METHODS: We analyzed the 2007 California Health Interview Survey for Asian (Japanese, Chinese, Filipino, Korean, Vietnamese, other Asian) and white women within age groups relevant to US Preventive Services Task Force (USPSTF) screening guidelines: cervical: ages 21-65 (n = 15,210) and breast: ages 50-74 (n = 11,163). Multilevel logistic regression models predicted meeting USPSTF screening guidelines both with and without self-reported health literacy controlling for individual-level and contextual-level factors.
RESULTS: Low health literacy significantly (p < 0.05) predicted lower cancer screening in final models for both cancer types. In unadjusted models, Asians were significantly less likely than whites to receive both screening types and significantly more likely to report low health literacy. However, in multivariable models, the addition of the low health literacy variable did not diminish Asian vs. white cancer screening disparities.
CONCLUSIONS: Self-reported health literacy predicted cervical and breast cancer screening, but was not able to explain Asian cancer screening disparities. We provide new evidence to support a relationship between health literacy and cancer screening. Health literacy is likely a useful focus for interventions to improve cancer screening and ultimately reduce the burden of cancer. To specifically reduce Asian cancer disparities, additional areas of focus should be considered.
方法:我们分析了2007年加州亚洲健康访谈调查(日语,中文,菲律宾人,韩语,越南人,其他亚洲人)和与美国预防服务工作组(USPSTF)筛查指南相关的年龄组内的白人妇女:宫颈:21-65岁(n=15,210)和乳腺:50-74岁(n=11,163)。多水平逻辑回归模型预测在有或没有自我报告的健康素养控制个体水平和上下文水平因素的情况下都符合USPSTF筛查指南。
结果:健康素养低(p<0.05)预测两种癌症类型的最终模型中癌症筛查率较低。在未调整的模型中,与白人相比,亚洲人接受两种筛查类型的可能性要小得多,并且报告健康素养低的可能性要高得多。然而,在多变量模型中,低健康素养变量的增加并没有减少亚洲人与白人癌症筛查差异。
结论:自我报告的健康素养可预测宫颈癌和乳腺癌筛查,但无法解释亚洲癌症筛查差异。我们提供了新的证据来支持健康素养与癌症筛查之间的关系。健康素养可能是改善癌症筛查并最终减轻癌症负担的干预措施的有用重点。为了特别减少亚洲癌症的差异,应考虑其他重点领域。