Differential Patterns of Healthcare Service Use Among Chinese and Korean Immigrant Elders

A Comparison of Palliative Care Delivery between Ethnically Chinese and Non-Chinese Canadians in the Last Year of Life

BACKGROUND

Ethnically Chinese adults in Canada and the United States face multiple barriers in accessing equitable, culturally respectful care at the end-of-life. Palliative care (PC) is committed to supporting patients and families in achieving goal-concordant, high-quality serious illness care. Yet, current PC delivery may be culturally misaligned. Therefore, understanding ethnically Chinese patients' use of palliative care may uncover modifiable factors to sustained inequities at the end-of-life.

OBJECTIVE

To compare the use and delivery of PC in the last year of life between ethnically Chinese and non-Chinese adults.

DESIGN

Population-based cohort study.

PARTICIPANTS

All Ontario adults who died between January 1st, 2012, and October 31st, 2022, in Ontario, Canada.

EXPOSURES

Chinese ethnicity.

MAIN MEASURES

Elements of physician-delivered PC, including model of care (generalist; specialist; mixed), timing and location of initiation, and type of palliative care physician at initial consultation.

KEY RESULTS

The final study cohort included 527,700 non-Chinese (50.8% female, 77.9 ± 13.0 mean age, 13.0% rural residence) and 13,587 ethnically Chinese (50.8% female, 79.2 ± 13.6 mean age, 0.6% rural residence) adults. Chinese ethnicity was associated with higher likelihoods of using specialist (adjusted odds ratio [aOR] 1.53, 95%CI 1.46-1.60) and mixed (aOR 1.32, 95%CI 1.26-1.38) over generalist models of PC, compared to non-Chinese patients. Chinese ethnicity was also associated with a higher likelihood of PC initiation in the last 30 days of life (aOR 1.07, 95%CI 1.03-1.11), in the hospital setting (aOR 1.24, 95%CI 1.18-1.30), and by specialist PC physicians (aOR 1.33, 95%CI 1.28-1.38).

CONCLUSIONS

Chinese ethnicity was associated with a higher likelihood of mixed and specialist models of PC delivery in the last year of life compared to adults who were non-Chinese. These observed differences may be due to later initiation of PC in hospital settings, and potential differences in unmeasured needs that suggest opportunities to initiate early, community-based PC to support ethnically Chinese patients with serious illness.

Association between social capital and utilization of essential public health services among elderly migrants: a multilevel logistic study based on the 2017 China migrant dynamic survey (CMDS)

BACKGROUND

As the number of elderly migrants in China continues to grow, it is necessary to pay closer attention to their health and health services. Some studies have confirmed that social capital plays a significant role in the utilization of health services. Therefore, an in-depth exploration of the relationship between social capital and the utilization of essential public health services (EPHS) by elderly migrants will not only contribute to improving their overall health but also facilitate a more balanced development of public health service system in China.

METHODS

Based on the cross-sectional data from the 2017 China Migrants Dynamic Survey (CMDS), this study examined the impact of social capital on the utilization of EPHS among elderly migrants. We evaluated social capital at two distinct levels: the individual and the community, and considered two dimensions of social capital: structural social capital (SSC) and cognitive social capital (CSC). The study aimed to delve into the impact of these forms of social capital on the utilization of EPHS among elderly migrants, and whether the migration range moderates this impact by multilevel logistic regression analysis.

RESULTS

A total of 5,728 migrant elderly individuals were selected. The health records establishment rate and health education acceptance rate were approximately 33.0% and 58.6%, respectively. Social capital influenceed the utilization of EPHS among elderly migrants. Specifically, individual-level SSC and CSC have impacts on both the establishment of health records (OR = 1.598, 95%CI 1.366-1.869; OR = 1.705, 95%CI 1.433-2.028) and the acceptance of health education (OR = 1.345, 95%CI 1.154-1.567; OR = 2.297, 95%CI 1.906-2.768) among elderly migrants, while community-level SSC only affected the acceptance of health education (OR = 3.838, 95%CI 1.328-11.097). There were significant differences in individual-level SSC, health records, and health education among different migration range subgroups among elderly migrants. Migration range moderated the effect of social capital on the utilization of EPHS, crossing provinces could weaken the relationship between SSC and health education.

CONCLUSIONS

Social capital is associated with a higher utilization rate of EPHS among elderly migrants. It is necessary to encourage them to actively participate in social activities, strengthen public services and infrastructure construction in the area, and improve their sense of belonging and identity.

Beyond Dichotomy and Stability: ICT Use Among Asian American Older Adults During the COVID-19 Pandemic

This study examined the effect of the COVID-19 pandemic on information and communications technology (ICT) use and the typology of ICT users among older Chinese and Korean Americans. Survey data were collected from 513 Chinese and Korean older adults in New York City. We measured ICT use for social contact, grocery shopping, health care, and COVID-19 information seeking. In the study sample, ICT use for online shopping with others, contact with doctors, and telehealth significantly increased during the pandemic. Three groups of ICT users were identified: limited, users, expanding users, and active users. Older Chinese Americans and those with better English proficiency were more likely to be expanding and active ICT users. The patterns and heterogeneity of ICT use among older Asian Americans are multifaceted and dynamic beyond dichotomy and stability. The findings of this study offer helpful guidance for future development of ICT-based interventions for older Asian Americans.

The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review

A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.

A study on the factors influencing the utilization of public health services by China's migrant population based on the Shapley value method

BACKGROUND

The health of migrants has received significant global attention, and it is a particularly significant concern in China, which has the largest migrant population in the world. Analyzing data on samples from the Chinese population holds practical significance. For instance, one can delve into an in-depth analysis of the factors impacting (1) the health records of residents in distinct regions and (2) the current state of family doctor contracts. This study explores the barriers to access these two health services and the variations in the effects and contribution magnitudes.

METHODS

This study involved data from 138,755 individuals, extracted from the 2018 National Migration Population Health and Family Planning Dynamic Monitoring Survey database. The theoretical framework employed was the Anderson health service model. To investigate the features and determinants of basic public health service utilization among the migrant population across different regions of China, including the influence of enabling resources and demand factors, x2 tests and binary logistic regression analyses were conducted. The Shapley value method was employed to assess the extent of influence of each factor.

RESULTS

The utilization of various service types varied among the migrant population, with significant regional disparities. The results of the decomposition of the Shapley value method highlighted variations in the mechanism underlying the influence of propensity characteristics, enabling resources, and demand factors between the two health service types. Propensity characteristics and demand factors were found to be the primary dimensions with the highest explanatory power; among them, health education for chronic disease prevention and treatment was the most influential factor.

CONCLUSION

To better meet the health needs of the migrant population, regional barriers need to be broken down, and the relevance and effectiveness of publicity and education need to be improved. Additionally, by considering the education level, demographic characteristics, and mobility characteristics of the migrant population, along with the relevant health policies, the migrant population needs to be guided to maintain the health records of residents. They should also be encouraged to sign a contract with a family doctor in a more effective manner to promote the equalization of basic health services for the migrant population.

Use of tangible, educational and psychological support services among Chinese American dementia caregivers

BACKGROUND AND OBJECTIVES

Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans in this field. Guided by Andersen's behavioral model of health services use, we aimed to understand what factors were associated with utilizing multiple types of services among Chinese American dementia caregivers.

RESEARCH DESIGN AND METHODS

We collected survey data from 134 Chinese dementia caregivers in New York City. Logistic regression models were conducted to test the associations between predisposing, enabling, and need factors and the likelihood of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) support services.

RESULTS

Several variables conceptualized by Andersen's model, including caregiver's knowledge about services, caring tasks, length of care and burden, and care recipient's physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services. Three sociocultural factors-residing in Chinatown, availability of alternative family caregivers, and diagnosis of cognitive deterioration-were also associated with higher likelihood of using educational or psychological services.

DISCUSSION AND IMPLICATIONS

The findings extend the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and considering sociocultural factors in future research and practice.

Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature

Background

There are over seven million older adult immigrants in the United States, and that number is expected to increase. Older adult immigrants in the United States have unique factors that influence their health.

Methods

In this integrative review, we systematically review 20 years of peer-reviewed literature on the barriers (i.e. isolation, lack of English Language Proficiency, low health literacy, lack of SES resources, discrimination) and facilitators (i.e. English Language Proficiency and maintaining ones native language, social support, culturally sensitive providers, healthcare access) of health among older adult immigrants in the United States.

Results

We found differing uses of the term ‘older adult’, emphasis on the lack of homogeneity among older adult immigrants, social support and isolation as significant barriers and facilitators of older adult immigrant health, and inconsistencies in uses and definitions of acculturation. We also examined relevant theories in the literature. Based on the literature review, focusing on Acculturation Theory, Social Cognitive Theory, and Successful Aging Theory, combining these three theories with findings from the literature to create the Older Adult Immigrant Adapted Model for Health Promotion.

Conclusions

Public health strives to promote health and prevent adverse health outcomes. Our integrative review not only systematically and thoroughly explicates 20 years of literature, but the Older Adult Immigrant Adapted Model for Health Promotion, provides guidance for future research and interventions.

Perceptions of Patient-Provider Communication Across the Six Largest Asian Subgroups in the USA

BACKGROUND

Asians are the fastest-growing racial/ethnic minority group in the USA and many face communication barriers when seeking health care. Given that a high proportion of Asians are immigrants and have limited English proficiency, poor patient-provider communication may explain Asians' relatively low ratings of care. Though Asians are linguistically, economically, and culturally heterogeneous, research on health care disparities typically combines Asians into a single racial/ethnic category.

OBJECTIVES

To estimate racial/ethnic differences in perceptions of provider communication among the six largest Asian subgroups.

DESIGN AND PARTICIPANTS

Using a nationally representative sample of adults from the 2014-2017 Medical Expenditure Panel Survey (N = 136,836, round-specific response rates range from 72% to 98%), we estimate racial/ethnic differences in perceptions of provider communication, adjusted for English proficiency, immigration status, and sociodemographic characteristics.

MAIN MEASURES

The main dependent variable is a 4-item scale ranging from 0 to 100 measuring how positively patients view their health care providers' communication, adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS©) program. Respondents report how often their providers explain things clearly, show respect, listen carefully, and spend enough time with them.

KEY RESULTS

Asians, overall, had less positive perceptions of their providers' communication than either Whites or Latinxs. However, only Chinese-White differences remained after differences in English proficiency and immigration status were controlled (difference = - 2.67, 95% CI - 4.83, - 0.51). No other Asian subgroup differed significantly from Whites.

CONCLUSIONS

Negative views of provider communication are not pervasive among all Asians but, rather, primarily reflect the perceptions of Chinese and, possibly, Vietnamese patients. Researchers, policymakers, health plan executives, and others who produce or use data on patients' experiences with health care should, if possible, avoid categorizing all Asians into a single group.

Literacy of Breast Cancer and Screening Guideline in an Immigrant Group: Importance of Health Accessibility

Little is known about predictors of breast cancer literacy among immigrant women. A cross-sectional survey investigated predisposing, enabling, and need factors of breast cancer literacy among 233 Korean American women living in a southeastern U.S. city. Breast cancer literacy was measured by questions that asked awareness of cancer screening methods and a 5-item questionnaire derived from the American Cancer Society's breast cancer screening guidelines and risk factors. Annual checkup was an enabling factor of awareness of Clinical Breast Exam (CBE) and mammogram, and also for breast cancer literacy covering the knowledge of breast cancer screening guidelines and risk factors. Health status was a need factor of CBE awareness. Marital status was a predisposing factor of mammogram awareness, and age and years of residence in the US were predisposing factors of breast cancer literacy. The findings of the study illuminate probable avenues of intervention to promote breast health knowledge for Korean American women.

Andersen's utilization model for cataract surgical rate and empirical evidence from economically-developing areas

Background

Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen’s utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China.

Methods

The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately.

Results

Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn’t impact cataract surgical resources (β = 0.29, 95% CI: − 0.12, 0.75). In China, residents’ average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; β_CSR-paying = 0.77, 95% CI: 0.25, 0.90; β_paying-GDP/P = 0.89, 95% CI: 0.82, 0.93).

Conclusions

In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.

Patterns in Geographic Access to Health Care Facilities Across Neighborhoods in the United States Based on Data From the National Establishment Time-Series Between 2000 and 2014

IMPORTANCE

The association between proximity to health care facilities and improved disease management and population health has been documented, but little is known about small-area health care environments and how the presence of health care facilities has changed over time during recent health system and policy change.

OBJECTIVE

To examine geographic access to health care facilities across neighborhoods in the United States over a 15-year period.

DESIGN, SETTING, AND PARTICIPANTS

Using longitudinal business data from the National Establishment Time-Series, this cross-sectional study examined the presence of and change in ambulatory care facilities and pharmacies and drugstores in census tracts (CTs) throughout the continental United States between 2000 and 2014. Between January and April 2019, multinomial logistic regression was used to estimate associations between health care facility presence and neighborhood sociodemographic characteristics over time.

MAIN OUTCOMES AND MEASURES

Change in health care facility presence was measured as never present, lost, gained, or always present between 2000 and 2014. Neighborhood sociodemographic characteristics (ie, CTs) and their change over time were measured from US Census reports (2000 and 2010) and the American Community Survey (2008-2012).

RESULTS

Among 72 246 included CTs, the percentage of non-US-born residents, residents 75 years or older, poverty status, and population density increased, and 8.1% of CTs showed a change in the racial/ethnic composition of an area from predominantly non-Hispanic (NH) white to other racial/ethnic composition categories between 2000 and 2010. The presence of ambulatory care facilities increased from a mean (SD) of 7.7 (15.9) per CT in 2000 to 13.0 (22.9) per CT in 2014, and the presence of pharmacies and drugstores increased from a mean (SD) of 0.6 (1.0) per CT in 2000 to 0.9 (1.4) per CT in 2014. Census tracts with predominantly NH black individuals (adjusted odds ratio [aOR], 2.37; 95% CI, 2.03-2.77), Hispanic/Latino individuals (aOR 1.30; 95% CI, 1.00-1.69), and racially/ethnically mixed individuals (aOR, 1.53; 95% CI, 1.33-1.77) in 2000 had higher odds of losing health care facilities between 2000 and 2014 compared with CTs with predominantly NH white individuals, after controlling for other neighborhood characteristics. Census tracts of geographic areas with higher levels of poverty in 2000 also had higher odds of losing health care facilities between 2000 and 2014 (aOR, 1.12; 95% CI, 1.05-1.19).

CONCLUSIONS AND RELEVANCE

Differential change was found in the presence of health care facilities across neighborhoods over time, indicating the need to monitor and address the spatial distribution of health care resources within the context of population health disparities.

Explaining Health Outcomes of Asian Immigrants: Does Ethnicity Matter?

The present study intended to evaluate whether 4 discrete ethnic groups of Asian immigrants could, for empirical reasons, be assigned a set of unique operating factors explaining health outcomes of members. The set comprised several acculturation, social structure, lifestyle, and health-related factors. Our study asked if these factors uniformly explained health outcomes across the 4 groups. We pooled National Health Interview Survey (NHIS) data dating 1999-2015 and developed 2 outcomes: self-rated health and self-reported chronic illness (specifically, diagnosis of cardiovascular disease, prediabetes/diabetes, hypertension, cancer, or stroke). Since data for smaller Asian ethnic groups are not readily available, we confined our analyses to respondents of Chinese, Filipino, Asian Indian, and "other Asian" ethnicity. Descriptive statistics suggested that Asian Indian respondents were least likely to report having 1 of the 5 specified serious illnesses and self-rated their health higher than the other 3 respondent groups. Additionally, while some factors (e.g., body mass index, depression) proved related to the health outcomes across the 4 ethnic groups, we did observe for each group a unique pattern of factors associated with the outcomes. Our results confirmed, furthermore, a moderating role for ethnicity in associations between the outcomes and those operating factors in the set we evaluated. The study results should be of use in tailoring preventive and intervention programs to various ethnic groups of Asian immigrants; clearly, in promoting health, one approach will not fit all.

"Living happily despite having an illness": Perceptions of healthy aging among Korean American, Vietnamese American, and Latino older adults

BACKGROUND/OBJECTIVE

The growingly diverse aging population presents a challenge for the geriatric workforce, particularly its capacity to effectively respond to the sociocultural and linguistic needs of ethnic minority older adults. Informed by research on the importance of culturally-competent care in reducing racial and ethnic health disparities, this study sought to understand the meaning of healthy aging from the perspectives of Korean American, Vietnamese American, and Latino older adults.

METHODS

Interviews were conducted with 30 participants recruited from community-based organizations in Southern California.

RESULTS

Several dimensions emerged in the participants' understanding of healthy aging: (1) having good physical and mental health (2) optimism and acceptance; (3) social connectedness; (4) taking charge of one's health; and (5) independence and self-worth.

CONCLUSIONS

Results could inform the development of a culturally-responsive geriatric healthcare system that takes into account older adults' beliefs, preferences, and needs to promote successful aging.

The Relationship Between Depressive Symptoms and Health Services Utilization in U.S. Chinese Older Adults

BACKGROUND AND OBJECTIVES

Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization.

RESEARCH DESIGN AND METHODS

Cross-sectional data were derived from the Population Study of Chinese Elderly in Chicago (PINE) collected between July 2011 and June 2013 (N = 3,159). Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between depressive symptoms and physician visits, ED visits, and hospitalization.

RESULTS

U.S. Chinese older adults with depressive symptoms were more likely to have at least one ED visit (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.44-2.28) and hospitalization (OR = 1.9, 95% CI = 1.47-2.33) in the past 2 years than those without depressive symptoms, while adjusting for sociodemographic and health-related covariates. Other significant factors associated with health services utilization in this population included number of people in household, health insurance coverage, and acculturation.

DISCUSSION AND IMPLICATIONS

Depressive symptoms are positively associated with hospitalization and ED visits among U.S. Chinese older adults. Routine screenings of depressive symptoms should be part of the clinical encounter in these care settings so that appropriate treatment or timely mental health service referrals could be provided to this population to ultimately optimize their utilization of health services.

The Effects of Religious Participation and Familial Assistance on Mental Health among Older Chinese and Korean Immigrants: Multiple Mediator Analyses

Older Asian immigrants are one of the fastest growing segments of the U.S. population and a growing number of them reside in non-traditional destination cities. However, there is a paucity of research on older Asian immigrants living in these non-traditional destination cities, and how this residential choice impacts their stress and mental health. In the current study, we examined how stressors and social support contribute to the overall mental health of older Asian immigrants who lack access to culturally responsive formal social support services. Using a convenience sample of older Chinese (n = 120) and Korean (n = 118) immigrants living in Arizona, we conducted multiple mediator analyses, focusing specifically on how ethnicity would differentially influence mediating effects of religious participation and familial assistance in the relationships between physical/acculturative stressors and mental health outcomes. The results showed that among older Chinese immigrants, religious participation significantly mediated the relationships between both physical/acculturative stressors and mental health, while there was no significant mediation effect detected among older Korean immigrants. Although Asian Americans are often perceived as a monolithic homogeneous group, the multiple mediator models suggest significant differences in the use of cultural/information resources in coping with life stressors and their impact on mental health outcomes between the older Chinese and Korean immigrants in our study. The study findings suggest a need for developing and strengthening formal social services in non-traditional destination cities that are culturally and linguistically responsive to those older Asian immigrants.

Bibliometric analysis of global migration health research in peer-reviewed literature (2000-2016)

BACKGROUND

The health of migrants has become an important issue in global health and foreign policy. Assessing the current status of research activity and identifying gaps in global migration health (GMH) is an important step in mapping the evidence-base and on advocating health needs of migrants and mobile populations. The aim of this study was to analyze globally published peer-reviewed literature in GMH.

METHODS

A bibliometric analysis methodology was used. The Scopus database was used to retrieve documents in peer-reviewed journals in GMH for the study period from 2000 to 2016. A group of experts in GMH developed the needed keywords and validated the final search strategy.

RESULTS

The number of retrieved documents was 21,457. Approximately one third (6878; 32.1%) of the retrieved documents were published in the last three years of the study period. In total, 5451 (25.4%) documents were about refugees and asylum seekers, while 1328 (6.2%) were about migrant workers, 440 (2.1%) were about international students, 679 (3.2%) were about victims of human trafficking/smuggling, 26 (0.1%) were about patients' mobility across international borders, and the remaining documents were about unspecified categories of migrants. The majority of the retrieved documents (10,086; 47.0%) were in psychosocial and mental health domain, while 2945 (13.7%) documents were in infectious diseases, 6819 (31.8%) documents were in health policy and systems, 2759 (12.8%) documents were in maternal and reproductive health, and 1918 (8.9%) were in non-communicable diseases. The contribution of authors and institutions in Asian countries, Latin America, Africa, Middle East, and Eastern European countries was low. Literature in GMH represents the perspectives of high-income migrant destination countries.

CONCLUSION

Our heat map of research output shows that despite the ever-growing prominence of human mobility across the globe, and Sustainable Development Goals of leaving no one behind, research output on migrants' health is not consistent with the global migration pattern. A stronger evidence base is needed to enable authorities to make evidence-informed decisions on migration health policy and practice. Research collaboration and networks should be encouraged to prioritize research in GMH.

Predictors of Breast Cancer Screening Among Korean American Women: Is Having an Annual Checkup Critical?

Objective: Korean American (KA) immigrant women underutilize breast cancer screening. This study examined factors predicting breast cancer screening behavior among KA women in the United States. Methods: 233 KA women aged 19 to 85 were recruited in the metro area of Atlanta, Georgia. Andersen’s behavioral model theoretically guided the study. Result: Of the predisposing factors, age (OR=1.043, p<.01, 95% CI [1.017, 1.069]) and marital status (OR=2.154, p<.05, 95% CI [1.022, 4.539]) were significantly associated with clinical breast exam (CBE), while income (OR=2.289, p<.05, 95% CI [1.060, 4.945]) and annual checkup (OR=2.725, p<.01, 95% CI [1.342, 5.533]) were linked to CBE as enabling factors. For the receipt of mammographic screening, annual checkup was only significantly associated among enabling factors (OR=4.509, p<.05, 95% CI [1.263, 16.102]), while family cancer history was identified as the only significant need factor (OR=.112, p<.01, 95% CI [.023, .552]). Conclusion: Differing factors explained the receipt of CBEs and mammographic use among KA women. Specifically, the findings shed light on the importance of having an annual checkup for the uptake of both CBEs and mammographic use. Intervention strategies should focus on promoting health accessibility for KA women to adhere to recommended breast cancer screening.