Cancer Control Research1R03CA158419-01A1
HEALTH LITERACY AND CANCER SCREENING DISPARITIES IN ASIAN AMERICAN POPULATIONS
DESCRIPTION (provided by applicant): Cancer is the leading cause of death among Asian Americans (AA), yet screening rates for breast, colorectal, and cervical cancer are lower for AA than for many other racial/ethnic groups. Adult health literacy (HL), defined in Healthy People 2010 as the "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services for appropriate health decisions" is an established correlate to cancer screening that is not well studied in AA. Understanding the relationship of HL to cancer screening in AA is particularly important due to the high prevalence of limited English proficiency (LEP) in many AA populations. LEP is associated with less cancer screening in AA, and may contribute to and exacerbate the consequences of low HL in AA. Contextual factors, such as screening facility availability and neighborhood ethnic density, are also associated with health behaviors. Contextual factors are understudied in HL research, but may impact the relationship of individual HL to cancer screening, especially in AA with LEP. Currently, our core knowledge base: 1) lacks population-based rates of, and individual and contextual-level correlates to, cancer screening by HL for AA overall and within diverse AA subpopulations; 2) has not established if low HL explains health disparities among AA as it does in other populations; and 3) has not specified the interaction of HL with individual or contextual-level linguistic access variables. This R03 will use the Behavioral Model of Health Services Utilization as a conceptual guide to fill in these critical knowledge gaps through a secondary data analysis of the 2007 California Health Interview Survey (CHIS), a population-based study with rich data on AA populations, merged with contextual-level data from Census and CMS at the policy-relevant level of the Medical Service Study Area. Specifically we will: (1) Determine if breast, cervical, and colon cancer screening rates differ by HL in AA generally and in AA subpopulations when relevant individual and contextual-level factors are considered; (2) Test if HL explains cancer screening disparities a) for AA compared to non-Hispanic whites, and b) within AA subpopulations; and (3) Quantify the interaction of HL with individual LEP as well as contextual linguistic access variables (doctor- patient language concordance, community LEP, AA ethnic density) for cancer screening in AA. This study is an important addition to, and a novel synthesis of, four emerging streams of research with distinct implications for improving cancer morbidity/mortality and reducing health disparities: 1) the role of HL in explaining health disparities; 2) the importance of LEP to health and health care access; 3) variation in cancer correlates and outcomes in AA subpopulations, and 4) contextual/individual-level interactions in health. We address the stated NCI/NIH goals of improving HL, reducing cancer screening disparities, and gaining detailed portraits of AA subpopulations using a novel combination of NCI-funded data. This study also provides key background for our future research to reduce cancer incidence, mortality, and health disparities among AA. 1 PUBLIC HEALTH RELEVANCE: Cancer is the leading cause of death among Asian Americans (AA), yet screening rates for breast, colorectal, and cervical cancer are lower for AA than for many other racial/ethnic groups. Adult health literacy is known to predict cancer screening in other racial/ethnic groups, but this topic has not been studied in AA. This research project will: (1) Determine if breast, cervical, and colon cancer screening rates differ by health literacy in AA generally and in AA subpopulations when relevant individual and contextual level factors are considered; (2) Test if health literacy explains cancer screening disparities a) for AA compared to non-Hispanic whites, and b) within AA subpopulations; and (3) Quantify the interaction of low health literacy with individual and contextual linguistic access variables for cancer screening rates in AA.