This article reports the development of a short (12-item) acculturation scale for Hispanics. Separate factor analyses of the responses of 363 Hispanics and 228 non-Hispanic whites produced three factors: "Language Use," "Media," and "Ethnic Social Relations." The 12-item scale (explaining 67.6% of the variance for Hispanics) correlated highly with the following validation criteria: respondents' generation, length of residence in the U.S., age at arrival, ethnic self-identification, and with an acculturation index. The first factor consists of only five items and explains 54.5% of the variance while maintaining strong correlations with the various criteria. The validity and reliability coefficients for this new short scale are comparable to those obtained for other published scales. Separate validations for Mexican Americans and Central Americans showed similar results.

This investigation studied the effects of acculturation on attitudinal familism in 452 Hispanics compared to 227 white nonHispanics. Despite differences in the national origin of Hispanics, Mexican-, Central -and Cuban-Americans reported similar attitudes toward the family indicating that familism is a core characteristic in the Hispanic culture. Three basic dimensions of familism were found: Familial obligations, perceived support from the family and family as referents. The high level of perceived family support, invariable despite changes in acculturation, is the most essential dimension of Hispanic familism. Familial obligations and the perception of the family as referents appear to diminish with the level of acculturation, but the perception of family support doesn't change. Although these two dimensions of familism decrease concurrently with the level of acculturation, the attitudes of persons with high levels of acculturation are more familistic than those of white nonHispanics.

To identify access, attitudes, and health practices of Latina women undergoing regular mammography and Pap smear screening, 977 Latinas aged 40 to 74, residing in four California cities, answered a telephone interview. Forty-one percent of women had regular mammography, and 73% had regular Pap smear screening. Cancer screening maintenance was associated with having health insurance, a regular place of care, and fewer fatalistic attitudes about cancer. Regular mammography and Pap smear screening were also associated with ever being married, attending church, and having taken hormone replacement therapy. Being older than 50, residing in the United States a long time, and having had a hysterectomy predicted mammography maintenance. Pap smear screening maintenance was negatively associated with poverty, old age, and negative attitudes toward physicians. There are structural and attitudinal barriers to regular cancer screening among Latinas. Interventions that increase access to care and address women's attitudes about cancer are needed.

The behavioral theory constructs most often used to study mammography utilization-perceived benefit, perceived susceptibility, self-efficacy, intention, and subjective norms-have neither been developed nor sufficiently tested among diverse racial/ethnic subgroups. The authors explored these constructs and their underlying assumptions relating to the social context of Filipina and Latina women. The mixed-methods study included testing construct measures in the multilingual surveys of a concurrent intervention study of 1,463 women from five ethnic groups. social context and individual screening behavior. In-depth interviews were conducted with 11 key informant scholars, 13 community gatekeepers, and 29 lay women, and a supplemental study videotaped and interviewed 9 mother-daughter dyads. Three social context domains emerged: relational culture, social capital, and transculturation and transmigration. The meaning and appropriateness of the five behavioral constructs were analyzed in relation to these domains. In contradistinction to tenets of behavioral theory, the authors found that social context can influence behavior directly, circumventing or attenuating the influence of individual beliefs; contextual influences, synthesized from multiple perspectives, can operate at an unconscious level not accessible to the individual; and contextual influences are dynamic, contingent on distal and proximal forces coming together in a given moment and are thus not consistent with an exclusive focus at the individual level. This article describes the study methods, summarizes main findings, and previews the detailed results presented in the other articles in this issue.Keywords behavioral theory; culture; social context; mixed methods; mammographyThe compass is a device whose function is inseparable from its context of origin, the planet Earth. Based on the concept of a magnetic north, a compass would not be useful, for example, on Mars with that planet's multiple magnetic fields. According to one NASA scientist, "If you were a boy scout with a compass on Mars, you would be lost" (J. E. P. Connerney, personal communication, August 22, 2003). Much of health behavior theory, anchored in the realm of individual cognition, has been developed and tested predominantly among university students (Ajzen, 1991) and then applied far more broadly. The bases for the theories are commonalities within groups in factors that influence behavior and the consistency and predictability of relationships among those factors. But these theoretically derived patterns do not operate in the same way for all people. Instead, when used in multicultural settings and among those of diverse socioeconomic backgrounds, this body of work can be likened to "a compass on Mars," a navigational tool that is designed for a set of forces and principles likely to operate differently-or not at all-in another milieu. Yet there is an implied universality in the way health behavior theories and their constructs are used. Despite the current emphasis on dissemin...

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Research targeting disparities in breast cancer detection has mainly utilized theories that do not account for social context and culture. Most mammography promotion studies have used a conceptual framework centered in the cognitive constructs of intention (commonly regarded as the most important determinant of screening behavior), self-efficacy, perceived benefit, perceived susceptibility, and/or subjective norms. The meaning and applicability of these constructs in diverse communities are unknown. The purpose of this study is to inductively explore the social context of Filipina and Latina women (the sociocultural forces that shape people’s day-to-day experiences and that directly and indirectly affect health and behavior) to better understand mammography screening behavior. One powerful aspect of social context that emerged from the findings was relational culture, the processes of interdependence and interconnectedness among individuals and groups and the prioritization of these connections above virtually all else. The authors examine the appropriateness of subjective norms and intentions in the context of relational culture and identify inconsistencies that suggest varied meanings from those intended by behavioral theorists.

The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, This article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.

BACKGROUND:Interpreter services for medical care increase physician-patient communication and safety, yet a "formal certification" process to demonstrate interpreter competence does not exist. Testing and training is left to individual health care facilities nationwide. Bilingual staff are often used to interpret, without any assessment of their skills. Assessing interpreters' linguistic competence and setting standards for testing is a priority. OBJECTIVE:To assess dual-role staff interpreter linguistic competence in an integrated health care system to determine skill qualification to work as medical interpreters.DESIGN: Dual-role staff interpreters voluntarily completed a linguistic competency assessment using a test developed by a language school to measure comprehension, completeness, and vocabulary through written and oral assessment in English and the second language. Pass levels were predetermined by school as not passing, basic (limited ability to read, write, and speak English and the second language) and medical interpreter level. Five staff-interpreter focus groups discussed experiences as interpreters and with language test. RESULTS:A total of 840 dual-role staff interpreters were tested for Spanish (75%), Chinese (12%), and Russian (5%) language competence. Most dual-role interpreters serve as administrative assistants (39%), medical assistants (27%), and clinical staff (17%). Two percent did not pass, 21% passed at basic level, 77% passed at medical interpreter level. Staff that passed at the basic level was prone to interpretation errors, including omissions and word confusion. Focus groups revealed acceptance of exam process and feelings of increased validation in interpreter role. CONCLUSIONS:We found that about 1 in 5 dual-role staff interpreters at a large health care organization had insufficient bilingual skills to serve as interpreters in a medical encounter. Health care organizations that depend on dual-role staff interpreters should consider assessing staff English and second language skills.KEY WORDS: interpreter services; language proficiency; limited english proficient (LEP); ad-hoc interpreters.