Impact of Asian Ethnicity on Colorectal Cancer Screening: A Population-Based Analysis

Disparities in colorectal cancer screening among South Asians in New York City: a cross-sectional study

Despite improvements in colorectal cancer (CRC) screening in New York City (NYC) since the early 2000s, the degree to which disparities persist for specific Asian American subgroups has yet to be fully elucidated. The purpose of this study is to examine disparities in rates of timely colonoscopy screening among five racial/ethnic groups in NYC. We performed a retrospective cross-sectional analysis of combined 2014-2018 NYC Community Health Survey data. Prevalence estimates of timely colonoscopy screening (within the past 10 years) among individuals ≥ 50 years of age were calculated and presented overall (n = 24,288) and by socio-demographic variables. Racial/ethnic categories included White, Black, Hispanic, East Asian, and South Asian. Multivariable models examined socio-demographic and racial/ethnic predictors of timely colonoscopy screening. A trend analysis examined colonoscopy screening by race/ethnicity and year from 2012 to 2018 (n = 33,130). Age-adjusted prevalence of timely colonoscopy screening was lowest among Asian Americans (South Asian 61.1% and East Asian 65.9%) compared to Hispanics (71.3%), Blacks (70.2%), and Whites (68.6%). Adjustment by socio-demographics, including insurance status, further explained disparities for South Asians (adjusted risk ratio [RR] = 0.84, 95% CI = 0.73-0.97) compared to Hispanics; additionally, Whites (adjusted RR=0.88, 95% CI = 0.84-0.92) were less likely to have received a timely colonoscopy compared to Hispanics. Age, health insurance, poverty group, and education were significant predictors in adjusted regression. Results indicate that South Asians have not equally benefited from campaigns to increase colonoscopy screening in NYC. Our findings support the development of targeted, and linguistically and culturally adapted campaigns that facilitate access to health systems and leverage existing community assets and social support systems among South Asian populations.

A systematic review of ethnic disparities in the uptake of colorectal cancer screening

AIMS

Colorectal cancer (CRC) screening reduces mortality, but variation exists in uptake. Ethnicity is suggested to play a role; however, there is no high-level evidence to support this. We aim to clarify the impact of Ethnicity on CRC screening uptake and our barriers to its understanding.

METHODS

A systematic review to identify studies reporting on the participation of ethnic minorities in CRC screening worldwide was performed. MEDLINE, Embase, Scopus and Google Scholar databases up until 31 May 2019 were searched. Compliance with screening according to ethnic groups and screening modality was evaluated compared to the 'White' control group.

RESULTS

Twenty-two studies were included in the review reporting on 2,084,213 patients. Substantial variation in categorisation of ethnicities (40 sub-categories), screening modality studied and confounding factors accounted for was observed. 8/15 studies for 'Blacks', 10/13 for 'Hispanics', 2/2 for 'Asians' and 1/1 for 'South East Asians' suggest a less likely or significantly decreased compliance with screening for all screening modalities (p < .05) compared to 'Whites'. Interestingly 'Japanese', 'Vietnamese' and 'Filipino' groups consistently show no difference in the uptake of CRC screening compared to the 'White' majority.

CONCLUSION

This is the only systematic review on this topic. It highlights the inconsistency in screening uptake behaviour in different ethnic minority groups and identifies barriers like variation in ethnicity categorisation, screening modality and study design utilised to understanding the intricacies of this relationship. Further collaboration and action needs to be undertaken internationally to clarify and improve inequity in the uptake of screening.

Interventions for cancer screening among Chinese Americans: A systematic review and meta-analysis

Background

Cancer is the leading cause of death among Chinese Americans (CAs). Although death rates of cancers can be significantly reduced by screening cancers at an early stage, cancer screening (CS) rates are low among CAs. Interventions on CS may increase the uptake rates of CS and help to decrease the death rates of cancers in CAs.

Objectives

This study aims to summarize the intervention methods on CS among CAs and compare effects of various intervention methods on the outcomes of CS, including knowledge levels of CS, intentions to complete CS, and actual completions of CS.

Methods

A systematic review and meta-analysis design was used. Keyword searching was conducted on PubMed, Google Scholar, PsycINFO, and CINAHL. Inclusion and exclusion criteria were applied. The PEDro scale was used to evaluate the quality of the studies. Data was analyzed using Review Manager Version 5.4 software. Random effect model and subgroup analyses were conducted.

Results

The search yielded 13 eligible studies. All of the reviewed interventions were culturally tailored. Systematic review results were categorized by intervention delivery objects, intervention led, intervention contact, intervention types, and intervention focus according to group consensus. Meta-analysis results showed that the interventions on CS had a positive effect on all outcomes, including a 1.58 (95% CI, 1.17–2.14; P = 0.003), 1.78 (95% CI, 1.27–2.48; P = 0.0007), and 1.72 (95% CI, 1.22–2.42; P = 0.002) effect on knowledge of CS, intentions to complete CS, and completions of CS, respectively, compared to the control group. The subgroup analysis suggested that physician-led, individual-based, face-to-face client-focused interventions with multiple components increased CS among CAs, with the OR ranging from 1.60 (95% CI, 1.08–2.39; P = 0.02) to 3.11 (95%CI, 1.02–9.49; P = 0.05).

Discussion

Interventions on CS significantly increased CAs’ knowledge of CS, intentions to complete CS, and completions of CS. Physician-led, individual-based, face-to-face client-focused interventions with multiple components should be utilized for CAs.

Factors Associated With Colorectal Cancer Screening Among First-Degree Relatives of Patients With Colorectal Cancer in China

BACKGROUND

First-degree relatives of patients with colorectal cancer have an elevated risk of colorectal cancer. However, the behavior and factors potential influencing first-degree relatives regarding colorectal cancer screening in China remain unknown.

OBJECTIVE

The aim of this study was to explore the screening behavior and related factors of first-degree relatives of colorectal cancer patients.

METHODS

A cross-sectional design was applied, and 201 first-degree relatives participated from August 2018 to July 2019. Data were collected about demographic information, the "Colorectal Cancer Perceptions Scale," and screening behavior of first-degree relatives. Factors associated with screening behavior were identified using logistic regression analysis.

RESULTS

Only 18.9% of first-degree relatives had participated in colonoscopy screening. Two Health Belief Model factors were the influencing factors of their participation in colorectal cancer screening. Higher possibility of colorectal cancer screening of first-degree relatives was associated with higher perceived susceptibility (odds ratio, 1.224; 95% confidence interval, 1.075-1.395) and lower perception of barriers (odds ratio, 0.880; 95% confidence interval, 0.820-0.944) of first-degree relatives.

CONCLUSIONS

Participation in colorectal cancer screening by first-degree relatives requires improvement; perceived susceptibility and perception of barriers were the most important predictors.

IMPLICATIONS FOR PRACTICE

Health professionals can enhance awareness of colorectal cancer susceptibility and address barriers to colorectal cancer screening among first-degree relatives at both individual and social levels.

Culturally-adapted behavioral intervention to improve colorectal cancer screening uptake among foreign-born South Asians in New Jersey: the Desi Sehat trial

Objectives: Colorectal cancer (CRC) is the third most common cancer among Americans of South Asian (SA) descent and is a significant public health concern in SA communities. Rates of screening compliance among foreign-born SAs are very low. The goal of this study was to report on the development, acceptability, and preliminary impact of a culturally-targeted 1:1 intervention delivered in English, Hindi, and Urdu, called Desi-Sehat.Design: Ninety-three foreign-born SAs between the ages of 50 and 75 were recruited using community-based organization methods. Participants completed a baseline survey, participated in a 1:1 session with a community health educator, and a follow-up survey was administered four months after the baseline.Results: The acceptance rate was moderate (52.8%). Attendance at the intervention session was high. More than half of the population did not complete the follow-up survey (58.7%). Participant evaluations of the intervention were high. Intent-to-treat analyses indicate a 30% four month follow-up CRC screening uptake. There were significant increases in knowledge and significant reductions in perceived barriers to screening, worry about CRC screening tests, and worry about CRC. Effect sizes for significant changes were in the medium to large range.Conclusions: Desi Sehat was a well-evaluated and participation in the session was high, participant knowledge significantly increased, and screening barriers, worry about CRC, and worry about CRC screening tests declined significantly. Future studies should focus on enhancing recruitment and retention and include a randomized control design.

A Qualitative Analysis of Barriers to Colorectal Cancer Screening among Korean Americans

Colorectal cancer (CRC) is the second most-commonly diagnosed cancer among Korean Americans after breast cancer, with incidence rates exceeding that of lung, prostate, and stomach cancers. However, CRC screening rates are lower among Korean Americans than the general U.S. population. To understand barriers to screening in this population, we conducted 11 focus groups with 51 Korean Americans ages 40+ in the Washington, DC, metropolitan area between 2011 and 2016. Our analysis used the Health Belief Model as a framework. Motivators to seek screening include a family or personal history of cancer or gastrointestinal disease (high perceived susceptibility), knowing people with CRC (high severity), favorable test results reducing worry (high benefits), and physician recommendations (cues to action). Barriers to screening include the common misperception that Korean lifestyles prevent CRC (low susceptibility), the belief that cancer is normal for older adults (low severity), the assumption that screening only benefits symptomatic people (low benefits), the costs and potential risks of testing along with a preference for traditional Korean approaches to wellness (high barriers), and lack of health insurance (low self-efficacy). Interventions seeking to increase the rate of cancer screening in the Korean American community will benefit from emphasizing the burden from CRC among Korean Americans (increasing perceived susceptibility to CRC), explaining that colonoscopies can prevent CRC rather than just diagnosing it (increasing perceived benefits of screening), reducing anxieties about test procedures and embarrassment (reducing perceived barriers to screening), and improving clinical communication (improving cues to action and self-efficacy).

The Importance of Health Insurance in Addressing Asian American Disparities in Utilization of Clinical Preventive Services: 12-Year Pooled Data from California

Purpose: Previous research has shown that Asian Americans are less likely to receive recommended clinical preventive services especially for cancer compared with non-Hispanic whites. Health insurance expansion has been recommended as a way to increase use of these preventive services. This study examines the extent to which utilization of preventive services by Asians overall and by ethnicity compared with non-Hispanic whites is moderated by health insurance. Methods: Data from the California Health Interview Survey (CHIS) was used to examine preventive service utilization among non-Hispanic whites, Asians, and Asian subgroups 50-64 years of age by insurance status. Six waves of CHIS data from 2001 to 2011 were combined to allow analysis of Asian subgroups. Logistic regression models were run to predict the effect of insurance on receipt of mammography, colorectal cancer (CRC) screening, and flu shots among Asians overall and by ethnicity compared with whites. Results: Privately insured Asians reported significantly lower adjusted rates of mammography (83.1% vs. 87.6%) and CRC screening (54.7% vs. 59.4%), and higher rates of influenza vaccination (48.7% vs. 38.5%) than privately insured non-Hispanic whites. Adjusted rates of cancer screening were lower among Koreans and Chinese for mammography, and lower among Filipinos for CRC screening. Conclusion: This study highlights the limitations of providing insurance coverage as a strategy to eliminate disparities for cancer screening among Asians without addressing cultural factors.

Prevalence of and Risk Factors for Diseases in Korean Americans and Native Koreans Undergoing Health Checkup

BACKGROUND

Korean Americans constitute the fifth largest subgroup in the Asian American population. Despite their increasing population, research and guidelines regarding their health status assessment and disease screening are lacking. This study aimed to compare the prevalence of diseases in Korean Americans and native Koreans to determine the risk factors and guidelines for disease screening.

METHODS

Patients who visited the Gangnam Severance Hospital from February 2010 to May 2015 for a health checkup were enrolled in this study. Baseline characteristics, laboratory data, and the organs (stomach, colon, thyroid, brain, prostate, lung, liver, kidney, pancreas, adrenal gland, and heart) of patients were examined. Data regarding patients' dietary patterns were also obtained. Overall, 1,514 Korean Americans (group 1) and 1,514 native Koreans (group 2) were enrolled.

RESULTS

The following diseases were more prevalent in group 1 than in group 2: reflux esophagitis (12.9% vs. 10%), gastric ulcer (3.0% vs. 5.5%), colorectal polyp (37.7% vs. 28.7%), hemorrhoids (32.2% vs. 29.9%), and benign prostatic hyperplasia (30.2% vs. 14.3%). Although not statistically significant, coronary artery disease has a high prevalence rate of >20% in both groups. Dietary patterns were not significant between the two groups.

CONCLUSION

This study showed that the prevalence of several diseases in Korean Americans differed from that observed in native Koreans. Therefore, a foundation for setting up new guidelines for disease screening among Korean Americans is established.

A family-based multimedia intervention to enhance the uptake of colorectal cancer screening among older South Asian adults in Hong Kong: a study protocol for a cluster randomized controlled trial

BACKGROUND

Colorectal cancer (CRC) screening, such as fecal occult blood test (FOBT), is an effective way to prevent CRC, one of the most common cancers worldwide. However, studies found that South Asian ethnic minorities tend not to utilize CRC screening, whose importance on CRC prevention shall be educated among those from ethnic minorities, especially older adults. The purpose of this study is to develop and implement a family-based, multimedia intervention to augment the knowledge of CRC prevention among older South Asian adults in Hong Kong and enhance their motivation for undergoing FOBT. The acceptability and effectiveness of the intervention will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

METHODS

A cluster randomized controlled trial will be carried out. Three hundred and twenty South Asian dyads, comprising an older adult aged between 50 and 75 and a younger family member aged between 18 and 49, will be recruited in ten districts in Hong Kong through community organizations that provide support services for South Asians in local communities. Dyads will be randomly allocated to either the intervention or wait-list control group. Intervention dyads will receive intervention, whose contents are based on the health belief model, via multiple forms of media including PowerPoint presentation, video clip and health information booklet. Control dyads will receive intervention after post-intervention data are collected. For dyads in both groups, an appointment with a family doctor will be arranged for those willing to undergo FOBT. Outcomes will be assessed at baseline and post-intervention. Data will be analysed using the Generalised Linear Models Procedure in an intention-to-treat manner.

DISCUSSION

Findings of this study will provide evidence of the benefits of utilizing multimedia and family-based approaches in intervention development to enhance the effectiveness of health promotion interventions for ethnic minorities. Further, the findings would provide reference to the potential incorporation of the intervention in the existing support services for South Asian ethnic minorities in local communities.

TRIAL REGISTRATION

This trial is registered at the ISRCTN Registry ( ISRCTN72829325 ) on 19th July 2018.

Colorectal Cancer Screening Compliance among Asian and Pacific Islander Americans

Colorectal cancer (CRC) screening prevalence remains low among Asians and Pacific Islanders. This study examined disparities and predictors of CRC screening compliance in adults age 50-75 years in Asians and Pacific Islanders in Hawai'i. Hawai'i Behavioral Risk Factor Surveillance System (BRFSS) data for 2011-2014 were analyzed. CRC screening status was dichotomized. Logistic regression was used to examine ethnic differences in and predictors of CRC screening status. Filipinos (OR 0.56), Chinese (OR 0.70), and Hawaiians (OR 0.75) were significantly less likely than whites to be CRC compliant. Higher education and income, employment, regular health provider, and routine checkups were important predictors of CRC compliance. Findings confirm lower CRC screening compliance in three of the four largest Asian and Pacific Islander groups in Hawai'i and that CRC screening compliance is influenced by several factors. Culturally tailored education and navigation services may be effective in reducing these disparities.

Factors influencing colonoscopy behaviour among Koreans with a positive faecal occult blood tests

OBJECTIVE

Colonoscopy is important for colorectal cancer (CRC) screening in individuals with a positive faecal occult blood test (FOBT). The purpose of the present study was to identify factors affecting the colonoscopy screening behaviour of FOBT-positive individuals, based on the health belief model (HBM).

METHODS

This study involved a cross-sectional survey of 213 individuals aged 50 years or older who underwent CRC screening at a general hospital in Seoul, Korea, as part of the Korean National Cancer Screening Programme and who tested positive on FOBT. The questionnaire was created based on HBM instruments. The collected data were analysed using descriptive statistics, and factors associated with adherence to colonoscopy were examined using logistic regression analysis.

RESULTS

Of the FOBT-positive individuals, 44.1% adhered to colonoscopy. Three of the six evaluated HBM-driven factors (perceived seriousness, perceived barriers and health motivation) significantly differed between colonoscopy-adherent and non-adherent subjects. Perceived seriousness and perceived barriers were the most important factors influencing colonoscopy screening behaviour.

CONCLUSION

For early detection and prevention of CRC, colonoscopy screening behaviour should improve among FOBT-positive individuals. To this aim, education on the graveness of CRC should be provided, and barriers to CRC screening should be addressed.

Colorectal Cancer Screening Participation Among Asian Americans Overall and Subgroups in an Integrated Health Care Setting with Organized Screening

Background

Screening reduces colorectal cancer deaths, but <50% of Asian Americans are screening up-to-date according to surveys, with variability across Asian subgroups. We examined colorectal cancer screening participation among Asian Americans overall and Asian subgroups in a large integrated health care system with organized screening.

Methods

Data were electronically accessed to characterize screening in 2016 for Asians overall and subgroups relative to the National Colorectal Cancer Roundtable target of ≥80% screening and compared with non-Hispanic whites. Screening up-to-date was defined as a colonoscopy with 10 years, a sigmoidoscopy within 5 years, or a fecal immunochemical test (FIT) completed in 2016.

Results

Among 436,398 patients, 69,826 (16.0%) were Asian, of whom 79.8% were screening up-to-date vs. 77.6% of non-Hispanic whites (p < 0.001). Almost all subgroups met the 80% target: Chinese (83.3%), Vietnamese (82.4%), Korean (82.1%), other Asian (80.3%), Filipino (78.7%), Asian Indian (79.6%), and Japanese (79.0%). Among Asians overall and non-Hispanic whites, 50.6% and 48.4% of members were up-to-date with screening by colonoscopy, and 28.0% and 28.2% were up-to-date by FIT, respectively. Across Asian subgroups, colonoscopy most frequently accounting for being screening up-to-date (range: 47.4–59.7%), followed by FIT (range: 21.6–31.5%).

Conclusions

In an organized screening setting, there were minimal differences in screening participation among Asian subgroups and almost all met the 80% screening target, despite differences in language preference. Screening test type differences across subgroups suggest possible preferences in screening modality, which can inform future research into tailored education or outreach.

Colorectal Cancer Screening among Korean Americans in Chicago: Does It Matter Whether They had the Screening in Korea or the US?

Background:

Colorectal cancer (CRC) is one of the most common cancers in Korean Americans (KAs) and CRC screening can detect CRC early and may reduce the incidence of CRC by leading to removal of precancerous polyps. Many KAs in the US leave the country, primarily to travel to Korea, for health screening. The aim of this study was to (a) assess CRC screening rates, including fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy and (b) explore factors related to these tests among KAs by location of CRC screening.

Methods:

Descriptive and correlational research design with cross-sectional surveys was used with 210 KAs. Socio-demographics (age, gender, years in the US, marital status, education, employment, household income, and proficiency in spoken English), access to health care (health insurance and usual source of health care), and location of CRC screening utilization (Korea, the US, or both Korea and US) were measured and analyzed using descriptive statistics and multinominal logistic regression.

Results:

Out of 133 KA participants who had had lifetime CRC screening (i.e., had ever had FOBT, flexible sigmoidoscopy, or colonoscopy), 19% had visited Korea and undergone CRC screening in their lifetimes. Among socio-demographic factors and access to health care factors, having a usual source of health care in the US (OR=8.45) was significantly associated with having undergone lifetime CRC screening in the US. Having health insurance in the US and having had lifetime CRC screening in the US were marginally significant (OR=2.54).

Conclusion:

Access to health care in the US is important for KAs to have CRC screening in the US. As medical tourism has been increasing globally, the location of CRC screening utilization must be considered in research on cancer screening to determine correlates of CRC screening.

Colorectal cancer screening prevalence and predictors among Asian American subgroups using Medical Expenditure Panel Survey National Data

BACKGROUND

Asian American (AA) ethnic subgroups are diverse in socio-economic status, years in the United States, English proficiency, and cultures with different health seeking behaviors and health care access. Fifty-two percent of AAs age ≥50 years had colorectal cancer screening (CRCS) in 2013, compared with 61% of non-Hispanic whites. We hypothesized that CRCS prevalence among AA ethnicities is heterogeneous and that the reasons related to CRCS among AA subgroups are associated with demographic characteristics, acculturation, health care access, and health attitudes.

METHODS

Medical Expenditure Panel Survey data for 2009-2014 compared CRCS status among whites (n = 28,834), Asian Indians (n = 466), Chinese (n = 652), and Filipinos (n = 788). Multivariate logistic regression examined ethnic differences and correlates of CRCS accounting for complex sampling design.

RESULTS

Whites had the highest prevalence of screening (62.3%), followed by Filipinos (55.0%), Chinese (50.9%), and Asian Indians (48.6%). Older age, having health insurance, and having a usual care provider predicted CRCS across all ethnicities. Different demographic, health care access, and health attitude predictors within each ethnic group were related to CRCS.

CONCLUSION

This study contributes to the literature on influences of differential CRCS prevalence among AA subgroups. CRCS promotion should be tailored according to attitudes and structural barriers affecting screening behavior of specific ethnic subgroups to truly serve the health needs of the diverse AA population. Cancer 2018;124:1543-51. © 2018 American Cancer Society.

The Role of Physician Recommendation in Colorectal Cancer Screening Receipt Among Immigrant Chinese Americans

Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physicians should offer all CRC screening modalities (fecal occult blood test [FOBT], sigmoidoscopy, colonoscopy) to Chinese Americans to increase screening. Seven hundred and twenty-five Chinese Americans were asked in a survey if their physician had ever recommended CRC screening and to self-report receipt and type of CRC screening. Participants whose physician had recommended all CRC screening modalities were significantly more likely to report ever having screening (adjusted odds ratio 4.29, 95% CI 1.26-14.68) and being up-to-date (4.06, 95% CI 2.13-7.74) than those who reported that their physician only recommended FOBT. Participants who received a recommendation of only one type of screening did not report a significant difference in ever having or being up-to-date for screening. A potential strategy to increase CRC screening among Chinese Americans is for clinicians to recommend all available CRC screening modalities to each patient.

Unraveling the Determinants to Colorectal Cancer Screening Among Asian Americans: a Systematic Literature Review

Colorectal cancer (CRC) is one of the top three cancers experienced among Asian American (AA) men and women. One effective way to decrease incidence and mortality from CRC is the adherence of regular CRC screening; however, AA continue to receive the lowest screening rates compared to other racial/ethnic groups. When disaggregating this heterogeneous population, further disparities exist between subgroups. Examination of facilitators and barriers to cancer screening among AA subgroups is fairly recent and the synthesis of this information is limited. As such, a systematic review was conducted examining the facilitators and the barriers among Chinese, Filipino, Korean, and Japanese Americans using a systematic literature review method. The Health Belief Model served as the primary theoretical framework for this study and used to organize and synthesize the facilitators and barriers to CRC screening. In total, 22 articles yielded 29 examinations of each of the AA subgroups. Different facilitators and barriers to screening uptake for each subgroup were revealed; however, consistent across all the subgroups was physician recommendation as a facilitator and participants' unawareness of screening tests and those stating having no problems/symptoms of CRC as a barrier across screening modalities. Tailored approach in outreach and intervention efforts are suggested when achieving to improve CRC screening in AA ethnic subgroups.

Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials

INTRODUCTION

Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans.

DESIGN

Cluster randomized comparative trial.

SETTING/PARTICIPANTS

From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin.

INTERVENTION

Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls.

MAIN OUTCOME MEASURES

Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015.

RESULTS

This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date.

CONCLUSIONS

Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT00947206.

Colorectal cancer screening: Opportunities to improve uptake, outcomes, and disparities

Colorectal cancer screening has become a standard of care in industrialized nations for those 50 to 75 years of age, along with selected high-risk populations. While colorectal cancer screening has been shown to reduce both the incidence and mortality of colorectal cancer, it is a complex multi-disciplinary process with a number of important steps that require optimization before tangible improvements in outcomes are possible. For both opportunistic and programmatic colorectal cancer screening, poor participant uptake remains an ongoing concern. Furthermore, current screening modalities (such as the guaiac based fecal occult blood test, fecal immunochemical test and colonoscopy) may be used or performed suboptimally, which can lead to missed neoplastic lesions and unnecessary endoscopic evaluations. The latter poses the risk of adverse events, such as perforation and post-polypectomy bleeding, as well as financial impacts to the healthcare system. Moreover, ongoing disparities in colorectal cancer screening persist among marginalized populations, including specific ethnic minorities (African Americans, Hispanics, Asians, Indigenous groups), immigrants, and those who are economically disenfranchised. Given this context, we aimed to review the current literature on these important areas pertaining to colorectal cancer screening, particularly focusing on the guaiac based fecal occult blood test, the fecal immunochemical test and colonoscopy.

Is Colorectal Cancer A Western Disease? Role of Knowledge and Influence of Misconception on Colorectal Cancer Screening among Chinese and Korean Americans: A Mixed Methods Study

Background:

Chinese and Korean Americans have lower colorectal cancer (CRC) screening rates than other racial/ethnic groups, which may be explained by a low level of CRC knowledge and a high level of misconceptions. This study explores the role of knowledge in CRC screening among these groups.

Methods:

Chinese (N=59) and Korean (N=61) Americans older than 50 were recruited from the Washington D.C. Metropolitan area. They completed a detailed survey and participated in focus groups to discuss their knowledge on CRC and CRC screening. Seventeen physicians, community leaders, and patient navigators participated in key informant interviews. Using a mixed methods approach, data were analyzed quantitatively and qualitatively.

Results:

Participants lacked knowledge about CRC and CRC screening. More than half did not know that screening begins at age 50 and there are several types of tests available. More than 30% thought CRC screening was not necessary if there were no symptoms or there was nothing they could do to prevent CRC. Focus group findings suggested understanding about CRC was limited by an inadequate source of linguistically and culturally relevant health information. For example, many participants considered CRC a western condition mainly caused by unhealthy diet. This led to under-estimations about their susceptibility to CRC. Knowledge was positively associated with self-reported screening. Participants who had higher knowledge scores were more likely to report ever having had a colonoscopy and confidence in ability to have CRC screening.

Conclusions:

Mixed-methods analysis provides multi-faceted perspectives on CRC knowledge and its influence on screening. Study findings can help inform interventions to increase CRC screening among Chinese and Korean Americans.

Persistent racial and ethnic disparities in flu vaccination coverage: Results from a population-based study

BACKGROUND

The Advisory Committee on Immunization Practices recommends annual flu vaccination for all adults. We aimed to identify predictors of receiving a flu vaccination, with an emphasis on the impact of race and ethnicity.

METHODS

We used data from the 2011-2012 California Health Interview Survey and included all individuals aged ≥18 years. We performed a survey-weighted logistic regression on receipt of flu vaccination within the last year, adjusted by demographic and socioeconomic variables, and calculated odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Our study included a population-weighted sample of 27,796,484 individuals. Overall, 35.8% received a flu vaccination within the last year. Blacks were 33% less likely (95% CI, 21%-43%) to have been vaccinated than whites. Conversely, Koreans (OR, 1.77; 95% CI, 1.35-2.33) and Vietnamese (OR, 1.57; 95% CI, 1.19-2.07) were more likely than whites to have been vaccinated. No differences were seen between whites and the remaining racial and ethnic groups (Latino, Japanese, Chinese, Filipino, South Asian, Asian other, and other).

CONCLUSIONS

Racial and ethnic disparities in flu vaccination uptake exist in California. Namely, blacks have lower vaccination rates than whites, and there are disparate vaccination rates among the Asian-American subgroups. Efforts to increase vaccination rates among these groups are needed.

Prevalence of colorectal neoplasms in young, average risk individuals: A turning tide between East and West

AIM

To determine the prevalence of colorectal neoplasia in average risk persons 40-59 years of age in Israel and to compare the results with other populations.

METHODS

We reviewed the results of asymptomatic average-risk subjects, aged 40 to 59 years, undergoing their first screening colonoscopy between April 1994 and January 2014. The detection rates of adenoma, advanced adenoma (AA) and colorectal cancer (CRC) were determined in the 40’s and 50’s age groups by gender. The prevalence of lesions was compared between age groups. After meticulous review of the literature, these results were compared to published studies addressing the prevalence of colorectal neoplasia in similar patient groups, in a variety of geographical locations.

RESULTS

We included first screening colonoscopy results of 1750 individuals. The prevalence of adenomas, AA and CRC was 8.3%, 1.0% and 0.2% in the 40-49 age group and 13.7%, 2.4% and 0.2% in the 50-59 age group, respectively. Age-dependent differences in adenoma and AA rates were significant only among men (P < 0.005). Literature review disclosed 17 relevant studies. As expected, in both Asian and Western populations, the risks for overall adenoma and advanced adenoma was significantly higher in the 50's age group as compared to the 40's age group in a similar fashion. The result of the current study were similar to previous studies on Western populations. A substantially higher rate of adenoma, was observed in studies conducted among Asian populations in both age groups.

CONCLUSION

The higher rate of colorectal neoplasia in Asian populations requires further investigation and reconsideration as to the starting age of screening in that population.

Colorectal Cancer Screening Among Foreign-born South Asians in the Metropolitan New York/New Jersey Region

The goal of this study was to examine colorectal cancer (CRC) screening practices and factors associated with CRC screening among foreign-born South Asians living in the metropolitan New York-New Jersey area. Two hundred and eight men and women recruited from community settings in the New York and New Jersey metropolitan area completed a questionnaire that included demographics, CRC screening practices, health care access and practices, attitudes about the health care system, primary care physician support for CRC screening, cultural factors, and attitudes about CRC screening and CRC worry. Almost a third of the sample had not heard of any of CRC screening tests. Approximately 62 % of the sample had never had a CRC screening test and approximately 69 % of the sample was not currently on schedule with regard to CRC screening. When the relative contribution of significant correlates were evaluated, participants who had lived in the US for a longer time, who endorsed more CRC screening benefits, and who endorsed fewer CRC screening barriers were significantly more likely to have had CRC screening in the past. Participants who were more likely to use English in their daily life, who endorsed more CRC screening benefits, and endorsed fewer CRC screening barriers were more likely to be on schedule with regard to CRC screening. In conclusion, awareness of CRC screening and uptake of screening was low in this population of foreign-born South Asians. Interventions to promote CRC screening may benefit from targeting this subgroup of Asian Americans.

Racial/Ethnic Differences in the Use of Primary Care Providers and Preventive Health Services at a Midwestern University

Many universities seek to improve the health and wellbeing of their faculty and staff through employer wellness programs but racial/ethnic disparities in health care use may still persist. The purpose of this research was to identify racial/ethnic disparities in the use of preventive health services at a Midwestern university. A record review was conducted of self-reported health data from University employees, examining the use of primary care and common screening procedures collected in a Personal Health Assessment conducted by the University's wellness program. Results show that there were significant racial/ethnic differences in the use of primary care and participation in screening. Notably, Asian employees in this sample were less likely to have a primary care provider and participate in routine cancer screenings. The observed racial/ethnic differences in screening behavior were mediated by the use of primary care. Together, these data show that despite equal access to care, racial and ethnic disparities in screening persist and that having a primary care provider is an important predictor of screening behavior. Results suggest that health communications designed to increase screening among specific racial/ethnic minority groups should target primary care use.

Screening or Symptoms? How Do We Detect Colorectal Cancer in an Equal Access Health Care System?

BACKGROUND

Detection of colorectal cancer ideally occurs at an early stage through proper screening. We sought to establish methods by which colorectal cancers are diagnosed within an equal access military health care population and evaluate the correlation between TNM stage at colorectal cancer diagnosis and diagnostic modality (i.e., symptomatic detection vs screen detection).

MATERIALS AND METHODS

A retrospective chart review of all newly diagnosed colorectal cancer patients from January 2007 to August 2014 was conducted at the authors' equal access military institution. We evaluated TNM stage relative to diagnosis by screen detection (fecal occult blood test, flexible sigmoidoscopy, CT colonography, colonoscopy) or symptomatic evaluation (diagnostic colonoscopy or surgery).

RESULTS

Of 197 colorectal cancers diagnosed (59 % male; mean age 62 years), 50 (25 %) had stage I, 47 (24 %) had stage II, 70 (36 %) had stage III, and 30 (15 %) had stage IV disease. Twenty-five percent of colorectal cancers were detected via screen detection (3 % by fecal occult blood testing (FOBT), 0.5 % by screening CT colonography, 17 % by screening colonoscopy, and 5 % by surveillance colonoscopy). One hundred forty-eight (75 %) were diagnosed after onset of signs or symptoms. The preponderance of these was advanced-stage disease (stages III-IV), although >50 % of stage I-II disease also had signs or symptoms at diagnosis. The most common symptoms were rectal bleeding (45 %), abdominal pain (35 %), and change in stool caliber (27 %). The most common overall sign was anemia (60 %). Screening FOBT (odds ratio (OR) 8.7, 95 % confidence interval (CI) 1.0-78.3; P = 0.05) independently predicted early diagnosis with stage I-II disease. Patient gender and ethnicity were not associated with cancer stage at diagnosis.

CONCLUSIONS

Despite equal access to colorectal cancer screening, diagnosis after development of symptomatic cancer remains more common. Fecal occult blood screen detection is associated with early stage at colorectal cancer diagnosis and is the focus for future initiatives.

Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years

OBJECTIVES

We have shown that, in a randomized trial comparing adherence to different colorectal cancer (CRC) screening strategies, participants assigned to either fecal occult blood testing (FOBT) or given a choice between FOBT and colonoscopy had significantly higher adherence than those assigned to colonoscopy during the first year. However, how adherence to screening changes over time is unknown.

METHODS

In this trial, 997 participants were cluster randomized to one of the three screening strategies: (i) FOBT, (ii) colonoscopy, or (iii) a choice between FOBT and colonoscopy. Research assistants helped participants to complete testing only in the first year. Adherence to screening was defined as completion of three FOBT cards in each of 3 years after enrollment or completion of colonoscopy within the first year of enrollment. The primary outcome was adherence to assigned strategy over 3 years. Additional outcomes included identification of sociodemographic factors associated with adherence.

RESULTS

Participants assigned to annual FOBT completed screening at a significantly lower rate over 3 years (14%) than those assigned to colonoscopy (38%, P<0.001) or choice (42%, P<0.001); however, completion of any screening test fell precipitously, indicating the strong effect of patient navigation. In multivariable logistic regression analysis, being randomized to the choice or colonoscopy group, Chinese language, homosexuality, being married/partnered, and having a non-nurse practitioner primary care provider were independently associated with greater adherence to screening (P<0.01).

CONCLUSIONS

In a 3-year follow-up of a randomized trial comparing competing CRC screening strategies, participants offered a choice between FOBT and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups. Patient navigation is crucial to achieving adherence to CRC screening, and FOBT is especially vulnerable because of the need for annual testing.

Increased risk for colorectal cancer under age 50 in racial and ethnic minorities living in the United States

Colorectal cancer (CRC) is the second most common cause of cancer death in USA. We analyzed CRC disparities in African Americans, Hispanics, Asians/Pacific Islanders, and American Indians/Alaska Natives compared to non‐Hispanic Whites. Current guidelines recommend screening for CRC beginning at age 50. Using SEER (Surveillance, Epidemiology, and End Results) database 1973–2009 and North American Association of Central Cancer Registries (NAACCR) 1995–2009 dataset, we performed frequency and rate analysis on colorectal cancer demographics and incidence based on race/ethnicity. We also used the SEER database to analyze stage, grade, and survival based on race/ethnicity. Utilizing SEER database, the median age of CRC diagnosis is significantly less in Hispanics (66 years), Asians/Pacific Islanders (68 years), American Indians/Alaska Natives (64 years), and African Americans (64 years) compared to non‐Hispanic whites (72 years). Twelve percent of Asians/Pacific Islanders, 15.4% Hispanics, 16.5% American Indians/Alaska Natives, and 11.9% African Americans with CRC are diagnosed at age <50 years compared to only 6.7% in non‐Hispanic Whites (P < 0.0001). Minority groups have more advanced stages at diagnosis compared to non‐Hispanic Whites. Trend analysis showed age‐adjusted incidence rates of CRC diagnosed under the age of 50 years have significantly increased in all racial and ethnic groups but are stable in African Americans. These results were confirmed through analysis of NAACCR 1995–2009 dataset covering nearly the entire USA. A significantly higher proportion of minority groups in USA with CRC are diagnosed before age 50 compared to non‐Hispanic Whites, documenting that these minority groups are at higher risk for early CRC. Further studies are needed to identify the causes and risk factors responsible for young onset CRC among minority groups and to develop intervention strategies including earlier CRC screening, among others.

Socioeconomic Disparities in Colorectal Cancer Screening in Korea: A Nationwide Cross-Sectional Study

Colorectal cancer (CRC) is a common cancer worldwide. The incidence and mortality rates of CRC are higher among lower socioeconomic status (SES) populations. We investigated the association between different indicators of SES and CRC screening rates in Korea. The eligible study population included males and females aged 50 to 74 years who participated in a nationwide cross-sectional survey (2010-2012). The "compliance with recommendation" category was applicable to participants who had undergone a fecal occult blood test (FOBT), double-contrast barium enema, or colonoscopy within 1, 5, or 10 years, respectively. In total, 6221 subjects (51.4% female, 55.6% aged 50 years) were included in the final analysis. Lower household income was significantly negatively related to compliance with screening recommendations (P for trend < 0.01) and marginally significantly related to noncompliance with recommendations (P for trend = 0.07). Older age and poor self-reported health were associated with the screening rate using the FOBT; male sex, older age, higher household income, having supplemental insurance, family history of cancer, and poor self-reported health were associated with a higher screening rate using colonoscopy. Lower household income was associated with a higher screening rate using the FOBT and with a lower screening rate using colonoscopy. To increase the rate of CRC screening using colonoscopy, efforts should be made toward improving the education and promotion of screening to the low household income target population.

Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices

Background

Complementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at who does not use these approaches, and why not.

Methods

To explore this issue two samples were created using data from the 2007 National Health Interview Survey Complementary and Alternative Medicine supplement. Of particular interest was the relationship between lack of health knowledge, as a reason for non-use, and key independent variables. The first sample was comprised of individuals who had never used any of four common complementary health practices -- acupuncture, chiropractic, natural products, and yoga. The second was a subset of those same non-users who had also reported low back pain, the most frequently cited health concern related to use of complementary therapies.

Results

A hypothesized association between lack of health knowledge, lower educational attainment, and other key socioeconomic indicators was supported in the findings. Although it was hypothesized that low back pain would be associated with greater information seeking, regardless of level of education, that hypothesis was not supported.

Conclusion

Lack of knowledge was found to affect utilization of common complementary health practices, regardless of the potentially motivating presence of back pain. Disparities in the utilization of complementary medicine, related to educational attainment and other socioeconomic factors, may negatively affect quality of care for many Americans. Creative approaches are needed to help reduce inequities in understanding and improve access to care for underserved populations.

Engaging traditional medicine providers in colorectal cancer screening education in a chinese american community: a pilot study

INTRODUCTION

Although colorectal cancer (CRC) screening is effective in preventing colon cancer, it remains underused by Asian Americans. Because Chinese Americans often use traditional Chinese medicine (TCM), we conducted a pilot study to explore the feasibility and acceptability of having TCM providers deliver education about CRC screening.

METHODS

Four TCM providers (2 herbalists and 2 acupuncturists) were trained to deliver small-group educational sessions to promote CRC screening. Each provider recruited 15 participants aged 50 to 75. Participants completed a baseline survey on CRC-related knowledge, attitudes, and behaviors and then attended one 2-hour educational session delivered by the providers in Cantonese or Mandarin. Three months later, participants completed a postintervention survey.

RESULTS

Sixty participants were recruited from the San Francisco Chinatown neighborhood. The average age was 62.4 years. Most participants had limited English proficiency (96.7%), annual household income less than $20,000 per year (60%), and low educational attainment (65.1% < high school education). At postintervention (n = 57), significant increases were found in having heard of CRC (from 52.6% to 79.0%, P < .001) and colon polyps (from 64.9% to 84.2%, P < .001). Knowledge regarding screening frequency recommendations also increased significantly. The rate of ever having received any CRC screening test increased from 71.9% to 82.5% (P <.001). The rate of up-to-date screening increased from 70.2% to 79.0% (P = .04).

CONCLUSION

The findings suggest that TCM providers can be trained to deliver culturally and linguistically appropriate outreach on CRC screening within their community. Participants reached by TCM providers increased CRC knowledge and self-reported CRC screening.

Colorectal cancer screening among Korean Americans: a systematic review

The incidence of colorectal cancer (CRC) among Korean Americans (KAs) has increased in recent years, even as the rate in nearly ever other population group in the United States has decreased. Reversing this trend will require improving screening rates, but a variety of sociocultural factors may inhibit this goal. We conducted a systematic review of the published literature on cancer screening among KAs, and identified thirteen eligible studies that examined CRC screening. KAs have CRC screening rates that are significantly lower than the national average. Only about one in four KAs ages 50 and older reports having ever had a fecal ocult blood test (FOBT) and only about 40 % have ever had a sigmoidoscopy or colonoscopy. KA adults are also significantly less likely than the general US population to say they have heard of FOBT, sigmoidoscopy, or colonoscopy. In the KA population, screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, more social support, and better access to healthcare services. Improving cultural and financial access to health education and healthcare services may increase CRC screening among KAs and reduce the incidence of the disease.

Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans

BACKGROUND

Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed to recall-based) rates of cancer screening. In this article, we seek to better understand cancer screening patterns in a population of insured Asian Americans.

METHODS

We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population and compared them with non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider- and patient-level) of screening completion among Asian patients.

RESULTS

Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient-physician language discordance for mammography [OR, 0.81; 95% confidence interval (CI), 0.71-0.92] and colorectal cancer screening (OR, 0.79; CI, 0.72-0.87) and positively associated with patient-provider gender concordance for mammography (OR, 1.16; CI, 1.00-1.34) and cervical cancer screening (OR, 1.66; CI, 1.51-1.82). In addition, patient enrollment in online health services increased mammography (OR, 1.32; CI, 1.20-1.46) and cervical cancer screening (OR, 1.31; CI, 1.24-1.37).

CONCLUSIONS

Language- and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations.

IMPACT

This study demonstrates how the use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting.

Colorectal cancer among Koreans living in South Korea versus California: incidence, mortality, and screening rates

OBJECTIVES

This study compared trends in colorectal cancer (CRC) incidence and mortality rates among Koreans in South Korea and Korean Americans and non-Hispanic whites in California between 1999 and 2009, and examined CRC screening rates and socio-demographic correlates of CRC screening in the two Korean populations.

DESIGN

Age-standardized CRC incidence and mortality rates of Koreans in South Korea and Korean Americans and non-Hispanic whites in California for the years 1999-2009 were obtained from annual reports of cancer statistics and modeled using joinpoint regression. Using 2009 data from the Korean National Health and Nutrition Examination Survey and the California Health Interview Survey, we estimated and compared CRC screening rates and test modalities. We used multiple logistic regression to examine socio-demographic correlates of completion of CRC screening according to the guidelines among the two Korean populations.

RESULTS

CRC incidence and mortality rates among South Koreans increased during 1999-2009 but more slowly during the late 2000s. In California, CRC incidence increased among Korean American females but decreased among non-Hispanic whites. About 37% of South Koreans and 60% of Korean Americans reported completion of CRC screening according to guidelines in 2009. Among South Koreans, married status, higher income, and private health insurance were associated with CRC screening, adjusting for other factors. Among Korean Americans, having health insurance was associated with CRC screening.

CONCLUSION

Despite almost identical CRC screening guidelines in South Korea and the USA and substantially higher screening rates among Korean Americans as compared to South Koreans, disparities remain in both populations with respect to CRC statistics. Thus, efforts to promote primary and secondary prevention of CRC in both Korean populations are critically important in both countries.

Understanding current racial/ethnic disparities in colorectal cancer screening in the United States: the contribution of socioeconomic status and access to care

BACKGROUND

Prior studies have shown racial/ethnic disparities in colorectal cancer (CRC) screening but have not provided a full national picture of disparities across all major racial/ethnic groups.

PURPOSE

To provide a more complete, up-to-date picture of racial/ethnic disparities in CRC screening and contributing socioeconomic and access barriers.

METHODS

Behavioral Risk Factor Surveillance System data from 2010 were analyzed in 2013. Hispanic/Latino participants were stratified by preferred language (Hispanic-English versus Hispanic-Spanish). Non-Hispanics were categorized as White, Black, Asian, Native Hawaiian/Pacific Islander, or American Indian/Alaska Native. Sequential regression models estimated adjusted relative risks (RRs) and the degree to which SES and access to care explained disparities.

RESULTS

Overall, 59.6% reported being up-to-date on CRC screening. Self-reported CRC screening was highest in the White (62.0%) racial/ethnic group; followed by Black (59.0%); Native Hawaiian/Pacific Islander (54.6%); Hispanic-English (52.5%); American Indian/Alaska Native (49.5%); Asian (47.2%); and Hispanic-Spanish (30.6%) groups. Adjustment for SES and access partially explained disparities between Whites and Hispanic-Spanish (final relative risk [RR]=0.76, 95% CI=0.69, 0.83); Hispanic-English (RR=0.94, 95% CI=0.91, 0.98); and American Indian/Alaska Native (RR=0.91, 95% CI=0.85, 0.97) groups. The RR of screening among Asians was unchanged after adjustment for SES and access (0.78, p<0.001). After full adjustment, screening rates were not significantly different among Whites, Blacks, or Native Hawaiian/Pacific Islanders.

CONCLUSIONS

Large racial/ethnic disparities in CRC screening persist, including substantial differences between English-speaking versus Spanish-speaking Hispanics. Disparities are only partially explained by SES and access to care. Future studies should explore the low rate of screening among Asians and how it varies by racial/ethnic subgroup and language.

Diabetes care and service access among elderly Vietnamese with type 2 diabetes

BACKGROUND

Vietnamese patients are disproportionately represented in type 2 diabetes mellitus statistics and also incur high rates of diabetes complications. This situation is compounded by limited access to health care. The aim of this project was to gain a deeper understanding of the difficulties Vietnamese patients experience when accessing services and managing their type 2 diabetes mellitus, and to identify factors that are important in promoting health service use.

METHODS

Three focus groups with 15 Vietnamese participants with type 2 diabetes mellitus, 60 to >70 years of age, were conducted in Vietnamese. Open-ended questions were used and focussed on experiences of living with diabetes and access to healthcare services in the Inner Northwest Melbourne region. Audio recordings were transcribed and then translated into English. Data were analysed using a thematic analysis framework.

RESULTS

Findings indicate four main themes, which together provide some insight into the experiences of living with diabetes and accessing ongoing care and support, for elderly Vietnamese with type 2 diabetes. Themes included: (1) the value of being healthy; (2) controlling diabetes; (3) staying healthy; and (4) improving services and information access.

CONCLUSIONS

Participants in this study were encouraged to adhere to diabetes self-management principles, based largely on a fear of medical complications. Important aspects of healthcare access were identified as; being treated with respect, having their questions answered and having access to interpreters and information in Vietnamese. Attention to these details is likely to lead to improved access to healthcare services and ultimately to improve glycemic control and overall health status for this community.

Racial and ethnic variations in the effects of family history of colorectal cancer on screening compliance

BACKGROUND & AIMS

Individuals with a family history of colorectal cancer (CRC) have a higher risk of developing CRC than the general population, and studies have shown that they are more likely to undergo CRC screening. We assessed the overall and race- and ethnicity-specific effects of a family history of CRC on screening.

METHODS

We analyzed data from the 2009 California Health Interview Survey to estimate overall and race- and ethnicity-specific odds ratios (ORs) for the association between family history of CRC and CRC screening.

RESULTS

The unweighted and weighted sample sizes were 23,837 and 8,851,003, respectively. Individuals with a family history of CRC were more likely to participate in any form of screening (OR, 2.3; 95% confidence limit [CL], 1.7, 3.1) and in colonoscopy screening (OR, 2.7; 95% CL, 2.2, 3.4) than those without a family history, but this association varied among racial and ethnic groups. The magnitude of the association between family history and colonoscopy screening was highest among Asians (OR, 6.1; 95% CL, 3.1, 11.9), lowest among Hispanics (OR, 1.4; 95% CL, 0.67, 2.8), and comparable between non-Hispanic whites (OR, 3.1; 95% CL, 2.6, 3.8) and non-Hispanic blacks (OR 2.6; 95% CL, 1.2, 5.7) (P for interaction < .001).

CONCLUSIONS

The effects of family history of CRC on participation in screening vary among racial and ethnic groups, and have the lowest effects on Hispanics, compared with other groups. Consequently, interventions to promote CRC screening among Hispanics with a family history should be considered.