New Immigrant Survey (NIS) 2003 Wave 1, a longitudinal study of people who are granted permanent residence to the U.S. Data were collected between June 2003 and June 2004 through telephone and in person interviews. The chi-square test of independence was used to determine relationships between the explanatory variables (age, national origin, educational level, marital status, employment status, regular source of health care, and recent physician contact) and the outcome variable (use of pap test). Multiple logistic regression was used to identify predictors of use of pap test.

 Results: Results from the chi-square test of independence indicated that receipt of a pap test was dependent upon marital status, educational level, having a regular source of care and having seen or talked to a medical doctor. Further analysis of the chi-square percentages showed that women who were not married, with fewer years of schooling, and no regular source of care were less likely to have received a pap test. Having talked to or seen a doctor in the last year was the strongest independent predictor of use of pap test (OR = 2.816; 95% CI, 1.724 – 4.601, p<.001).

Implications: Consistent with the CSHP model, the findings of this study shed light on women who may underutilize pap testing and the factors that could promote use of pap tests. Outreach efforts targeted at women who are not married, with fewer years of schooling, and no regular source of care, as well as interventions that seek to promote having a regular source of care and contact with medical personnel may improve cervical cancer screening rates of Sub-Saharan and North African/Middle Eastern women.