Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84.

Use of preventive health services (physical, dental, and eye examinations, Pap smear and breast examinations) among Mexican American, Cuban American, and Puerto Rican adults (ages 20-74) was investigated with data from the HHANES. Analyses focused on the relative importance of two predictors of recency of screening: access to services (health insurance coverage, having a routine place for care, type of facility used, having a regular provider, travel time) and acculturation (spoken and written language, ethnic identification). Regression analyses controlling for age, education, and income indicated that utilization of the preventive services was predicted more strongly by access to care than by acculturation. For each Hispanic group, having a routine place for health care, health insurance coverage, and a regular provider were each significantly associated with greater recency of screening. Type of facility used and travel time produced less consistent effects. These results replicate past studies that have demonstrated the important link between institutional access and use of health services. Of the acculturation variables, language but not ethnic identification (which was measured only for the Mexican Americans) predicted use. This latter finding, which has been demonstrated in other studies as well, suggests that the effect of language on screening practices should not be interpreted as a cultural factor, but as an access factor, i.e. use of English favors access to services.