Cancer in the Minnesota Hmong population

Gout prevalence in the Hmong: a prime example of health disparity and the role of community-based genetic research

Individuals of distinct Asian backgrounds are commonly aggregated as Asian, which could mask the differences in the etiology and prevalence of health conditions in the different Asian subgroups. The Hmong are a growing Asian subgroup in the United States with a higher prevalence of gout and gout-related comorbidities than non-Hmong. Genetic explorations in the Hmong suggest a higher prevalence of genetic polymorphisms associated with an increased risk of hyperuricemia and gout. History of immigration, acculturation, lifestyle factors, including dietary and social behavioral patterns, and the use of traditional medicines in the Hmong community may also increase the risk of developing gout and lead to poor gout management outcomes. Engaging minorities such as the Hmong population in biomedical research is a needed step to reduce the burden of health disparities within their respective communities, increase diversity in genomic studies, and accelerate the adoption of precision medicine to clinical practice.

Review of Hmong-Related Health Problems: A Quick Guide for Healthcare Providers

The people of Hmong descent are one of the largest resettled communities in the United States (US). The Central Valley of California is well known to be the home to the largest Hmong population in the US. However, despite the presence of such a large Hmong community in the Central Valley, our knowledge of their cultural perceptions of medicine is limited. Based on local Central Valley health providers' experiences and observations, the Hmong people have a number of health-related challenges that differ from those of the general population, and this should be considered when dealing with their healthcare needs. In this report, we present a quick guide about the Hmong community and their health-related issues. We hope this will help clinicians and researchers better understand the Hmong community, which in turn would help provide a better quality of healthcare to the Hmong people and stimulate intellectual curiosity among healthcare providers towards this unique Asian ethnicity.

Social-cultural, traditional beliefs, and health system barriers of hepatitis B screening among Hmong Americans: A case study

BACKGROUND

The incidence of liver cancer in Hmong Americans is 5 times higher than that of non-Hispanic whites, and there is a low hepatitis B screening rate (24%) among Hmong adults compared with other Asian American populations. The purpose of this study was to examine the Hmong's perceptions on social-cultural determinants, traditional health beliefs, and health care system barriers that influenced community-based hepatitis B screening interventions.

METHODS

A qualitative method was used, integrating a collective case study research design. In-depth interviews were used to collect data from 20 Hmong adults from the greater Sacramento area. A pattern matching analytic technique was used to analyze the data. The main core elements of Culture Care Theory were used to capture the key themes presented by the participants.

RESULTS

Protecting a family's reputation; fear of doctors, medical procedures, and test results; lack of trust in medical doctors and medical care services; and using Hmong herbal medicines and practicing spiritual healing were identified as social-cultural and traditional health belief barriers to obtaining HBV screening. Health care costs, perceived discrimination, lack of transportation, linguistic discordance, and poor quality of care were identified as barriers to accessing high-quality health care services and obtaining hepatitis B screening.

CONCLUSION

Providers, health policy makers, researchers, and community-based organizations will need to work together to develop intervention strategies to address the social-cultural factors, traditional health beliefs, and health care challenges that influence obtaining hepatitis B screening in the Hmong community. Cancer 2018;124:1576-82. © 2018 American Cancer Society.

Cancer incidence and mortality associated with non-occupational and low dose exposure to Libby vermiculite in Minnesota

BACKGROUND

A vermiculite processing plant in a Minneapolis, Minnesota neighborhood utilized asbestos-containing ore from Libby, Montana from the late 1930's until 1989. Multiple pathways of exposure to Libby asbestos were characterized in a cohort of over 6000 plant workers and residents living near the plant.

OBJECTIVE

We conducted a cohort linkage study to assess the impact of cumulative low dose exposure and the role of occupational history on asbestos-related mortality and cancer morbidity among cohort members residing near a vermiculite plant.

METHODS

Cohort members alive in 1988 (n = 5848) were linked to the Minnesota Cancer Surveillance System to identify incident cases of mesothelioma, lung cancer, and all-cancer diagnosed from 1988 to 2010. Proportional incidence ratios (PIRs) were calculated for mesothelioma and lung cancer. Vital status and cause of death were ascertained from Minnesota vital records and the National Death Index (1988-2011). Mortality rates of the cohort (2001-2011) for asbestos-related outcomes were compared to the Minnesota population to estimate standardized mortality ratios (SMRs) and stratified by gender, exposure, and occupational history categories.

RESULTS

We identified seven cases of mesothelioma, with elevated incidence only in females (PIR = 11.76, 95% CI: 3.17, 30.12). Lung cancer was elevated in both genders: PIR = 1.54 (95% CI: 1.19, 2.0) in males and 1.62 (95% CI: 1.21, 2.12) in females. We found elevated mortality from COPD, lung cancer, and mesothelioma among females (SMR for mesothelioma in females = 18.97, CI: 3.91, 55.45), among the 546 deaths identified. All four deaths from mesothelioma occurred in the >75th percentile of exposure (>0.0156 fiber/cc x months). The SMR for lung cancer and all respiratory cancer was elevated even after controlling for occupation.

CONCLUSIONS

Community exposure to Libby amphibole asbestos from a vermiculite processing plant is associated with increased risk of COPD, lung cancer and mesothelioma incidence and mortality, most notably among females, and is likely to remain a public health issue for years to come.

Systematic Review: Health Promotion and Disease Prevention Among Hmong Adults in the USA

Although disparities in the burden of disease and illness experienced across major racial and ethnic groups in the USA is well known, little is known about subgroups, including the Hmong population. This review sought to determine the current state of health disparities related to health promotion and disease prevention among Hmong adults from 1975 to 2015. Seventy-one descriptive (qualitative, mixed methods, and quantitative) studies were reviewed. Most focused on two areas: (1) health status (mainly breast and cervical cancers) and (2) health-related behaviors. This literature review confirms the existence of health disparities related to health promotion and disease prevention in the Hmong adult population. Effective intervention relies on identifying these disparities. A possible explanation for these disparities is the lack of health data collected on subgroup populations, which include the Hmong adult population. More research and more comprehensive health policies at the organizational level are needed to allow data to be collected on subgroup populations in order to better understand the social determinants that place the Hmong people at risk.

HPV Literacy and Associated Factors Among Hmong American Immigrants: Implications for Reducing Cervical Cancer Disparity

Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study's objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen's Behavioral Model of Health Services Use was used as the study's theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants' level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study's results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.

Health Literacy and Associated Factors Among Hmong American Immigrants: Addressing the Health Disparities

Hmong Americans face a disproportionate health burden ranging from the high prevalence of diabetes to depressive disorders. Little research attention has been paid toward exploring contributing factors to this disparity. As such, the present study seeks to fill the gap in the literature by examining the health literacy levels in Hmong Americans and its associated factors. The present study employed Andersen's behavioral model of health service as the theoretical framework. A cross-sectional survey research design was used and information was gathered from 168 Hmong American immigrants. Participants were recruited using a purposive sampling strategy. A multiple regression analysis was conducted to identify the factors linked to health literacy. Approximately half of the participants had low health literacy and reported that they did not understand health information well. Health literacy levels were found to differ significantly based on the number of years participants have lived in the U.S., their social or religious group attendance, health status, and whether they had difficulties with activities of daily living. Our exploratory findings could be used prompt more research to help inform the development of interventions aiming to improve health literacy levels and address the health disparities in Hmong American Population.

Evaluating teaching techniques in the Hmong breast and cervical cancer health awareness project

Cancer health disparities are a reality for Hmong women who are often diagnosed at a later stage and have low literacy and experienced care that are not culturally appropriate. Lack of attention to cultural appropriateness and literacy levels of cancer screening materials may contribute to disproportionately low levels of cancer screening among Hmong women. The purposes of this study were to evaluate the Hmong Health Awareness Project (HHAP), a program designed to create awareness and acceptance of breast and cervical cancer screening, and to examine participants' perceptions of the utility of the content of the workshops. Hmong researchers partnered with three Midwestern Hmong community centers to implement six workshops. Three teaching techniques: pictographs, videos, and hands-on activities were utilized to teach Hmong participants about cancer screening. Participants included 150 Hmong (male participants = 30 and female participants = 120). Teach-back method was used to assess the participants' understanding of cancer screening throughout the workshops. Qualitative data were collected in focus groups to assess the feasibility of teaching methods and participants' perceptions of the utility of the content of the workshops. Directed content analysis was used to analyze participants' responses. The three teaching techniques were helpful in increasing the Hmong people's understanding about breast and cervical cancer screening. Nearly, all participants perceived an increased in their understanding, greater acceptance of cancer screening, and increased willingness to be screened. Men expressed support for screening after the workshops. Findings can guide future interventions to improve health communications and screening and reduce diagnostic disparities among Hmong and immigrant populations.

Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study

BACKGROUND

Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk.

METHODS

Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation.

RESULTS

Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation.

CONCLUSIONS

LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing.

IMPACT

LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.

Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study

BACKGROUND

Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk.

METHODS

Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation.

RESULTS

Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation.

CONCLUSIONS

LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing.

IMPACT

LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.

Cervical cancer screening among Southeast Asian American women

The incidence of cervical cancer is high among Southeast Asian American women, but their participation in preventive cervical cancer screening is alarmingly low. This paper reviews the literature on factors associated with participation in cervical cancer screening among women of Vietnamese, Cambodian and Hmong descent in the United States. These factors include acculturation, age, marital status, knowledge about cervical cancer, apprehension about cervical cancer screening, financial concerns, access to health care, and physician characteristics and recommendation. Suggestions for future research include the need to investigate the role of physicians treating Southeast Asian American women, the need for more extensive up-to-date studies on the current generation of young Southeast Asian American women, and the use of more advanced assessments of acculturation. Overall, much more work is needed in order to deepen our understanding of the various ways to improve the rate of cervical cancer screening among Southeast Asian American women.

Seeking to bridge two cultures: the Wisconsin Hmong cancer experience

Compared to white non-Hispanics, Hmong report higher incidence rates of certain cancers and present at an advanced stage. Using a community-based participatory research approach, Hmong leaders partnered with academic researchers to assess the Wisconsin Hmong population's readiness to address cancer. Using the Colorado Tri-Ethnic Center's Community Readiness Assessment, face-to-face interviews were conducted with eight Hmong leaders. The stage of readiness to address cancer was "Vague Awareness". Six thematic areas provided insight into this stage and recommendations for effective intervention. Results emphasize the need for a bridge between Hmong and mainstream communities to provide basic, culturally appropriate education on the US healthcare system and cancer.

Factors associated with pap testing among Hmong women

This paper reports the baseline data on the proportion of Hmong women (n=402), ages 18-65, in Sacramento, California who reported that they had a Pap test for the early detection of cervical cancer. We assessed the association between sociodemographic characteristics and Pap test receipt using chi-squared and multiple logistic regression analyses. Only 74% had ever had a Pap test, with 61% tested in the previous three years, compared with 91% and 86%, respectively, of California women overall. Women were more likely to have had a recent Pap test if they were age 21-30 (OR=3.0 vs. age 51-65, 95% CI 1.4-6.7) or 31-40 (OR=3.0, 95% CI 1.4-6.4), and less likely if they were single (OR=0.4 vs. married/partnered, 95% CI 0.2-1.0) or born in the U.S. (OR=0.3 vs. <10 years in U.S., 95% CI 0.1-0.8).

Barriers to cancer screening in Hmong Americans: the influence of health care accessibility, culture, and cancer literacy

Hmong Americans face high cancer mortality rates even in comparison to their Asian American counterparts, and report low utilization of cancer screenings. To date, no study has been conducted on the cultural barriers this population faces in undergoing cancer screenings. A systematic review of the literature was conducted to examine the existing knowledge regarding the barriers to cancer screening for Hmong Americans. Potential barriers were identified from this examination to include: health access factors (type of health insurance, ethnicity of provider, low English proficiency, and years spent in the U.S.); cultural factors (belief in the spiritual etiology of diseases, patriarchal values, modesty, and mistrust of the western medical system); and cancer literacy factors (cancer and prevention illiteracy). Based on this review, potential cultural and ethnic group-specific prevention strategies and cancer health policies are discussed to address these barriers and enhance screening behavior among the Hmong.

Acculturation and environmental change impacts dietary habits among adult Hmong

Focus groups (n=65) were conducted with Hmong adults in St. Paul/Minneapolis, MN to determine how environmental factors, acculturation, and food insecurity influence dietary behavior, body mass index (BMI), and health. Acculturation was assessed by examining linguistic, social, and eating behavior, length of time in the US, and BMI for B-TL(1) (born in Thailand/Laos and in US < or =5 years), B-TL(2) (in Thailand/Laos through adolescence, had food memories, and in US >5 years), and B-US (born in US or in Thailand/Laos less than 8 years and no food memories from there). Acculturation was associated with years lived in the US, household size and income, and food assistance usage. Years lived in the US was correlated with food assistance usage, education, household size and income, and perception of diet. B-TL(1) and B-TL(2) were on average overweight (BMI> or =25<30), US men were obese (mean BMI=32.4+/-7.4), and women were overweight (mean BMI=29.1+/-6.8). Themes identified were cultural values impact eating and lifestyle behaviors, food insecurity history influences post-migration behavior, acculturation impacts BMI through diet and exercise, and health status is influenced by changed environments. Environmental changes and increased acculturation have negatively impacted the weight and health of Hmong adults.

Discordance between N-acetyltransferase 2 phenotype and genotype in a population of Hmong subjects

Polymorphisms of N-acetyltransferase 2 (NAT2) acetylation may influence drug toxicities and efficacy and are associated with a differential susceptibility to select cancers. Acetylation phenotype may have clinical implications. The purposes of this study were to determine the genetic basis of an apparent predominance of slow acetylation phenotype and to assess concordance with genotype in a population of Hmong residing in Minnesota. Urine and DNA obtained from unrelated Hmong 18 to 65 years of age were used to determine phenotype from caffeine metabolites, whereas direct nucleotide sequencing of the NAT2 coding region, followed by cloning, identified all known allelic variants. From 61 subjects (27 men, 30 +/- 11 years), analysis of 50 urine-DNA pairs identified 46 (92%) slow acetylators and 4 (8%) rapid acetylators by phenotype. Genotypic analysis inferred 5 (10%) slow acetylators and 45 (90%) rapid acetylators. There is 86% discordance between phenotype and genotype. A predominance of NAT2 slow acetylation phenotype in the Hmong is confirmed, and a significant discordance between NAT2 phenotype and genotype is identified. In this population, slow acetylation phenotype determined by a metabolic probe would not have been predicted by genotype alone. Environmental, genetic, or phenotypic anomalies that may contribute to this discordance should be considered and evaluated in future studies within this unique population.

Cancer incidence in the Hmong in California, 1988-2000

The Hmong represent a unique new Southeast Asian immigrant group to the U.S. Approximately 169,000 Hmong reside in the U.S., primarily in California, Minnesota, and Wisconsin. Previous studies of cancer in this population have indicated that Hmong experience an elevated risk of gastric, hepatic, cervical, and nasopharyngeal cancers and experience a reduced risk of breast, prostate, lung, and colorectal cancers. Approximately 65,000 Hmong live in California, where there has been a population-based cancer registry since 1988, and the authors used these data to calculate age-adjusted cancer incidence rates and to examine disease stage and tumor grade at diagnosis. Changes in rates during the period studied also were evaluated. These rates and proportions were compared with rates among the non-Hispanic white (NHW) and Asian/Pacific Islander (API) populations of California. Between 1988 and 2000, a total of 749 Hmong in California were diagnosed with invasive cancer, and the age-adjusted rate of cancer for the Hmong was 284 per 100,000 population, compared with 362.6 and 478 per 100,000 in the API and NHW populations, respectively. The age-adjusted incidence rates of cancer in the Hmong were elevated for hepatic, gastric, cervical, and nasopharyngeal cancers and for leukemia and non-Hodgkin lymphoma (NHL). Rates were lower in the Hmong for colorectal, lung, breast, and prostate cancers. For gastric cancer and lung cancer, age-adjusted rates increased between 1988 and 2000 in the Hmong, although breast cancer incidence declined. Cervical cancer incidence increased, rates of NHL were declining, and rates for colorectal cancer remained steady between 1988 and 2000. The Hmong experienced later disease stage at diagnosis than other API and generally poorer grade of disease at diagnosis. Hmong experienced lower overall invasive cancer incidence rates than API or NHW populations in California. However, they experienced higher rates of hepatic, gastric, cervical, and nasopharyngeal cancers; and, for most types of cancer, they were diagnosed in a later disease stage.

Verified predominance of slow acetylator phenotype N-acetyltransferase 2 (NAT2) in a Hmong population residing in Minnesota

Southeast Asians known as the Hmong have a high prevalence of tuberculosis and select cancers. The slow acetylation (SA) phenotype for N-acetyltransferase 2 (NAT2) has been associated with toxicity from the anti-tuberculosis drug, isoniazid and in increased risk of select cancers. Previous research indicates a 74.5% prevalence of SA in Hmong which differs from other Asian populations including the Japanese and Thai (range: 7%-45%). Given this contrast, the purpose of this study was to confirm or refute this unexpected predominance of the SA phenotype in Hmong. Unrelated, Minnesota Hmong between 18 and 65 years of age consented and participated by ingesting caffeine as the probe for NAT2. A urinary caffeine metabolic ratio AFMU/1X (<0.6) was used to classify subjects as slow acetylators. Among 51 analysable samples provided by 61 enrollees (27 male, 33 female, 1 sex unknown, age 30+/-11 years [mean+/-SD]) there were 47 (92.2%) slow and 4 (7.8%) rapid acetylators. The prevalence of the SA phenotype (92.2%) from this study exceeds the 74.5% (p<0.02 by chi-square test) previously noted in Minnesota Hmong (n=98). The predominance of the SA phenotype within Minnesota Hmong is confirmed. Further studies evaluating this unexpected prevalence, its genetic basis and potential clinical relevance to drug toxicity and disease are warranted.

Nasopharyngeal cancer in the California Hmong, 1988-2000

Although previous studies document elevated nasopharyngeal cancer incidence in the American Hmong, a descriptive analysis is lacking. The present case-series aims to identify important features of head and neck cancers in the California Hmong, specifically nasopharyngeal cancer. We assessed incident head and neck cancers identified by the California Cancer Registry from 1988-2000 for incidence, mortality and descriptive comparisons between the Hmong, non-Hispanic Whites (NHW) and Asian/Pacific Islanders (API). Nasopharyngeal cancer was the most frequent Hmong cancer (39 of 51 cases) with incidence 23 times greater than in NHW. Nasopharyngeal cancer mortality rates for Hmong, NHW and API were 10.4, 0.2 and 1.7/100,000 respectively. Hmong were more likely to be diagnosed with remote tumors and less likely to receive treatment. A public health disparity clearly exists regarding nasopharyngeal cancer in the Hmong. Education on culturally appropriate healthcare and efforts to encourage diagnosis and treatment are necessary to reduce this disparity.

Stone disease in the Hmong of Minnesota: initial description of a high-risk population

BACKGROUND AND PURPOSE

The Hmong are an ethically distinct refugee population from the highlands of Laos. Metropolitan Minneapolis-St. Paul, Minnesota is home to the largest population of Hmong ( 40,000) outside Asia. A clinical impression that the Hmong have a high rate of uric acid stone disease was evaluated.

PATIENTS AND METHODS

A retrospective chart review was performed. All adult Hmong patients seen between January 1, 2000, and December 31, 2001, by a large urology group practice (N = 205) were compared with a similar number of non-Hmong patients (N = 204).

RESULTS

Of these patients, 94 Hmong (46%) and 23 non-Hmong (11%) patients had stone disease (P < 0.001). After addition of 75 non-Hmong stone patients to create a suitable comparison group, a total of 86 Hmong and 88 non-Hmong stone patients had complete records. Sex (57% v 60% male) and mean age (47.9 v 47.3 years) were similar. Staghorn calculi were found in 21 Hmong (24%) and 0 non-Hmong patients (P < 0.001). Surgical treatments differed between Hmong and non-Hmong (P = 0.004): SWL (16 v 35), ureteroscopy (24 v 29), percutaneous nephrolithotomy (19 v 7), and nephrectomy (5 v 0). Treatment for staghorn calculi was refused by 9 Hmong patients (43%). Stone composition was available in 40 Hmong and 39 non-Hmong. Uric acid (>10%) was found in 50% of Hmong and 10% of non-Hmong stones (P < 0.001).

CONCLUSIONS

Hmong patients who come to urologic attention tend to do so for stone disease and tend to have uric acid calculi. The frequent requirement for invasive therapy, including nephrectomy, in the Hmong is of concern.

Cervical cancer among Hmong women in California, 1988 to 2000

BACKGROUND

The Hmong immigrated to the United States from Laos after the Vietnam conflict ended. Hmong encounter numerous readjustment issues, including health care. Traditional Hmong health beliefs and practices encompass more spiritual than biological etiologies. Hmong usually seek the first course of treatment from traditional healers, as they had in Laos. This practice delays early diagnosis and treatment of disease because biomedicine is used only as a last resort. This study examined cervical cancer incidence, mortality, and other tumor characteristics in the Hmong female population of California between 1988 and 2000.

METHODS

Data from the California Cancer Registry were used to calculate annual average incidence, mortality, and age-specific rates for Hmong women diagnosed with cervical cancer. The population at risk was estimated with linear interpolation using data from the 1990 and 2000 censuses.

RESULTS

Hmong women experienced incidence and mortality rates three and four times higher than Asian/Pacific Islander and non-Hispanic white women, respectively. Fifty-one percent of Hmong women chose no treatment, compared to 5.8% for Asian/Pacific Islander women and 4.8% for non-Hispanic white women. Hmong women aged >/= 40 years carried an unequal burden of cervical cancer. They were more likely to be diagnosed with cervical cancer at later stages and poorer histologic grades, and had a lower survival rate than younger Hmong females.

CONCLUSIONS

Cervical cancer is clearly a public health issue that threatens the health and well-being of Hmong women. Culturally sensitive screening and prevention programs need to be developed to target older Hmong women using bilingual and bicultural Hmong women health educators using verbal communication.

Genetic polymorphisms in the Hmong population

BACKGROUND

The Hmong, an isolated, agrarian people from southern China, migrated to the mountainous regions of what are today Vietnam, Cambodia, and Laos. Minnesota has the second largest Hmong population in the United States. The authors compared frequencies of common genetic polymorphisms believed to influence risk of malignancy to determine whether frequencies in the Hmong are different from those in other Asian populations and in white Minnesotans.

METHODS

Genotyping for glutathione S-transferase micro1 (GSTM1), glutathione S-transferase theta1 (GSTT1), myeloperoxidase (MPO) (C(-)463T), nicotinamide adenine dinucleotide phosphate:quinone oxidoreductase (NQO1) (C609T), 5,10-methylenetetrahydrofolate reductase (MTHFR) (C677T), MTHFR (A1298C), methionine synthase reductase (MTRR) (A66G), X-ray repair cross complementing 1 (XRCC1) 194 (Arg194Trp), XRCC1 280 (Arg280His), and XRCC1 399 (Arg399Gln) alleles was performed by TaqMan analysis using DNA isolated from newborn heel-stick spots provided by the Minnesota Department of Health.

RESULTS

The Hmong had significantly higher frequencies of the NQO1 T allele and the XRCC1 Trp polymorphism (Arg194Trp) and had significantly lower frequencies of the G allele in MTRR (A66G) and the T allele in MTHFR (C677T) compared with white Minnesotans. The Hmong also were significantly more likely to lack the GSTM1 and GSTT1 genes compared with whites (82% vs. 54% and 61% vs. 18%, respectively). Genotype frequencies were similar for MTHFR (A1298C), MPO (C(-)463T), and XRCC1 (Arg280His, Arg399Gln). Genotype frequencies at these loci also were compared with those reported for other Asian populations and showed notable differences between the Hmong and Chinese/Taiwanese, Korean, and Japanese populations.

CONCLUSIONS

The genetic differences identified have implications for both cancer etiology and prognosis in this unique population.