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Cervical Cancer Screening by Immigrant and Minority Women in Canada

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Abstract

Cervical cancer is one of the most preventable forms of cancer and the Pap smear test is one of the most widely accessible forms of cancer screening. An important public health issue is the extent to which Canadian women are engaging in regular screening for cervical cancer, particularly potentially at-risk groups such as recent immigrants and women from minority ethnic backgrounds. We use recent population health surveys to analyze immigrant and native-born women’s use of Pap smear testing, with a focus on how screening rates differ by ethnic background and characteristics of immigration. We find that almost all recent immigrant women have markedly lower use of Pap smear testing than comparable Canadian-born women, but these rates slowly increase with years in Canada. However, we find wide variation in rates of screening by ethnic background. Screening rates for White immigrant women from countries where the official language is neither English nor French approach Canadian-born women’s utilization rates after 15–20 years in Canada, as do the screening rates of Black and Hispanic women. Screening rates for those from Asian backgrounds remain significantly below native-born Canadian levels even after many years in Canada. As well, immigrant women of Asian background who arrived as children and second-generation Asian Canadians both exhibit significantly lower rates of Pap smear testing than Canadian-born White women.

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Notes

  1. Other recent work on cervical cancer includes Fehringer et al. [25] who study the determinants of Pap testing using administrative data from the Ontario Pap Test Registry. Related work includes Ng et al. [26] who examine mortality from cervical cancer by census metropolitan area using death registration data.

  2. The Anderson model that expresses help-seeking behavior as a function of predisposing characteristics and enabling resources yields similar predictions about the expected determinants of screening use [32].

  3. Another reason to pool cross-sectional datasets aside from increasing sample size is that in the absence of a longitudinal dataset with a large immigrant component, pooling independent cross-sections of data is required if arrival period effects and time effects are to be disentangled, a technical point that is discussed below.

  4. Restricting attention to foreign-born women, the correlation between region of birth and region of origin as indicated by ethnic minority status is generally high. For example, 99% of immigrant women of Southeast Asian ethnicity report being born in one of the Southeast Asian countries, and 89% of Hispanic women report being born in Central or South America. The most dispersed (non-White) ethnic groups are South Asians and Blacks. For foreign-born women of South Asian descent, 67% still report being born in a South Asian country (India, Pakistan, Bangladesh, Sri Lanka). Of the rest, 9% of this group was born in Africa, 6% in South America, 4% in Southeast Asia, with smaller percentages of South Asian women born in other regions of the world. Among foreign-born Blacks, 65% were born in the West Indies while 23% were born in Africa. Of the rest, 6% were born in South America and 3% were born in the UK.

  5. Other specifications not reported here included additional interactions of survey year with geographic indicators, but no meaningful effect on any of the variables of interest was found. Also, basic specifications with controls for period of arrival but not years in Canada were estimated separately for each survey and the key immigrant and ethnicity terms were comparable.

  6. Interactions of the language terms (for French and ‘‘other’’ languages) with an indicator for residents of Quebec, the only province of Canada that has French as the official language, were poorly determined and had no significant impact on the other results.

  7. Due to smaller sample sizes and ease of exposition, we also exclude the arrival cohort terms from the regressions. The inclusion of arrival cohort terms does not significantly affect the main results.

References

  1. Chen J, Ng E, Wilkins R. The health of Canada’s immigrants in 1994–1995. Stat Canada Health Rep 1996;7(4):33–35..

    Google Scholar 

  2. Perez C. Health status and health behaviour among immigrants. Stat Canada Health Rep 2002;13(Supplement).

  3. Newbold KB, Danforth J. Health status and Canada’s immigrant population. Soc Sci Med 2003;57(10):1981–95.

    Article  PubMed  Google Scholar 

  4. McDonald JT, Kennedy S. Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Soc Sci Med 2004;59(8):1613–27.

    Article  PubMed  Google Scholar 

  5. Ali JS, McDermott S, Gravel R. Recent research on immigrant health from statistics Canada’s population surveys. Can J Public Health 2004;5(3):I9–I13.

    Google Scholar 

  6. Wen S, Goel V, Williams J. Utilization of health care services by immigrants and other ethnic/cultural groups in Ontario. Ethnic Health 1996;1(1):99–109.

    Article  CAS  Google Scholar 

  7. Laroche M. Health status and health services utilization of Canada’s immigrant and non-immigrant populations. Can Pub Policy 2002;26(2):51–75.

    Google Scholar 

  8. Deri C. Social networks and health service utilization. J Health Econ 2005;24(6):1076–107.

    Article  PubMed  Google Scholar 

  9. Newbold KB, Patel A. Use of dental services by immigrant Canadians. J Can Dental Assoc 2006;72(2):143a–f.

    Google Scholar 

  10. Wu Z, Penning M, Schimmele C. Immigrant status and unmet health care needs. Can J Pub Health 2005;96(5):369–73.

    Google Scholar 

  11. Maclean H, Glynn K, Cao Z, Ansara D. Personal health practices. BMC Women’s Health 2004;4(Suppl 1):S4, http://www.biomedcentral.com/1472-6874/4/S1/S4.

  12. Public Health Agency of Canada. Background and history of cervical screening in Canada. Centre for Chronic Disease Prevention and Control 2003; http://www.phac-aspc.gc.ca/ccdpc-cpcmc/cc-ccu/index_e.html.

  13. Goel V. Factors associated with cervical cancer screening: results from the Ontario health survey. Can J Pub Health 1994;85:125–27.

    CAS  Google Scholar 

  14. Maxwell C, Bancej CM, Snider J, Vik SA. Factors important in promoting cervical cancer screening among Canadian women: findings from the 1996–1997 national population health survey (NPHS). Can J Pub Health 2001;92(2):127–33.

    CAS  Google Scholar 

  15. Woloshin S, Schwartz L, Katz S, Welsh H. Is language a barrier to the use of preventative services? J Gen Internal Med 1997;12:472–7.

    Article  CAS  Google Scholar 

  16. Matuk L. Pap smear screening practices in newcomer women. Women’s Health Issues 1996;6(2):82–8.

    Article  PubMed  CAS  Google Scholar 

  17. Gupta A, Kumar A, Stewart D. Cervical cancer screening among South Asian women in Canada: the role of education and acculturation. Health Care Women Int 2002;23(2):123–34.

    Article  PubMed  Google Scholar 

  18. Hislop TG, Inrig K, Bajdik C, Deschamps M, Tu S-P, Taylor V. Health care services and pap testing behavior for Chinese women in British Columbia. J Immigr Health 2003;5(4):143–52.

    Article  PubMed  Google Scholar 

  19. Hislop TG, Teh C, Lai A, Ralston J, Shu J, Taylor V. Pap screening and knowledge of risk factors for cervical cancer in Chinese women in British Columbia. Ethnic Health 2004;9(3):267–81.

    Article  Google Scholar 

  20. Harlan L, Bernstein A, Kessler L. Cervical cancer screening: who is not screened and why? Am J Pub Health 1991;81:885–91.

    Article  PubMed  CAS  Google Scholar 

  21. Luke K. Cervical cancer screening; meeting the needs of minority ethnic women. Brit J Cancer 1996;74(supp):47–50.

    Google Scholar 

  22. Lesjak M, Hua M, Ward J. Cervical screening among immigrant Vietnamese women seen in general practice: current rates, predictors and potential recruitment strategies. Aust New Zeal J Pub Health 1999;23(2):168–73.

    Article  CAS  Google Scholar 

  23. Goel M, Wee C, McCarthy E, Davis R, Ngo-Metzger Q, Phillips R. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care’. J Gen Internal Med 2003;18(12):1028–35.

    Article  Google Scholar 

  24. Juon H-S, Seung-Lee C, Klassen A. Predictors of regular Pap smears among Korean–American women. Prevent Med 2003;37:585–92.

    Article  Google Scholar 

  25. Fehringer G, Howlett R, Cotterchio M, Klar N, Majpruz-Moat V, Mai V. Comparison of papnicolaou (Pap) test rates across Ontario and factors associated with cervical screening. Can J Pub Health 2005;96(2):140–4.

    Google Scholar 

  26. Ng E, Wilkins R, Fung M, Berthelot JM. Cervical cancer mortality by neighborhood income in urban Canada from 1971 to 1996. Can Med Assoc J 2004;170(10):1545–9.

    Article  Google Scholar 

  27. Grossman M. On the concept of health capital and the demand for health. J Politic Econ 1972;80:223–5.

    Article  Google Scholar 

  28. Kenkel D. The demand for preventative medical care. Appl Econ 1994;26:313–25.

    Article  Google Scholar 

  29. Remmenick L. Breast screening practices among Russian immigrant women. Women Health 1999;28(4):29–51.

    Article  Google Scholar 

  30. Rajaram S, Rashidi A. Minority women and breast cancer screening: the role of cultural explanatory models. Prevent Med 1998;27:757–64.

    Article  CAS  Google Scholar 

  31. Raja Jones H. Breast screening and ethnic minority women: a literature review. Brit J Nursing 1999;8(19):1284–8.

    CAS  Google Scholar 

  32. Andersen R. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995;36:1–10.

    Article  PubMed  CAS  Google Scholar 

  33. Public Health Agency of Canada. Programmatic guidelines for screening for cancer of the cervix in Canada. Society of Gynecologic Oncologists of Canada; 1998.

  34. Borjas G. Assimilation and changes in cohort quality revisited: what happened to immigrant earnings in the 1980s? J Labor Econ 1985;13:201–45.

    Article  Google Scholar 

  35. Batten D, Brisbois F. Combining health surveys: a user’s guide. Statistics Canada Occasional Paper; 2005.

  36. Bertrand M, Luttmer E, Mullainathan S. Network effects and welfare cultures. Quart J Econ 2000;115:1019–55.

    Article  Google Scholar 

  37. McDonald JT, Kennedy S. Is migration to Canada associated with unhealthy weight gain? Overweight and obesity among Canada’s immigrants. Soc Sci Med 2005;61(12):2469–81.

    Article  PubMed  Google Scholar 

  38. Tu S-P, Jackson S, Yasui Y, Deschamps M, Hislop G, Taylor V. Cancer preventive screening: a cross-border comparison of United States and Canadian Chinese women. Prevent Med 2005;41:36–46.

    Article  Google Scholar 

  39. Bottorff J, Johnson J, Bhagat R, Grewal S, Balneaves L, Clarke H, Hilton A. Beliefs related to breast health practices: the perceptions of south Asian women living in Canada. Soc Sci Med 1998;47(12):2075–85.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Financial assistance from SSHRC (Grant # 410-2002-1357) and SEDAP at McMaster University is gratefully acknowledged. The authors have also benefited from helpful comments from anonymous referees. The econometric analysis in this paper was conducted at the Statistics Canada-CRISP Research Data Centre at the University of New Brunswick. Views expressed are those of the authors only and do not necessarily represent the views of Statistics Canada or the Australian Treasury.

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Authors and Affiliations

  1. Department of Economics, University of New Brunswick, P.O. Box 4400, Fredericton, NB, Canada, E3B 5A3

    James Ted McDonald

  2. Australian Treasury, Canberra, Australia

    Steven Kennedy

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Correspondence to James Ted McDonald.

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McDonald, J.T., Kennedy, S. Cervical Cancer Screening by Immigrant and Minority Women in Canada. J Immigrant Minority Health 9, 323–334 (2007). https://doi.org/10.1007/s10903-007-9046-x

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