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  • br Methods br Discussion The primary aim of this

    2019-08-11


    Methods
    Discussion The primary aim of this study was to examine cancer fatalism (i.e., the belief that there is little or nothing one can do to lower his/her risk of developing cancer) as a determinant of adherence to national guidelines for colorectal, breast, prostate, and cervical cancer screening in a large, population-based sample of the Hispanics/Latinos from Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Adjusting for well-established determinants of cancer screening (i.e., health insurance status, income, education, acculturation), lower cancer fatalism was marginally associated with greater adherence to screening for colorectal, breast, and prostate cancer. Results suggest that increasing an individual’s confidence in his/her ability to take action to lower his/her risk of developing cancer may be a viable intervention target to increasing screening adherence for the three most common cancers among Hispanics/Latinos [4]. Nevertheless, the effects of cancer fatalism were small and marginal, underlining that sociocultural factors like health insurance status, income, and acculturation are more robust determinants of cancer screening adherence among Hispanics/Latinos. These results await STA-21 before recommendations to reduce cancer fatalism among Hispanics/Latinos are warranted. As previously reported [79], having health insurance was a robust predictor of adherence to screening for all four cancer types. This finding is timely and notable in the current sociopolitical context in which many individuals in the U.S., including a disproportionate number of low income and minority individuals, may lose health insurance coverage if the Affordable Care Act (ACA) is repealed [82]. Other factors associated with greater cancer screening adherence, including higher income and a higher degree of U.S. American social relations (a facet of acculturation), have been previously documented [[34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47]]. Of note, a higher degree English language use (another facet of acculturation) was associated with lower screening adherence for breast and cervical cancer. This finding is contrary to previous research demonstrating lower cancer screening among Hispanics/Latinos with limited English proficiency [42,83,84]. Furthermore, limited English proficiency has been shown to be associated with lower enrollment in insurance programs like expanded Medicaid coverage through ACA [4] and the current study also demonstrated palynology a higher degree of English language use is associated with lower cancer fatalism. Therefore, these results should be interpreted with caution and await replication. While older age was associated with greater adherence to screening for colorectal, breast, and prostate cancer, younger age was uniquely associated with greater adherence to cervical cancer screening, which is congruous with the peak incidence of cervical cancer in women between ages 35 to 44 [85,86]. Hispanic/Latino men were less likely to be adherent to colorectal cancer screening than women, a pattern of results that diverges from research documenting higher overall rates of colorectal cancer screening in men than women in U.S. population-based studies [40,[87], [88], [89], [90]].
    Author contribution
    Sources of funding The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01-HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236), and San Diego State University (N01-HC65237). The following Institutes/Centers/Offices contribute to the HCHS/SOL through a transfer of funds to the NHLBI: National Center on Minority Health and Health Disparities, the National Institute of Deafness and Other Communications Disorders, the National Institute of Dental and Craniofacial Research, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the Office of Dietary Supplements. The HCHS/SOL Sociocultural Ancillary Study (HCHS/SOL SCAS) was funded by NHLBI (RC2 HL101649). P.I.M and S.J.S. was supported through a National Cancer Institute Training Grant (5T32CA193193). S.F.C. was supported by the SDSU/UCSD Cancer Center Comprehensive Partnership (U54 CA13238406A1/U54 CA13237906A1).