Abstract B66: State efforts to reduce cervical cancer disparities in Hispanic women

Though cervical cancer incidence has declined in the United States in recent years, cervical cancer incidence among women over age 30 for Hispanic women is nearly twice that of non-Hispanic women (CDC, 2002). Approximately 81% of women aged 18 years or older report receiving a Papanicolaou (Pap) test to screen for cervical abnormalities in the past 3 years, though use of testing varies by education level, health insurance, and English language proficiency (Coughlin, et al., 2002; Zambrana, et al., 1999). Studies also indicate that human papillomavirus (HPV) infection prevalence, the primary cause of cervical cancer, is common among Mexican American women in the United States (Dunne et al., 2007).

State lawmakers have sought to overcome this disparity by enacting laws that encourage minority populations to get Pap tests; educate Hispanic women about cervical cancer risks; require health insurers to provide or offer coverage for Pap testing, HPV testing, or cervical cancer treatment; or require cancer information to be translated into Spanish or require Spanish language interpretation for patients with limited English proficiency.

Using data from the National Cancer Institute's State Cancer Legislative Database (SCLD), this study will first examine and describe state efforts to reduce cervical cancer incidence among Hispanic women. By linking SCLD, Surveillance, Epidemiology and End Results (SEER), and Behavioral Risk Factor Surveillance System (BRFSS) datasets, we will also compare the patterns and associations between cervical cancer laws aimed at reducing cervical cancer disparities and cervical cancer screening and incidence data among states with small and large Hispanic populations. Finally, we will examine the various demographic, socioeconomic, and other contextual factors at play in cervical cancer disparities.

Initial SCLD data indicate that 45 states have laws related to cervical cancer prevention and treatment in Hispanic populations. SCLD variables of interest include: disparities awareness; laws addressing immigrants; language assistance; limited English proficiency; primary prevention; disparities research; screening information, reimbursement, and programs; and treatment information, reimbursement, and programs. State level demographic, socio-economic, screening, and incidence rates would be derived from BRFSS and SEER datasets. We will use both bivariate and multivariate analysis to examine the relationship between Hispanic population size, cervical cancer legislative activity, cervical cancer screening, and incidence. Participants will have a greater understanding of the potential relationships between state legislation aimed at reducing cervical cancer disparities and cervical cancer screening and incidence, particularly as it applies to Hispanic populations.