BMC Cancer 2007, 7:201 http://www.biomedcentral.com/1471-2407/7/201 surveyed in CHIS. CHIS 2001 was conducted in several languages allowing less acculturated and/or more recently immigrated Asians to be included in the analysis. The sur- vey was also reviewed by experts to assure cultural com- patibility and comprehensibility to target population groups. The demographic distributions of CHIS respond- ents were comparable to those from other surveys, sug- gesting that the survey was representative [38]. Our study also had several weaknesses. Because it was a secondary data analysis, we were limited in the variables we could examine. In particular, our dependent variable is a limited assessment of mammography use in the past two years. Because the information on screening and pre- dictors were all based on self-report, differential misclassi- fication may occur if misclassification in self-reporting of the predictor variables was associated with misclassifica- tion in reporting of mammography. Future studies designed specifically to address this question using RP might also incorporate cultural factors, such as knowledge and perceptions about preventive medical care, cancer screening, and breast cancer risk [26,51,52]; and modesty and embarrassment issues associated with mammogra- phy [27,52,53]. The response rates for CHIS 2001 were relatively low, yet these response rates are similar to the rates found in other population health surveys, such as the 2002 BRFSS [38]. Since CHIS is a telephone-based sur- vey, selection biases such as non-coverage of households without telephones and households who "screen" tele- phone calls, as well as higher response rates among indi- viduals of higher socioeconomic status, inherent to telephone surveys may exist. Conclusion In addition to documented socioeconomic and financial barriers, our findings suggest institutional, cultural, and linguistic barriers for Asian-American women meeting mammography screening recommendations. Specifically, our results suggest that there are three major categories of Asian American women who require additional targeted efforts to improve their screening behaviors, and that dif- ferent approaches are required for each group. The first group of women includes those who have health insur- ance and access their health care but do not see providers who specialize in women's health issues. This group may benefit from receiving reminders through their primary care providers or health care plan. The second group includes those who have health insurance and a usual source of care but who do not routinely access health care. These women tend to be more likely to be recent immi- grants or non-citizens and have limited English facility. Public health and health-care based interventions should continue to focus on culturally- and linguistically-appro- priate strategies for targeting these women. The third group includes those who do not have health insurance and/or a usual source of care. Outreach for this group could be effectively achieved through promoting screen- ing through public insurance carriers, state-funded screen- ing programs, and community-based interventions. Together with these methods, our data should be helpful in providing direction to those designing and implement- ing future interventions of benefit to the community of Asian women and in increasing rates of cancer screening in this group. Competing interests The author(s) declare that they have no competing inter- ests. Authors' contributions SLG conceived of the study, conducted aspects of the data analysis, and drafted the manuscript. ST participated in the design of the study, conducted the data analysis, and drafted the manuscript. THMK and CAC participated in the interpretation of data and drafted the manuscript. Acknowledgements The authors thank Laura McClure, Sarah Aroner, and the CHIS staff, par- ticularly Lee Habte and Wei Yen, for their assistance with this manuscript. The funding for this analysis was supported under contracts N01-CN- 65107 and N01-PC-35136 with the National Cancer Institute, National Institutes of Health, and with support of the California Cancer Registry, a project of the Cancer Surveillance Section, California Department of Health Services, under subcontracts 1000891 and N02-PC-15105 with the Public Health Institute, and by the Centers for Disease Control and Preven- tion's National Program of Cancer Registries under agreement U55/ CCR921930-02 awarded to the Public Health Institute. The content of this publication does not necessarily reflect the views or policies of the US Department of Health and Human Services or the California Department of Health Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or state of Cal- ifornia. References 1. 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