Abstract PR05: The effect of language on the self-rated health of Latina breast cancer survivors: Cancer self-efficacy and spiritual well-being as potential mediators of this association.
Authors: Garcia-Jimenez Maria DeLourdes , Santoyo-Olsson Jasmine , Ortiz Carmen , Napoles Anna M. 
Published: August 2014

Purpose of study: The study aim was to assess associations between various acculturation measures and self-rated health (SRH), as well as potential mediation by spiritual well-being and cancer self-efficacy of any associations.

Experimental procedure: Secondary analysis of data from a cross-sectional telephone survey of a population-based registry sample of 330 self-identified Latina breast cancer survivors was conducted. Multivariate logistic regression models assessed relationships between acculturation measures (i.e., the Short Acculturation Scale for Hispanics (SASH), country of birth (foreign or U.S. born), and English proficiency (main predictor)) and SRH (outcome). The role of cancer self-efficacy (measured with a version of the Cancer Behavior Inventory CBI-B) and spiritual well-being subscales (Sense of Peace/Meaning and Faith) of the Functional Assessment of Chronic Illness Therapy as mediators was also assessed in multivariate logistic regression models.

New Data: The sample mean age was 58.3 years (range 30-90 years; SD 11.9), about 60% were foreign-born and approximately half were English proficient (EP, speaks English well/very well) vs. limited English proficient (LEP, speaks English not at all/poorly/fairly well). Approximately 70% were of Mexican origin, about 70% had a high school education or less, and two-thirds were privately insured. Almost all were 2-3 years post-diagnosis (283; 85.8%). The mean cancer self-efficacy score was 3.43 (SD 0.59; range 1-4). The mean sense of peace/meaning score was 26.6 (SD 5.31; range 0-32) and the mean faith score was 14.20 (SD 2.99; range 0-16). About one-quarter of the women reported poor or fair SRH. In unadjusted analyses of the acculturation measures, English proficiency demonstrated the strongest association with SRH; women who were EP were more likely than LEP women to rate their health as good/very good/excellent (OR= 2.26 CI= 1.15, 4.45, p&lt;0.000). Country of birth and SASH scores were related to SRH at p&lt;0.15. Greater cancer self-efficacy (OR= 2.24 CI= 1.22, 4.10, p&lt;0.001) and sense of peace/meaning (OR= 3.00 CI= 1.66, 5.44, p&lt;0.001) were associated significantly with better SRH; faith was not.

In multivariate models English proficiency was associated significantly with SRH independent of other sociodemographic characteristics (OR=2.26; 95% CI 1.15, 4.45). Adding cancer self-efficacy to the model attenuated the effect of English proficiency on SRH (OR=1.76, 95% CI 0.87, 3.55), and self-efficacy was positively associated with SRH (OR=2.24, 95% CI 1.22, 4.10). In the final model, adding sense of peace/meaning was associated independently with SRH (OR= 2.44, 95% CI 1.30, 4.56) and attenuated the association of self-efficacy and SRH (OR=1.67, 95% CI 0.88, 3.18).

Conclusion: The association of English proficiency with SRH was partially mediated by cancer self-efficacy and sense of peace/meaning, with the latter explaining much of the effect. Findings support development of interventions for Latina breast cancer survivors that target modifiable resiliency factors, like sense of peace/meaning or self-efficacy, to address racial disparities in quality of life (QOL) and SRH for Latina breast cancer survivors; particularly for those at risk of poorer QOL and SRH given English proficiency limitations.

This abstract is also presented as Poster B25.

Citation Format: Maria DeLourdes Garcia-Jimenez, Jasmine Santoyo-Olsson, Carmen Ortiz, Anna M. Napoles. The effect of language on the self-rated health of Latina breast cancer survivors: Cancer self-efficacy and spiritual well-being as potential mediators of this association. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PR05.