OBJECTIVE: This study compared cervical cancer knowledge, screening practices, and barriers to screening among undocumented and documented Hispanic women. MATERIALS AND METHODS: An anonymous cross-sectional survey was administered to self-identifying Hispanic women older than 21 years at community-based clinics and health care-focused community sites in Rhode Island. The survey included demographics, immigration status, questions related to cervical cancer knowledge, screening practices, and barriers to screening. Participants were stratified based on their immigration status. Categorical variables were compared by χ2 or Fisher exact test. Knowledge scores and the number of barriers were compared by t test and Wilcoxon rank sum test, respectively. p values of less than .05 were considered statistically significant. RESULTS: Seventy-three undocumented women and 70 documented women were enrolled. Undocumented women had a significantly lower mean cervical cancer knowledge score (3.53, SD =1.97) compared with documented women (4.43, SD = 2.04; p = .0085) and also experienced more barriers to having cervical cytology or a human papillomavirus test (p = .001). Eighty-eight percent of the undocumented women and 47% of the documented women did not have health insurance (p < .0001). Sixty-two percent of the undocumented women felt that their lack of documentation was a barrier to cervical cancer screening. Fifty percent of the undocumented and 47% of the documented women had never heard of the human papillomavirus vaccine. CONCLUSIONS: Undocumented women have significantly lower mean cervical cancer knowledge scores compared with documented women. A lack of legal documentation is a significant barrier to cervical cancer screening among Hispanic women. Challenges inherent to being undocumented may contribute to women's lower knowledge scores and more pronounced barriers.
References
American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2015–2017 . Atlanta: American Cancer Society; 2015.
Robison K, Clark L, Eng W, et al. Cervical cancer prevention: Asian-American women's knowledge and participation in screening practices. Womens Health Issues 2014;24:e231–6.
American Cancer Society. Cancer Facts & Figures 2017 . Atlanta: American Cancer Society; 2017.
Watts L, Joseph N, Velazquez A, et al. Understanding barriers to cervical cancer screening among Hispanic women. Am J Obstet Gynecol 2009;201:199.e1–8.
Nardi C, Sandhu P, Selix N. Cervical cancer screening among minorities in the United States. J Nurse Pract 2016;12:675–82.
Rodríguez MA, Ward LM, Pérez-Stable EJ. Breast and cervical cancer screening: impact of health insurance status, ethnicity, and nativity of Latinas. Ann Fam Med 2005;3:235–41.
De Alba I, Hubbell FA, McMullin JM, et al. Impact of U.S. citizenship status on cancer screening among immigrant women. J Gen Intern Med 2005;20:290–6.
Moore de Peralta A, Holaday B, McDonell JR. Factors affecting hispanic women's participation in screening for cervical cancer. J Immigr Minor Health 2015;17:684–95.
Pigoga J, Kibria F, Pinilla M, et al. Barriers to health insurance pre- and post-Affordable Care Act implementation in Providence, RI. R I Med J (2013) 2015;98:35–9.
Morales-campos DY, Snipes SA, Villarreal EK, et al. Cervical cancer, human papillomavirus (HPV), and HPV vaccination: exploring gendered perspectives, knowledge, attitudes, and cultural taboos among Mexican American adults. Ethn Health 2018;1–19.
Adunlin G, Cyrus JW, Asare M, et al. Barriers and facilitators to breast and cervical cancer screening among immigrants in the United States. J Immigr Minor Health 2019;21:606–58.
Hacker K, Anies M, Folb BL, et al. Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy 2015;8:175–83.
Fernández A, Rodriguez RA. Undocumented immigrants and access to health care. JAMA Intern Med 2017;177:536–7.
U.S. Border Patrol Southwest Border Apprehensions by Sector Fiscal Year 2019. Available at: https://www.cbp.gov/newsroom/stats/sw-border-migration/usbp-sw-border-apprehensions . Accessed February 15, 2020.
Menard J, Kobetz E, Maldonado JC, et al. Barriers to cervical cancer screening among Haitian immigrant women in Little Haiti, Miami. J Cancer Educ 2010;25:602–8.
