Social Networks and Cancer Screening in Four U.S. Hispanic Groups Lucina Suarez, PhD, Amelie G. Ramirez, DrPH, Roberto Villarreal, MD, Jose Marti, MD, Alfred McAlister, PhD, Gregory A. Talavera, MD, Edward Trapido, ScD, Eliseo J. Perez-Stable, MD Background: Evidence shows that social relationships play an important role in health and health behavior. We examined the relationship between social networks and cancer screening among four U.S. Hispanic groups. Methods: We used telephone surveys to collect data in eight U.S. regions that have concentrations of diverse Hispanic-origin populations. We interviewed 8903 Hispanic adults, for a response rate of 83%; analysis was restricted to the 2383 women aged 40. As a measure of social integration, we formed a social network index from items on the number of close relatives and friends, frequency of contact, and church membership. We used logistic regression to estimate the effects of social integration on screening, adjusting for sociodemographic factors. Results: Among Mexican, Cuban, and Central-American women, the effect of social integration on mammography screening was slight. The odds ratios (OR) per unit change in social integration category ranged from 1.16 to 1.22 with confidence intervals (CI) that overlapped with the null. For Pap smear screening, the effect was strongest among Mexican-American women (OR=1.44, 95% CI=1.21 to 1.72), but also evident among Central-American women (OR=1.22, 95% CI=0.72 to 2.06) and Cuban women (OR = 1.25, 95% CI = 0.81 to 1.93). Among Puerto Rican women, social integration had no effect on either mammography (OR=1.03) or Pap smear screening (OR=1.08). Conclusions: Independent of socioeconomic factors, social integration appears to influence cancer screening participation of Hispanic women. The modest effect is not universal across Hispanic groups and was stronger for Pap smear than for mammography screening behavior. Researchers should recognize Hispanic group differences in social network characteristics and the potential of social networks to change screening behavior. Medical Subject Headings (MeSH): Hispanic Americans, mammography, mass screening, neoplasms, social support, vaginal smears (Am J Prev Med 2000;19(1):47–52) © 2000 American Journal of Preventive Medicine Introduction L ong-standing evidence indicates that social rela- tionships play an important role in individual health and health behavior. 1–6 Studies of health and social relationships most often measure structural (usually size) and interactional (usually frequency of contact) characteristics of a person’s social network. 4 It is assumed that such measures reflect the underlying support that individuals receive through interpersonal transactions within their social networks (affection, affirmation, aid), an underlying support that has a positive effect on physical and psychological well-be- ing. 4 Thus, in cancer control and prevention research, it may be important to consider the social networks of women, especially those of Hispanic women, who are less likely to participate in breast and cervical cancer screening because of societal and economic barriers. Recent research suggests that among underserved minority women, strong social networks can have posi- tive effects on their cancer screening participation. 7–9 In a study of African-American women living in Oak- land and San Francisco, California, women who scored high on a social network index were more likely to have From the Department of Disease Control and Prevention, Texas Depart- ment of Health (Suarez), Austin, Texas; Chronic Disease Prevention and Control Research Center, Baylor College of Medicine (Ramirez), Houston, Texas; South Texas Health Research Center, University of Texas Health Science Center at San Antonio (Villarreal), San Antonio, Texas; Brooklyn Hospital Center (Marti), New York City, New York; Center for Health Promotion Research and Development, University of Texas Houston Health Science Center (McAlister), Houston, Texas; San Diego State University (Talavera), San Diego, California; Sylvester Comprehensive Can- cer Center, University of Miami (Trapido), Miami, Florida; and University of California at San Francisco (Perez-Stable), San Francisco, California Address correspondence and reprint requests to: Amelie G. Ramirez, DrPH, Chronic Disease Prevention and Control Research Center, Baylor College of Medicine, Baylor One Plaza, Scurlock Tower, Suite 924, Houston, TX 77030. E-mail: aramirez@bcm.tmc.edu. 47 Am J Prev Med 2000;19(1) 0749-3797/00/$–see front matter © 2000 American Journal of Preventive Medicine • Published by Elsevier Science Inc. PII S0749-3797(00)00155-0