Table 15Studies of the association between acculturation and CRC screening

Author, Year
Study Design
Population Setting
Sample Size
Quality
Study AimsPrimary Outcome of Interest for ReviewPredictors ExaminedPotential Confounders/Modifiers ReportedVariables Associated with CRC ScreeningResults (95% CI)
Afable- Munsuz et al., 2009149

Cross- sectional, retrospective, national

NHIS, 2000, 2003, 2005, Latinos 50 years or older

N = 38,347 (2304 Mexicans; 503 Puerto- Ricans; 484 Cubans)

Good
Examine the relationship between acculturation and CRC screening among older Mexican, Puerto-Rican, and Cuban adultsFOBT in past year; FS in past 5 years; colonoscopy in past 10 years (self-report)Acculturation (i.e., US or foreign born; and language preference of interview)Age, sex, income status, education, insurance, usual source of care, number of chronic diseases↑ English language proficiency for FOBT

US born for endoscopy among Mexicans

US born for FOBT among Puerto Ricans
English language interview was positively associated with FOBT in past year (AOR, 2.5; 95% CI, 1.1, 5.4)

US born among Mexicans was positively associated with endoscopy (AOR, 1.5; 95% 1.1, 2.2) and negatively associated with FOBT among Puerto Ricans (AOR, 0.3; 95% CI, 0.2, 0.7)
Diaz et al., 2008161

Cross- sectional, retrospective, national

BRFSS, 2006, ≥ 50 years

N = 99,895

Good
Examine relationship between language and CRC screening among Latinos and non- LatinosFOBT in past year; endoscopy in past 10 years (self-report)English- language proficiency (non-Latinos responding to survey in English; Latinos responding in English; Latinos responding in Spanish)Age, gender, marital status, insurance, geographic region↑ English- language proficiencyLatinos responding in Spanish were 43% less likely to have obtained CRC screening than non-Latinos (AOR, 0.57; 95% CI, 0.44–0.74) and 36% less likely to have been screened when compared with Latinos responding in English (AOR, 0.64; 95% CI, 0.48–0.84)
Goel, et al., 2003147

Cross- sectional, retrospective, national

NHIS, 1998, ≥50 years

N = 32,440 (15% foreign- born)

Good
Determine whether foreign birthplace explains some racial/ethnic disparities in cancer screeningFOBT in past year or proctoscopy (as a proxy for FS) in past 5 yearsForeign-born (born outside US)Age, marital status, geographic region, education, income, health status, comorbidities, body mass index, hospitalizations in prior year, access to care (insurance status, visits in past year, usual source of care)No differences for foreign- born respondents once analysis adjusted for access to careForeign-born Hispanics and Asian Americans and Pacific Islanders were just as likely as US- both Hispanics and Asian Americans and Pacific Islanders to have been screened by FOBT (AOR, 1.05; 95% CI, 0.68–1.64 for Hispanics; AOR, 0.62; 95% CI, 0.29–1.33 for Asian Americans and Pacific Islanders) or for proctoscopy (AOR, 0.89; 95% CI, 0.59–1.37 for Hispanics; AOR, 0.96; 95% CI, 0.44–2.09 for Asian Americans and Pacific Islanders)
Jerant, et al., 20081

Cross- sectional, retrospective, national

MEPS, 2001- 2005, combined with NHIS, 2000–2004, ≥ 50 years

N = 22,973

Good

N = 22,419

Good
Examine correlates of screening among all 4 major US racial/ethnic categories (non-Hispanic whit, Asian, black, and Hispanic individuals)FOBT in past 2 years or endoscopy everLanguage spoken at home; foreign- or US-bornAge, sex, metropolitan statistical area (rurality), region of US, income, education, insurance, usual source of care, self-rated health↑ English- language proficiency

US-born
Respondents who reported speaking English at home were more likely to report being screened than those who did not (AOR, 1.84; 95% CI, 1.52–1.33 for combined screening with FOBT or endoscopy)

Those born in the US were also more likely to be screened than those who were not (AOR, 1.16; 95% CI, 1.01–1.33)

There were no differences in screening rates among other groups of Hispanics in terms of their reported screening
Shah, 2006121

National cross sectional survey; NHIS, 2000

Hispanics age 50–80

N = 1,163

Fair
Examine whether low acculturation is a risk factor for underutilization of CRC screening examinations in the Hispanic populationNot having had FOBT (at home) in past year and not having had lower endoscopy in past 5 yearsAcculturation (i.e., English language usage) in tertiles: low, moderate, highMarital status, age, education, difference in incomeNo screening rates based on language usageAdjusted rates for not being screened with low English language usage as the referent:

Moderate: AOR, 0.92; 95% CI, 0.60–1.42

High: AOR, 0.75; 95% CI, 0.45–1.25
Shih et al., 2008120

Cross- sectional, retrospective, national

NHIS, 2000, ≥ 50 years

N = 12,179

Good
Examine factors associated with CRC screening of US- and foreign-born groupsEver been screened by FOBT or endoscopy (self-report)Foreign-born by years in US (short = < 10 years; moderate = 10–14 years; long duration = ≥ 15 years)Age, gender, race/ethnicity, geographic region, urban vs. rural↓ Foreign- born and living in US ≤ 10 years or ≥ 15 yearsForeign-born respondents living in US ≤ 10 years were less likely than US-born non- Hispanic whites to be screened for CRC (AOR 0.46; 95% CI, 0.29‐ 0.71), as were foreign-born respondents living in US for 15 years or more (AOR 0.58; 95% CI, 0.51–0.67; P ≤ 0.001)
Schumacher et al., 2008122

Cohort study, several states (Alaska, Southwest United States)

Baseline survey, 2004- 2007, American Indian/Alaska Natives, 50+ years

N = 2,779

Fair
Investigate predictive factors associated with receiving each of the cancer screening testsColonoscopy or FS in past 5 years (self- report)English- language proficiency (language spoken at home)Age, location, gender, education, family history of cancer, family history of CRC, smoke cigarettes in past 5 years, history of chronic medical condition, language, residency, income, other screening tests↓ American Indians using native languages at homeRespondents speaking only native languages at home were less likely to have obtained CRC screening than those speaking English at home (AOR, 0.50; 95% CI, 0.33–0.76)

Those speaking English and native languages at home were also less likely to have received CRC screening (AOR, 0.65; 95% CI, 0.50–0.85)
Sun et al., 2004118

Cross- sectional, retrospective, Local

Chinese Americans, 1999–2000, 3 senior centers in New York City, ≥ 50 years

N = 203

Fair
Investigate factors associated with CRC screening among senior Chinese AmericansFOBT only in past year, FOBT + FS in past 5 years, or no test (claims)Years of US residency (< 10 years; 10–19 years; ≥ 20 years)Age, gender, marital status, home owner, ethnicity, years at residence, education, income, insurance, employment, family history of CRC, worries or fears, perceived susceptibility, self-efficacy, social influence, intention, efficacy of screening↑ Years in USYears living in US was a predictor of FOBT only (AOR, 0.64; 95% CI, 0.41–0.99; P < 0.05); or for either FOBT only or FOBT + FS (AOR, 0.54; 95% CI, 0.64–0.94)
Wong et al., 20052

Cross- sectional, retrospective, State

California Health Interview Survey, 2001, ≥ 50 years

N = 1,771 Asian Americans

Fair
Factors related to screening rates among Asian Americans compared with non-Latino whitesFOBT in past year or endoscopy in past 10 years, or both (self-report)Foreign-born and years living in US (< 15 years in the US or ≥ 15 years in US)Ethnic group, age, gender, education, marital status, household size and income, years in US, comorbidities, English language proficiency, family history of CRC↓ Living in US for < 15 yearsForeign-born respondents living in US for < 15 years were less likely to have ever received CRC screening (AOR, 0.48; 95% CI, 0.32–0.71) or to be up-to-date with screening (AOR, 0.58; 95% CI, 0.40–0.82)

AOR, adjusted odds ratio; BRFSS, Behavioral Risk Factor Surveillance Survey; CI, confidence interval; CRC, colorectal cancer; FOBT, fecal occult blood test; FS, flexible sigmoidoscopy; MEPS, Medical Expenditure Panel Survey; NHIS, National Health Interview Survey; US, United States.

*

Arrow symbols (↓ or ↑) are provided as a quick reference point of overall findings and represent the association reported between each variable and CRC screening.

From: 4, Results

Cover of Enhancing the Use and Quality of Colorectal Cancer Screening
Enhancing the Use and Quality of Colorectal Cancer Screening.
Evidence Reports/Technology Assessments, No. 190.
Holden DJ, Harris R, Porterfield DS, et al.

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