Abstract
Bhutanese–Nepali refugees are one of the largest refugee groups to be resettled in the U.S. in the past decade. Cervical cancer is a leading cause of cancer disparity in this population, yet screening rates are suboptimal. Nepali-speaking interviewers administered a community health needs questionnaire to a convenience sample of Bhutanese–Nepali refugees in a Midwestern city between July to October of 2015. Descriptive statistics were used to describe socio-demographic characteristics, Pap smear beliefs, post-migration living difficulties, and screening status. Differences in Pap test uptake between groups were tested using t test and Chi square statistics. Of the 97 female participants, 44.3% reported ever having had a Pap smear. Screening rates were lowest among women who did not know English at all. Most women had positive perceptions of Pap smears (80%) and 44.4% had received a Pap test recommendation from their healthcare provider, family, or friends. Pap testing was significantly higher among those who had positive perceptions (58.3 vs. 11.1% for women of negative perception, p = 0.01) and those who had received a recommendation (87.5 vs. 18.6% for women who had no recommendations, p < 0.001). Significant predictors of having a Pap smear were having a healthcare provider/family/friends recommendation (OR 65.3, 95% CI 11.4-373.3) and greater number of post-migration living difficulties (OR 1.18, 95% CI 1.02–1.37). The results of this study have important implications for the development of cervical cancer prevention programs targeting Bhutanese–Nepali refugees. Providing cancer prevention interventions early in the resettlement process could impact Pap test uptake in this population.
Similar content being viewed by others
References
Brown, A., Stepler, R. (2016). Statistical portrait of the foreign-born population in the United States. http://www.pewhispanic.org/2016/04/19/statistical-portrait-of-the-foreign-born-population-in-the-united-states/. Retrieved Oct 2016.
Office of Refugee Resettlement. (2014). http://www.acf.hhs.gov/programs/orr/resource/refugee-arrival-data. Retrieved Oct 2016.
Ginsburg, O., Bray, F., Coleman, M. P., Vanderpuye, V., Eniu, A., Kotha, S. R., & Conteh, L. (2016). The global burden of women’s cancers: A grand challenge in global health. Lancet, 389(10071), 847–860. doi:10.1016/S0140-6736(16)31392-7.
Torre, L. A., Siegel, R. L., Ward, E. M., & Jemal, A. (2016). Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiology, Biomarkers & Prevention, 25(1), 16–27. doi:10.1596/978-1-4648-0349-9_ch2.
Global Burden of Disease Cancer Collaboration, Fitzmaurice, C., Allen, C., Barber, R. M., Barregard, L., Bhutta, Z. A., Naghavi, M. (2015). Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990–2015: A systematic analysis for the global burden of disease study. JAMA Oncology. doi:10.1001/jamaoncol.2016.5688.
American Cancer Society (2016). Cancer facts & Figs. 2016. Atlanta, GA: American Cancer Society.
Haworth, R. J., Margalit, R., Ross, C., Nepal, T., & Soliman, A. S. (2014). Knowledge, attitudes, and practices for cervical cancer screening among the Bhutanese refugee community in Omaha, Nebraska. Journal of Community Health, 39(5), 872–878. doi:10.1007/s10900-014-9906-y.
Dorji, T., Tshomo, U., Phuntsho, S., Tamang, T. D., Tshokey, T., Baussano, I., & Clifford, G. (2015). Introduction of a national HPV vaccination program into Bhutan. Vaccine, 33(31), 3726–3730. doi:10.1016/j.vaccine.2015.05.078.
American Cancer Society. (2015). Guidelines for the early detection of cancer. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-046343.pdf. Retrieved Sept 2016.
Committee on Practice Bulletins-Gynecology. (2012). ACOG practice bulletin number 131: Screening for cervical cancer. Obstetrics & Gynecology, 120(5), 1222–1238.
CDC (2016). Breast cancer. http://www.cdc.gov/cancer/breast/basic_info/screening.htm. Retrieved Sept 2016.
Kandula, N. R., Wen, M., Jacobs, E. A., & Lauderdale, D. S. (2006). Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: Cultural influences or access to care? Cancer, 107(1), 184–192. doi:10.1002/cncr.21968.
Tsui, J., Saraiya, M., Thompson, T., Dey, A., & Richardson, L. (2007). Cervical cancer screening among foreign-born women by birthplace and duration in the United States. Journal of Women’s Health, 16(10), 1447–1457. doi:10.1089/jwh.2006.0279.
Reyes, A. M., & Miranda, P. Y. (2015). Trends in cancer screening by citizenship and health insurance, 2000–2010. Journal of Immigrant and Minority Health, 17(3), 644–651. doi:10.1007/s10903-014-0091-y.
CDC. (2012). Cancer screening—United States, 2010. (No. 61(03)). Atlanta, GA: Morbidity and Mortality Weekly Report.
Pickle, S., Altshuler, M., & Scott, K. (2014). Cervical cancer screening outcomes in a refugee population. Journal of Immigrant & Refugee Studies, 12(1), 1–8.
Grieco, E. M., Acosta, Y. D., de la Cruz, G. P., Gryn, T., Larsen, L. J., Trevelyan, E. N., & Walters, N. P. (2012). The foreign-born population in the United States: 2010. Washington, D.C.: U.S. Census Bureau.
Office of Refugee Resettlement. (2015). Refugee arrival data. http://www.acf.hhs.gov/orr/resource/refugee-arrival-data. Retrieved Oct 2016.
Quigley, J. (2004). Bhutanese refugees in Nepal: What role now for the European Union and the United Nations high commission for refugees? Contemporary South Asia, 13(2), 187–200.
Community Research Partners. (2015). Impact of refugees in central Ohio: 2015 report. http://www.communityresearchpartners.org/portfolios/impact-of-refugees-in-central-ohio/. Retrieved Aug 2016.
Ferenchik, M., & Pyle, E. (2015). Ohio sees growing Bhutanese refugee population. Washington, D.C.: The Washington Times
Pasick, R.J., Oliva, G., Goldstein, E., Nguyen, T. (2010). Community-engaged research with community-based organizations: A resource manual for UCSF researchers. San Francisco: Clinical Translational Science Institute.
Kue, J., Pyakurel, S., & Yotebieng, K. (2016). Building community-engaged research partnerships with Bhutanese-Nepali refugees: Lessons learned from a community health needs assessment project. Practicing Anthropology, 38(4), 37–40.
Minkler, M. (2005). Community-based research partnerships: Challenges and opportunities. Journal of Urban Health, 82, ii3–ii12.
Taylor, V. M., Schwartz, S. M., Jackson, J. C., Kuniyuki, A., Fischer, M., Yasui, Y., & Thompson, B. (1999). Cervical cancer screening among Cambodian-American women. Cancer Epidemiology, Biomarkers & Prevention, 8(6), 541–546.
Aragona, M., Pucci, D., Mazzetti, M., & Geraci, S. (2012). Post-migration living difficulties as a significant risk factor for PTSD in immigrants: A primary care study. Italian Journal of Public Health, 9(3), e7525-1–e7525-8.
Schweitzer, R. D., Brough, M., Vromans, L., & Asci-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: Contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45, 299–307.
Agresti, A. (1992). A survey of exact inference for contingency tables. Statistical Science, 7(1), 131–177.
Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18(12), 1028–1035. doi:10.1111/j.1525-1497.2003.20807.x.
Taylor, V. M., Yasui, Y., Burke, N., Nguyen, T., Acorda, E., Thai, H., & Jackson, J. C. (2004). Pap testing adherence among Vietnamese American women. Cancer Epidemiology, Biomarkers & Prevention, 13(4), 613–619.
Jackson, J. C., Taylor, V. M., Chitnarong, K., Mahloch, J., Fischer, M., Sam, R., & Seng, P. (2000). Development of a cervical cancer control intervention program for Cambodian American women. Journal of Community Health, 25(5), 359–375.
Nguyen, T. T., McPhee, S. J., Nguyen, T., Lam, T., & Mock, J. (2002). Predictors of cervical pap smear screening awareness, intention, and receipt among Vietnamese–American women. American Journal of Preventive Medicine, 23(3), 207–214. doi:10.1016/S0749-3797(02)00499-3.
Pham, C. T., & McPhee, S. J. (1992). Knowledge, attitudes, and practices of breast and cervical cancer screening among Vietnamese women. Journal of Cancer Education, 7(4), 305–310. doi:10.1080/08858199209528187.
Taylor, V. M., Jackson, J. C., Yasui, Y., Kuniyuki, A., Acorda, E., Marchand, A., & Thompson, B. (2002). Evaluation of an outreach intervention to promote cervical cancer screening among Cambodian American women. Cancer Detection and Prevention, 26(4), 320–327.
Fox, S. A., Heritage, J., Stockdale, S. E., Asch, S. M., Duan, N., & Reise, S. P. (2009). Cancer screening adherence: Does physician-patient communication matter? Patient Education and Counseling, 75(2), 178–184. doi:10.1016/j.pec.2008.09.010.
O’Malley, A. S., Forrest, C. B., & Mandelblatt, J. (2002). Adherence of low-income women to cancer screening recommendations. Journal of General Internal Medicine, 17(2), 144–154. doi: 10.1046/j.1525-1497.2002.10431.x.
Morrison, T. B., Wieland, M. L., Cha, S. S., Rahman, A. S., & Chaudhry, R. (2012). Disparities in preventive health services among Somali immigrants and refugees. Journal of Immigrant and Minority Health, 14(6), 968–974. doi:10.1007/s10903-012-9632-4.
Saadi, A., Bond, B. E., & Percac-Lima, S. (2015). Bosnian, Iraqi, and Somali refugee women speak: A comparative qualitative study of refugee health beliefs on preventive health and breast cancer screening. Women’s Health Issues, 25(5), 501–508. doi:10.1016/j.whi.2015.06.005.
Kue, J., Zukoski, A., Keon, K. L., & Thorburn, S. (2014). Breast and cervical cancer screening: Exploring perceptions and barriers with Hmong women and men in Oregon. Ethnicity & Health, 19(3), 311–327. doi:10.1080/13557858.2013.776013.
Kagawa-Singer, M., Valdez Dadia, A., Yu, M., & Surbone, A. (2010). Cancer, culture, and health disparities: Time to chart a new course? CA, 60, 12–39. doi:10.3322/caac.20051.
Donaldson, S. L., & Grant-Vallone, E. J. (2002). Understanding self-report bias in organizational behavior research. Journal of Business and Psychology, 17(2), 245–260.
Acknowledgements
We thank the Bhutanese–Nepali Community of Columbus for allowing us into their community and for their guidance throughout this project. We also thank Refugee Women in Action for their support. We want to acknowledge Jhuma Acharya, Dil Pyakurel, Sudarshan Pyakurel, and Kelly Yotebieng for their engagement in the project.
Funding
This project was supported by the Ohio State University Center for Clinical and Translational Science and Award # UL1TR001070 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest to declare.
Rights and permissions
About this article
Cite this article
Kue, J., Hanegan, H. & Tan, A. Perceptions of Cervical Cancer Screening, Screening Behavior, and Post-Migration Living Difficulties Among Bhutanese–Nepali Refugee Women in the United States. J Community Health 42, 1079–1089 (2017). https://doi.org/10.1007/s10900-017-0355-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-017-0355-2