Comparing acculturation scales and their relationship to cancer screening among older Mexican-American women.
BACKGROUND: Hispanic women in the United States are less likely to participate in breast and cervical cancer screening than women of other racial and ethnic groups. To plan appropriate interventions requires an understanding of the barriers to participation, including those of acculturation and assimilation. Few studies have examined the effects of acculturation and assimilation on the cancer-screening behavior of Mexican-American women. PURPOSE: Because of the extensive use of the Cuellar acculturation scale and the more recent use of the Hazuda scale, we explore the utility of these two measures to predict Pap smear and mammography screening. Using a population-based sample of Mexican-American women aged 40 years and older, we compare the two scales with each other and describe their relationship to sociodemographic factors and to participation in cancer screening. METHODS: The data are from baseline surveys in El Paso and Houston, Tex., conducted before the implementation of community interventions to improve Pap smear and mammography screening in low-income Mexican-American women. Study subjects were 923 randomly selected Mexican-American women aged 40 years and older living in 16 El Paso census tracts and seven Houston census tracts. Personal interviews solicited information on age, martial and employment status, household annual income and size, education, health insurance coverage, Pap smear and mammogram history, and a series of acculturation dimensions. Acculturation was measured using the abbreviated version of the Cuellar scale developed for the Hispanic Health and Nutrition Examination Survey, 1982-1984, and the Hazuda scale developed for the San Antonio Heart Study. The eight-item Cuellar acculturation scale assessed the extent to which Spanish and English were spoken, preferred, read, and written; the ethnic identification of the respondent and her parents; and generational status in the United States. The Hazuda scale assessed the following dimensions of acculturation: adult proficiency in English, adult pattern of English versus Spanish language usage, value placed on preserving Mexican cultural origin, attitude toward traditional family structure and sex-role organization, and adult interaction with members of mainstream society. RESULTS: The Cuellar scale was highly correlated with Hazuda's two language dimension. The Hazuda scale dimensions, Mexican cultural values and traditional family attitudes, correlated the least with Cuellar's scale. All the acculturation dimensions, Cuellar's and Hazuda's, were strongly associated with education and health insurance coverage. With the use of multiple logistic regression to adjust for education, health insurance, and other variables, English proficiency was a predictor of both a recent Pap smear and a recent mammogram. No other language-based acculturation dimension was associated with a recent screening with adjustment for education, health insurance, and other variables. However, in controlling for these factors, we found that a woman's attitude toward traditional family structure was related inversely to mammogram screening. That is, women who held the strongest traditional Mexican family attitudes were more likely to participate in mammography screening. CONCLUSION: This study shows the importance of separating the effects of acculturation on cancer screening from those due to social and economic conditions. Results suggest that the Hazuda scale provides a more multidimensional approach than the Cuellar scale and is a superior measure of the acculturation process. Traditional Mexican family attitudes positively influence mammogram-screening behavior, and this finding has implications for cancer control interventions in this population.