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Latina Women and Breast Cancer Screening: Sociocultural Factors
Relative to non-Latina white women, Latinas are diagnosed at later stages of breast cancer, and experience a lower survival rate. Evidence suggests that Latinas are not screened for breast cancer at the same rate as non-Latina white women, possibly accounting for some of these disparities. However, there is controversy concerning the predictors of breast cancer screening among Latinas. Whereas some research suggests that Latino cultural values or beliefs (e.g., “fatalism”) are associated with decreased screening, other research indicates that low socioeconomic status (SES) and other structural factors (e.g., limited access to health care) create barriers to screening. The objectives/hypotheses of the study are to address various questions: (1) What are Latinas’ beliefs about breast cancer?; (2) What is the relationship between beliefs about cancer, SES, acculturation and cancer screening?; (3) Is acculturation related to breast cancer screening when controlling for age and SES?; (4) Do cancer knowledge and beliefs, and access to health care mediate the relationships between acculturation, SES and cancer screening? The specific aims are to: (1) explore women’s beliefs about cancer, and (2) develop and test a theoretical model concerning the predictors of breast cancer screening, specifically, mammograms and clinical breast examinations, among Latinas. The study design involves both qualitative and quantitative survey methods. Participants will be recruited from primary care clinics and community-based organizations that serve Latinas, and data will be collected via face-to-face interviews. For the qualitative phase, semi-structured interviews will be conducted to explore beliefs about fatalism and breast cancer. These data will be content-analyzed to develop a culturally-based measure of cancer health beliefs. This measure will be integrated into the quantitative phase of the project to test a theoretical model on the effects of breast cancer beliefs and knowledge, SES, acculturation, and access to health care on screening. Quantitative data will be collected via structured interviews, and the model will be tested using Structural Equation Modeling statistical methods. The potential outcomes and benefits of the study are to elucidate factors that predict breast cancer screening among Latinas, which will assist in developing culturally-relevant interventions. The potential findings could also suggest shifts for future research and policy.
Compared with non-Latina white women, Latinas are diagnosed with breast cancer at a later stage of disease and experience a lower survival rate. A number of hypotheses concerning these ethnic disparities have been proposed. Because early detection of breast cancer is one of the most effective means of assuring timely treatment and survival, a growing number of studies focus on the differences between Latinas and non-Latinas in receipt of breast cancer screening tests. Because some studies suggest that Latinas are not screened for breast cancer at the same rate as non-Latina white women, it has been hypothesized that cultural values or beliefs, such as “fatalism” (the belief that little can be done to change the course of one’s fate) prevent Latinas from being screened. In contrast, other research indicates that broader factors related to structure of American society create barriers to screening, such as disparities in socioeconomic status (SES; e.g., low income) and access to health care (e.g., lack of health insurance). Therefore, there is some controversy concerning the most important determinants of screening for Latinas. The objectives/hypotheses of the study are to address questions concerning Latinas’ beliefs about breast cancer; and the relationship between these beliefs, SES, acculturation, access to health care, and cancer screening. The specific aims are: (1) to understand Latina’s cultural values and beliefs about breast cancer, and (2) to use this information to test a comprehensive theory on factors that affect screening. The study will test whether cultural versus other (e.g., SES) factors affect receipt of mammograms and clinical breast examinations among Latinas. The study design includes interviews with Latinas, using various analytic techniques to examine women’s beliefs about cancer, and statistical methods that identify the relative impact of cultural versus SES and access to health care variables on screening. The potential outcomes and benefits of the study are to identify the most important predictors of screening, which can be used to inform health interventions and health care policies that address disparities in breast cancer between Latinas and non-Latinas. For example, findings may indicate that, rather than beliefs, lack of health insurance is a significant barrier to screening for Latina women. This would suggest health policy interventions for improving the survival rate from breast cancer among Latinas--a disease that can be detected early.