Abstract
Background: Depression has repeatedly been shown to be a barrier to cancer survivorship behavior. Depressed survivors appear to be unable to effectively follow health-related practices, whether directly recommended by health care providers or self-indicated. In addition to depression-related barriers, some cancer survivors are further inhibited by socioeconomic and cultural factors characteristic of ethnic minorities, especially Low English language facility. Here we sought to identify factors influencing Latina breast cancer survivors' behavior involving screening for other possible cancer, emphasizing the complex interplay of cultural and non-cultural factors in breast cancer survivorship.
Methods: A cross-sectional sample of 117 Latina breast cancer survivors reported demographic measures, perceived barriers to health care, acculturation and depression. Low English language facility was determined utilizing Marin's short acculturation scale for Hispanics. Depression was measured using the Center for Epidemiological Studies Depression scale (CES-D). Chi-squared and T-tests were used to identify the association of outcomes with Low English language facility, depression and other potential influences. Multiple logistic regression was used to construct models of Latina breast cancer survivor behavior relative to their obtaining colorectal and ovarian screening.
Results: Only 12.8% and 32.5% of all women obtained ovarian or colorectal screening, respectively. 51% spoke little or no English. 31.6% scored above the threshold for depression, 50.0% were characterized by Low English language facility, and 22.2% were both depressed and experienced Low English language facility. Of depressed women, 10.8% and 27.0% obtained either screening. Of Low English language facility women, 11.9% and 33.9% were screened for ovarian or colorectal abnormalities. 7.7% and 23.1% of women who were both depressed and Low English language facility received ovarian or colorectal screening. In multivariate analysis, depression, Low English language facility, generational status, sociodemographic characteristics and socioeconomic barriers were inversely associated with screening. There was no interactive effect of Low English language facility and depression.
Conclusions: Low rates of ovarian and colorectal screening in Latina breast cancer survivors involve both cultural and non-cultural influences, particularly Low English language facility and depression. These occur at varying conceptual proximity to actual behavior. Interventions to recruit and retain breast cancer survivors to interventions as well as improve health care among them must address both Low English language facility and the effects of depression, especially among Latinas or other non-English speakers.
Citation Format: Alan E C Holden, Pamela Otto, Kipling Gallion, Amelie G. Ramirez. Low English language facility, depression, and cancer screening among Latina breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A45.
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