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Med Care. 2010 Dec;48(12):1088-96. doi: 10.1097/MLR.0b013e3181f53542.

Access versus acculturation: identifying modifiable factors to promote cancer screening among Asian American women.

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  • 1Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90024, USA.



Asian Americans (AA) have the lowest rates of cancer screening of all ethnic groups. Reasons for these low rates of screening frequently include low acculturation levels. However, screening rates remain low for most AA populations despite differences in acculturation levels, suggesting presence of other important modifiers such as access barriers.


To compare the relative impact of access versus acculturation on breast and cervical cancer screening for AA subgroups.


Multiple regressions models, controlling for sociodemographics, were developed for each AA subgroup.


Women ages 18 and older from the 2003 California Health Interview Survey were included in this study. We included women with Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese origins.


The dependent variables included clinical breast examination in the past year, mammogram in the past 2 years, and Pap test in the past 3 years. Independent variables included AA subgroup, access indicators, acculturation indicators, and other sociodemographics.


Access explained more variation that acculturation alone in cancer screening for most AA women. The exceptions were in mammograms for Japanese, Koreans and South Asians and Pap test among Japanese. No insurance reduced the likelihood of clinical breast examination for immigrant Chinese and Filipinos, and no usual source of care reduced likelihood of Pap test for Japanese and South Asians compared with US born.


Access indicators represent the ability to navigate the US health care system but have a differential impact on AA groups. These differences should be integrated into interventions designed to improve cancer screening rates.

[PubMed - indexed for MEDLINE]
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