Perceived Neighborhood Social Cohesion and Cervical and Breast Cancer Screening Utilization Among Immigrant and U.S.-Born Women

Background/Purpose: Although cervical and breast cancer are considered highly treatable if detected early, research consistently shows low utilization of preventive screenings among immigrant women, particularly recent arrivals. Some of the main factors predisposing immigrant women to postpone preventive healthcare are language and cultural barriers, along with the lack of health insurance, but these factors do not fully explain disparities in screening utilization. Immigration involves finding sources of social support within new neighborhoods. Although the social environment has been shown to influence health outcomes, it has not been widely analyzed in this area. In this study, we examined the extent to which neighborhood social cohesion and sociodemographic characteristics may influence screening utilization among immigrant and U.S.-born women.

Methods: Data came from the 2018 National Health Interview Survey (NHIS), a nationally representative cross-sectional household interview survey of the U.S. civilian, non-institutionalized population. We limited the samples for the current study to the 7,722 (99%) women ages 21-64 who reported Pap test data, and the 3,298 (78%) women ages 40-64 who reported mammogram data. Nineteen percent of the women in the study sample were foreign-born. Perceived neighborhood social cohesion was measured as a sum-score of relevant NHIS questions. Individual level variables included demographic variables (age, marital status, and race/ethnicity); socioeconomic status (SES) variables (education, employment status, family income); health insurance; nativity, and acculturation level among immigrants (years living in the United States). We used logistic regression to examine 3 models stratified by nativity: an unadjusted model, a model adjusted for demographic characteristics, and a full model that also included socioeconomic status variables.

Results: The key driving factors of screening utilization were demographic and socioeconomic variables. Perceived neighborhood social cohesion was not a significant predictor. Socially disadvantaged women had lower odds of Pap test and mammogram utilization, regardless of birthplace. Pap tests odds were lower among foreign-born women, those who were never married, unemployed, had income between 100-199% of the FPL, did not have insurance, and who had lived in the United States for less than 10 years. Foreign-born Asian women had lower odds of Pap test utilization than foreign-born White women. Among U.S.-born women, those who were never married, had less education and lower income, or lacked insurance coverage also had lower odds. Regarding mammograms, among foreign-born women, Black (compared with White) and unemployed women had higher odds of mammogram utilization, while poor women had lower odds than women with income at least 400% of the FPL. Among U.S.-born women, those who were unemployed had significantly lower odds of mammogram utilization.

Conclusions and Implications: We found that immigrant status played a role in the use of preventive health services among women in this study. In addition, our findings showed that overall, individual level factors, not perceived neighborhood social cohesion, impacted screening utilization. Finally, differences by race and ethnicity suggest the need to tailor interventions to address each group’s needs.