Social Network Characteristics and Breast Cancer Screening Behavior in Vietnamese American Women
The last 40 years have seen a large influx of Vietnamese immigrants to the United States (U.S.) as a result of the Vietnam War. The Vietnamese now constitute one of the fastest growing Asian and Pacific Islander populations in the U.S. Breast cancer is the most commonly diagnosed cancer in Vietnamese American women, with incidence rates steadily increasing in this immigrant population. Early detection of breast cancer through mammography screening and clinical breast examination is critical for reducing breast cancer morbidity and mortality. However, Vietnamese American women are less likely to be screened than non-Hispanic white women. This dissertation investigates social network characteristics and their relationship to breast cancer screening behavior in Vietnamese American women aged 40 and older within a community-based breast cancer screening intervention study based in Santa Clara County, California. Because this intervention study was embedded in the framework of interpersonal relationships, it presents an ideal opportunity and optimal approach to exploring how social networks influence breast screening behavior in an underserved population.
A positive association between social network integration and breast cancer screening was found for recent receipt of a clinical breast examination (CBE) but not for mammography. Women in the highest tertile of social network integration were more likely to receive a CBE than women in the lowest tertile (OR = 1.20, 95% CI: 1.07-1.33). This dissertation also examined perceived availability of different types of social support (emotional, instrumental, informational, affectionate, and positive social interaction) and the relative contributions of each type of support to recent use of mammography and CBE. Findings indicate that Vietnamese American women generally perceived moderate to high levels of available social support across all types. Instrumental support was the single most important social support predictor for recent use of mammography (OR = 1.05, 95% CI: 1.02-1.08). Because breast cancer screening is only optimally effective for early detection if women adhere to annual screening guidelines, this dissertation also examined breast cancer screening norms as one type of social network influence on intention to receive screening in the future. Results showed no associations between social influence and intention to receive a mammogram or CBE within the next 12 months. Findings from this analysis suggest challenges in measuring both social influence and screening intention constructs in Vietnamese American women and warrant further methodological investigation in developing more culturally appropriate, accurate, and comprehensive measures.
Overall, findings from this dissertation have laid the necessary groundwork for identifying new opportunities for future research on social networks and health. Such research will enable us to gain a better understanding of ways in which social networks can inform more effective interventions and programs to close the gap in breast cancer health disparities.