Pathways between preventive cancer screening and citizenship

Background: Cancer is the second leading cause of death among immigrants, but overall immigrants remain a largely unexplored vulnerable population in regards to cancer screening. The passing of the ACA which provides insurance access to lawful residents, along with emerging evidence on length of residence in the U.S. and cancer screening among immigrant women, suggests the importance in further research regarding factors associated with citizenship.  Methods: Structural equation modeling is used to examine pathways between citizenship and mammogram in a pooled sample of women ages 40 and older from the National Health Interview Survey in 2000, 2005, and 2010 (N=12,014).  We analyzed the data with Mplus 6.12, using the weighted least squared estimator with mean and variance adjusted (WLSMV). Results: Lack of citizenship decreases one’s chance of receiving a mammogram, regardless of their race and SES (CFI=.962 and RMSEA=.023; (p<.001). Discussion: This study addresses the emerging importance of immigration policies for lawful residence and breast cancer screening by examining the pathways through which citizenship influences a woman’s likelihood of receiving a mammogram.  While access to insurance remains an important pathway for an immigrant woman to receive a mammogram, citizenship remains an independent major factor in this process and should continue to be explored as a structural barrier for breast cancer screening among this vulnerable population.