Fabio Sabogal

Pathways to early cancer detection in the multiethnic population of the San Francisco Bay Area

The Pathways project studied the relationship of race/ethnicity, socioeconomic status, and culture to breast and cervical cancer screening. A multidisciplinary, multicultural team of investigators assessed the knowledge, attitudes, and practices of women from five race/ethnic groups (N = 4,228) and their barriers to screening utilization. A planning framework guided the development of interventions and analyses of the similarities and differences in screening behaviors across race/ethnic groups. Baseline data for women ages 18 to 74 years showed that levels of screening were higher than national averages for Latina, white, and black women but lower for Chinese and Vietnamese women. Analyses revealed the importance of education and insurance in obtaining recommended screening regardless of race/ethnicity. However, race, ethnicity, and culture are important to the tailoring of effective interventions.

Access and Attitudinal Factors Related to Breast and Cervical Cancer Rescreening: Why are Latinas Still Underscreened?

To identify access, attitudes, and health practices of Latina women undergoing regular mammography and Pap smear screening, 977 Latinas aged 40 to 74, residing in four California cities, answered a telephone interview. Forty-one percent of women had regular mammography, and 73% had regular Pap smear screening. Cancer screening maintenance was associated with having health insurance, a regular place of care, and fewer fatalistic attitudes about cancer. Regular mammography and Pap smear screening were also associated with ever being married, attending church, and having taken hormone replacement therapy. Being older than 50, residing in the United States a long time, and having had a hysterectomy predicted mammography maintenance. Pap smear screening maintenance was negatively associated with poverty, old age, and negative attitudes toward physicians. There are structural and attitudinal barriers to regular cancer screening among Latinas. Interventions that increase access to care and address womens attitudes about cancer are needed.

Gender, Ethnic, and Acculturation Differences in Sexual Behaviors: Hispanic and Non-Hispanic White Adults.

Hispanics have an increased prevalence of sexually transmitted diseases (STDs). To describe the prevalence of sexual behaviors of Hispanics, we conducted surveys of randomly selected residents in census tract areas and members of a health maintenance organization (n = 2,596). Hispanic men were more likely to start sexual intercourse at an earlier age and reported lower rates of condom use than non-Hispanic White men. Hispanic women reported having a higher number of children, less use of barrier contraception, fewer lifetime sexualpartners, andfewer STDs than non-Hispanic White women. Less-acculturated Hispanic men reported a younger age for theirfirst sexual intercourse and a lower frequency of condom use than did more highly acculturated Hispanic men. Highly acculturated Hispanic women reporteda highernumberof lifetime sexual partners than did less-acculturated women. Gender differences, mediated by marital status, age, and education, were more significantly associated with sexual behavior than ethnicity.

The Role of Acculturation in the Attitudes, Norms, and Expectancies of Hispanic Smokers

Data from 263 Hispanic smokers in the San Francisco area showed that, in general, among the highly acculturated, attitudes, norms, and expectancies toward smoking resembled those held by an equivalent group of white non-Hispanic smokers. Level of acculturation had no significant effect on generalized attitudes toward smoking, but it was associated with the level of certainty with which five stereotypes were assigned to smokers. Acculturation level also affected the perceived normative influence of parents and the willingness to follow the desires of parents and physician. Acculturation had a more significant effect on discriminating the importance assigned to antecedents and consequences of smoking; responses of the highly acculturated again resembled those of the white non-Hispanics. The implications of these findings in the development of culturally appropriate smoking cessation materials for less acculturated Hispanics are discussed.

Printed Health Education Materials for Diverse Communities: Suggestions Learned from the Field:

Health education materials designed for the general population may be perceived as unattractive, irrelevant, or unclear by members of certain cultural groups. Given the increasingly multicultural demographics of the United States, planners need to be aware of the specific characteristics of a target audience to address cultural differences and similarities in health messages. The authors describe the use of the subjective culture methodology and social marketing to develop health education materials targeted to multicultural populations, illustrate cultural factors that should be considered when designing printed materials, and outline steps in the design of attractive, stimulating, and culturally appropriate materials. The authors describe the challenges and problems in designing printed materials for multiethnic communities, give suggestions for written educational messages, present a summary of the lessons learned in the development of materials for ethnically diverse populations, and give examples of success stories in multiethnic communities.

Pathways to Early Cancer Detection for Latinas: En Acción Contra el Cáncer

Latinas have less breast cancer, have more cervical cancer, and obtain fewer screening tests at recommended intervals. This article reviews the epidemiology and use of screening tests for these cancers and cultural factors that affect screening. En Acción Contra el Cáncer was designed to increase use of breast and cervical cancer screening services by distributing free cancer educational materials in Spanish, implementing a media campaign, conducting community outreach, training lay networkers, and assisting clinicians. A survey of 1,601 Latinas, 20 to 74 years old, ascertained screening behavior and knowledge and attitudes about cancer. Comparison of intervention and control cities showed significant differences in proportion insured, married, born in the United States, and less acculturated. There were no significant differences in mammography and Pap smear use, knowledge, and attitudes. Culturally appropriate prevention interventions that target ethnic-specific concerns arc needed.

Changes in information as a function of a culturally appropriate smoking cessation community intervention for Hispanics

Tested a 7-month, media-based, community intervention among Hispanics in San Francisco designed to change levels of information on the damaging effects of cigarette smoking and on the availability of culturally appropriate cessation services. Three community-wide surveys of Hispanics were conducted with independent random samples, two as baselines (n = 1,660 and 2,053) and one postintervention (n = 1,965). Results showed that changes in the level of awareness of cessation services had taken place after implementation of the intervention. Furthermore, those changes took place primarily among the less acculturated Spanish-speaking Hispanics who were the target of the intervention. The changes in information reported here demonstrate that a culturally appropriate information dissemination campaign that utilizes multiple channels can produce changes in a communitys level of information even when the campaign is implemented for a relatively short period.

HIV Risk Factors, Condom Use, and HIV Antibody Testing among Heterosexual Hispanics: The National AIDS Behavioral Surveys (NABS).

The rate of HIV infection and AIDS cases among heterosexual Hispanics is increasing. Data from a national probability survey of HIV-related risk factors among 4,390 heterosexual Hispanics in the 1990-1991 National AIDS Behavioral Surveys reveal that 164% of respondents reported an HIV risk factor; of these, 35.3% had been tested for HIVl Multiple sex partners and risky main sexual partner were the major risk factors. Men and middle-income Hispanics reported a higher prevalence of HIV testing. Half of those at highest riskfor HIV infection had neither been tested for HlV antibody nor had used condoms to protect themselves. The results suggest that HIV infection poses a great threat, particularly among certain heterosexual Hispanic subgroups where condom use and HIV testing is relatively low, illustrating the extreme need for developing new HIV prevention strategies among specific Hispanic risk groups.

Perceived Self-Efficacy to Avoid Cigarette Smoking and Addiction: Differences Between Hispanics and Non-Hispanic Whites

We interviewed 263 Hispanic and 150 non-Hispanic white smokers in order to evaluate cultural differences in perceived self-efficacy to avoid cigarette smoking, and addiction to cigarettes. Non-Hispanic whites have higher levels of addiction to nicotine and smoke more cigarettes than Hispanics, but increasing acculturation minimized cultural differences. Perceived self-efficacy to avoid smoking was negatively related to the perceived level of addiction and to self-reported cigarette consumption in both ethnic groups. Acculturation tended to be inversely related to self-efficacy, but directly related to addiction among Hispanics. The higher self-efficacy to avoid smoking and lower addiction levels indicate that Hispanics may have higher quit rates and lower relapse rates compared to non-Hispanic whites after comparable cessation interventions.

Problems and Progress in Translation of Health Survey Questions: The Pathways Experience:

Pathways to Early Cancer Detection in Four Ethnic Groups is a program project funded by the National Cancer Institute aimed at increasing the use of breast and cervical cancer screening among underserved African American, Chinese, Hispanic, and Vietnamese women. The program project core is dedicated to cross-cultural studies including development of survey questions that are comparable in four languages. This article describes the Pathways surveys, summarizes the challenges encountered in question translation, and presents an adapted approach to translation. Concurrent, multilingual, decentered translation was the process through which an English version of each question was selected only when it could be directly and meaningfully translated into Mandarin, Cantonese, Spanish, and Vietnamese. Examples of challenges and how these were addressed in the Pathways surveys are presented, along with lessons learned throughout this process.