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Yendewa GA, Salata RA, Olasehinde T, Mulindwa F, Jacobson JM, Mohareb AM. Self-reported hepatitis B testing among noninstitutionalized adults in the United States before the implementation of universal screening, 2013-2017: A nationwide population-based study. J Viral Hepat 2024. [PMID: 39078109 DOI: 10.1111/jvh.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 06/09/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024]
Abstract
In 2023, the US Centers for Disease Control and Prevention recommended universal screening for hepatitis B virus (HBV); however, the proportion of US adults screened before implementing this recommendation is unknown. We analysed nationally representative data from the National Health Interview Survey (2013-2017) on self-reported HBV testing among noninstitutionalized US adults ≥18 years. We employed Poisson logistic regression to identify factors associated with self-reported testing, using a conceptual framework that included four overarching factors: sociodemographic characteristics, healthcare access, health-seeking behaviours and experiences, and access to internet-based health information. Among 149,628 survey respondents, the self-reported HBV testing rate was 27.2% (95% CI 26.2-28.7) and increased by 1.7% from 2013 to 2017 (p = .006). In adjusted analysis, health-seeking behaviours and experiences had the strongest associations of self-reported testing including a history of hepatitis (AOR 2.68, 95% CI 1.92-3.73), receipt of hepatitis B vaccination (AOR 5.11, 95% CI 4.61-5.68) and prior testing for hepatitis C (AOR 9.14, 95% CI 7.97-10.48) and HIV (AOR 2.69, 95% CI 2.44-2.97). Other factors associated with testing included being male (AOR 1.14, 95% CI 1.03-1.26), ages 30-44 years (AOR 1.37, 95% CI 1.17-1.61), 45-60 years (AOR 1.55, 95% CI 1.30-1.80) and ≥60 years (AOR 1.53, 95% CI 1.28-1.84), residence in the Western US region (AOR 1.23, 95% CI 1.06-1.43), and access to internet-based health information (AOR 1.32, 95% CI 1.18-1.47). Being Hispanic was associated with lower odds of testing (AOR 0.80, 95% CI 0.66-0.97). These findings may help guide optimal HBV screening in the universal testing era.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Temitope Olasehinde
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Frank Mulindwa
- United Health Services Wilson Medical Center, Johnson City, New York, USA
| | - Jeffrey M Jacobson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amir M Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Partida D, Powell J, Ricco M, Naugle J, Magee C, Zevin B, Masson CL, Fokuo JK, Gonzalez D, Khalili M. Formal Hepatitis C education increases willingness to receive therapy in an onsite shelter-based HCV model of care in persons experiencing homelessness. Open Forum Infect Dis 2022; 9:ofac103. [PMID: 35369281 PMCID: PMC8968162 DOI: 10.1093/ofid/ofac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/28/2022] [Indexed: 12/09/2022] Open
Abstract
Abstract
Background
To evaluate the effectiveness of formal Hepatitis C (HCV) education on engagement in therapy in persons experiencing homelessness in an onsite shelter-based model of care. As policies to eliminate Medicaid access restrictions to HCV treatment are expanded, patient education is paramount to achieving HCV elimination targets in difficult to engage populations including persons experiencing homelessness.
Methods
This prospective study was conducted at four shelters in San Francisco and Minneapolis from August 2018 to January 2021. Of the 162 HCV Ab positive participants, 150 participated in a 30-minute HCV education session. Post-education changes in knowledge, beliefs, barriers to care and willingness to accept therapy scores were assessed.
Results
Following education, knowledge scores (mean change 4.4 ± 4.4, p<0.001) and willingness to accept therapy (70% to 86% p=0.0002) increased. Perceived barriers to HCV care decreased (mean change -0.8 ± 5.2 p=0.001). Higher baseline knowledge was associated with lesser gain in knowledge following education (coef. -0.7, p<0.001). Post-education knowledge (OR 1.2, p=0.008) was associated with willingness to accept therapy.
Conclusions
An HCV educational intervention successfully increased willingness to engage in HCV therapy in persons experiencing homelessness in an onsite shelter-based HCV model of care.
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Affiliation(s)
- Diana Partida
- Department of Medicine, University of California San Francisco, San Francisco, CA, U.S.A
| | | | | | - Jessica Naugle
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, U.S.A
| | - Catherine Magee
- Department of Medicine, Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital, San Francisco, CA, U.S.A
| | - Barry Zevin
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, U.S.A
| | - Carmen L Masson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, U.S.A
| | - J Konadu Fokuo
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, U.S.A
| | - Daniel Gonzalez
- University of California San Francisco Liver Center, San Francisco, CA, U.S.A. Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - Mandana Khalili
- University of California San Francisco Liver Center, San Francisco, CA, U.S.A. Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, U.S.A
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Chu JN, Stewart SL, Gildengorin G, Wong C, Lam H, McPhee SJ, Chen MS, Bastani R, Maxwell AE, Taylor VM, Nguyen TT. Effect of a media intervention on hepatitis B screening among Vietnamese Americans. ETHNICITY & HEALTH 2022; 27:361-374. [PMID: 31608675 PMCID: PMC7162532 DOI: 10.1080/13557858.2019.1672862] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
Objective: There is a lack of controlled studies of community-wide interventions to increase screening for hepatitis B (HBV) among Asian Americans, particularly Vietnamese Americans, who disproportionately suffer from HBV-related illnesses. The objective of our study was to develop, implement, and evaluate the effectiveness of a media campaign to promote HBV screening among Vietnamese Americans.Design: We designed and implemented a three-year media campaign promoting HBV screening among Vietnamese Americans. Evaluation consisted of cross-sectional pre- and post-intervention population-based telephone surveys of Vietnamese Americans adults age 18-64 who spoke English or Vietnamese and lived in the Northern California (intervention) or Greater Washington, D.C. (comparison) communities in 2007 or 2011. Statistical analysis was completed in 2012. The main outcome was self-report of HBV testing, defined as participants answering 'Yes' to the question: 'Have you ever had a blood test to check for hepatitis B?'Results: The sample sizes at pre- and post-intervention were 1,704 and 1,666, respectively. Both communities reported increased exposure to HBV-related booklets, radio and television advertisements, and websites. Only the intervention community reported increased exposure to newspaper elements. HBV screening increased in both communities (intervention: 65.3% to 73.1%, p < 0.01, comparison: 57.7% to 66.0%, p < 0.01). In multivariable analyses, there was no intervention effect. In both communities, exposure to media elements (Odds Ratio 1.26 [95% Confidence Interval: 1.21, 1.31] for each additional element) was significantly associated with screening.Conclusions: Among Vietnamese Americans in 2 large communities, HBV screening rates were sub-optimal. Screening increased in both the intensive media intervention and comparison communities, and exposure to HBV-related media messages was associated with increased screening. Efforts to address HBV screening among Vietnamese Americans should include mass media messaging.
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Affiliation(s)
- Janet N. Chu
- Division of General Internal Medicine, Department of
Medicine, University of California, San Francisco; San Francisco, CA, USA
| | - Susan L. Stewart
- Department of Public Health Sciences, University of
California, Davis; Davis, CA, USA
| | - Ginny Gildengorin
- Division of General Internal Medicine, Department of
Medicine, University of California, San Francisco; San Francisco, CA, USA
| | - Ching Wong
- Division of General Internal Medicine, Department of
Medicine, University of California, San Francisco; San Francisco, CA, USA
| | - Hy Lam
- Division of General Internal Medicine, Department of
Medicine, University of California, San Francisco; San Francisco, CA, USA
| | - Stephen J. McPhee
- Division of General Internal Medicine, Department of
Medicine, University of California, San Francisco; San Francisco, CA, USA
| | - Moon S. Chen
- Division of Hematology and Oncology, Department of Internal
Medicine, University of California, Davis; Davis, CA, USA
| | - Roshan Bastani
- Department of Health Policy and Management, University of
California, Los Angeles; Los Angeles, CA, USA
| | - Annette E. Maxwell
- Department of Health Policy and Management, University of
California, Los Angeles; Los Angeles, CA, USA
| | - Victoria M. Taylor
- Division of Public Health Sciences, Fred Hutchinson
Cancer Research Center; Seattle, WA, USA
| | - Tung T. Nguyen
- Division of General Internal Medicine, Department of
Medicine, University of California, San Francisco; San Francisco, CA, USA
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Maxwell AE, Vargas C, Santifer R, Chang LC, Crespi CM, Lucas-Wright A. Facilitators and Challenges to Health Promotion in Black and Latino Churches. J Racial Ethn Health Disparities 2022; 9:59-67. [PMID: 33230738 PMCID: PMC8141063 DOI: 10.1007/s40615-020-00929-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Churches are important assets for the African American and Latino communities. They can play a critical role in health promotion, especially in areas that are under-resourced and in which residents have limited access to health care. A better understanding of health promotion in churches is needed to support and maintain church collaborations and health initiatives that are integrated, data-driven, and culturally appropriate. The purpose of this study is to identify churches' facilitators and challenges to health promotion and to contrast and compare Black and Latino churches of different sizes (< 200 members versus > 200 members). METHODS We interviewed leaders of 100 Black and 42 Latino churches in South Los Angeles to assess their history of wellness activities, resources, facilitators, and challenges to conduct health promotion activities. RESULTS Eighty-three percent of African American and 86% of Latino church leaders reported at least one health activity in the last 12 months. Black and Latino churches of different sizes have similar interests in implementing specific health promotion strategies and face similar challenges. However, we found significant differences in the composition of their congregations, number of paid staff, and the proportions of churches that have a health or wellness ministry and that implement specific wellness strategies. Fifty-seven percent of African American and 43% of Latino church leaders stated that they needed both financial support and professional expertise for health promotion. DISCUSSION Our findings highlight the importance of conducting a readiness assessment for identifying intervention content and strategies that fit the intervention context of a church.
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Affiliation(s)
- Annette E Maxwell
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
- UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Claudia Vargas
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Rhonda Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - L Cindy Chang
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
- UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Catherine M Crespi
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
- UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Nguyen T, Pham T, Tang HK, Phan L, Mize G, Lee WM, Gish R, Trang A, Le A, Phan HT, Nguyen BT, Dao DY. Unmet needs in occupational health: prevention and management of viral hepatitis in healthcare workers in Ho Chi Minh City, Vietnam: a mixed-methods study. BMJ Open 2021; 11:e052668. [PMID: 34642198 PMCID: PMC8513255 DOI: 10.1136/bmjopen-2021-052668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Vietnam is an endemic area for hepatitis B virus and hepatitis C virus infection (HBV-HCV), yet its largest city, Ho Chi Minh City (HCMC), has no comprehensive policy to educate, screen, treat and protect healthcare workers (HCWs) from viral hepatitis. We conducted a mixed-methods study to document HBV-HCV infection rates, risk factors, local barriers and opportunities for providing education, screening and medical care for HCWs. DESIGN This mixed-methods study involved an HBV and HCV serological evaluation, knowledge, attitude and practice survey about viral hepatitis and many in-depth interviews. Descriptive statistics and thematic content analysis using inductive and deductive approaches were used. SETTING HCMC, Vietnam. PARTICIPANTS HCWs at risk of viral hepatitis exposure at three hospitals in HCMC. RESULTS Of the 210 invited HCWs, 203 were enrolled. Of the 203 HCWs enrolled, 20 were hepatitis B surface antigen-positive, 1 was anti-hepatitis C antibody (anti-HCV Ab)-positive, 57 were anti-hepatitis B core Ab-positive and 152 had adequate anti-hepatitis B surface Ab (anti-HBs Ab) titre (≥10IU/mL). Only 50% of the infected HCWs reported always using gloves during a clinical activity involving handling of blood or bodily fluid. Approximately 50% of HCWs were still not vaccinated against HBV following 1 year of employment. In-depth interviews revealed two major concerns for most interviewees: the need for financial support for HBV-HCV screening and treatment in HCWs and the need for specific HBV-HCV guidelines to be independently developed. CONCLUSIONS The high HBV infection rate in HCWs coupled with inadequate preventive occupational practices among the population in HCMC highlight the urgent needs to establish formal policy and rigorous education, screening, vaccination and treatment programmes to protect HCWs from HBV acquisition or to manage those living with chronic HBV in Vietnam.
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Affiliation(s)
- Tran Nguyen
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Trang Pham
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hong K Tang
- Department of Epidemiology, Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
| | - Loc Phan
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
| | - Gary Mize
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
| | - William M Lee
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
| | - Robert Gish
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
| | - Amy Trang
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
| | - Anh Le
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
| | - Hai T Phan
- Medic Medical Center, Ho Chi Minh CIty, Vietnam
| | - Binh T Nguyen
- Ho Chi Minh City Department of Health, Ho Chi Minh City, Vietnam
| | - Doan Y Dao
- Vietnam Viral Hepatitis Alliance, Reston, Virginia, USA
- Center of Excellence for Liver Disease in Vietnam, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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Vu M, Huynh VN, Berg CJ, Allen CG, Nguyen PLH, Tran NA, Srivanjarean Y, Escoffery C. Hepatitis B Testing Among Vietnamese in Metropolitan Atlanta: The Role of Healthcare-Related and Acculturation-Related Factors. J Community Health 2021; 46:767-776. [PMID: 33180219 PMCID: PMC8113341 DOI: 10.1007/s10900-020-00947-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Compared to other racial/ethnic groups, U.S. Vietnamese have higher Hepatitis B infection prevalence, which is a major liver cancer risk factor. Increased testing could reduce this disparity. It is critical to understand subgroups of U.S. Vietnamese least likely to have been tested for Hepatitis B and design appropriate interventions. We examined healthcare- and acculturation-related factors influencing Hepatitis B testing among U.S. Vietnamese. METHODS Survey data of 100 U.S. Vietnamese attending health fairs/programs hosted by community-based organizations (2017-2018) were analyzed. Healthcare-related predictors included insurance and past 2-year checkup. Acculturation-related predictors included Vancouver Acculturation Index, percentage of lifetime in the U.S., and Vietnamese and English fluency. We conducted a multiple logistic regression controlling for age, sex, education, and household income. RESULTS The sample was an average 37.5 years old and 61.6% female. Insurance coverage was reported by 83.0%. Average percentage of lifetime in the U.S. was 56.8%. Seventy percent reported having received Hepatitis B testing. Hepatitis B testing was associated with health insurance (aOR = 2.61, 95% CI = [1.05-6.47], p = .04) but not any acculturation-related predictors CONCLUSION: Improving insurance coverage and options can be a strategy to increase Hepatitis B testing among U.S. Vietnamese. More education regarding Hepatitis B (e.g., via community-based, culturally-appropriate, lay health worker-led programs) is needed to ensure that individuals are aware of their testing status and pursue appropriate healthcare decisions.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Victoria N Huynh
- Emory College of Arts & Sciences, Emory University, Atlanta, GA, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C, USA
| | - Caitlin G Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | | | - Ngoc-Anh Tran
- Nguyen Hue High School for the Gifted, Hanoi, Vietnam
| | | | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
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Mukhtar NA, Evon DM, Yim C, Lok AS, Lisha N, Lisker-Melman M, Hassan M, Janssen HL, Khalili M. Patient Knowledge, Beliefs and Barriers to Hepatitis B Care: Results of a Multicenter, Multiethnic Patient Survey. Dig Dis Sci 2021; 66:434-441. [PMID: 32239377 PMCID: PMC7529692 DOI: 10.1007/s10620-020-06224-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A greater understanding of the determinants of health behavior among those with and at-risk of chronic hepatitis B virus (HBV) infection is needed for effective design and implementation of public health initiatives. AIMS To determine factors associated with (1) willingness to accept HBV antiviral treatment and (2) satisfaction with provider communication regarding HBV care in a diverse cohort of HBV-infected patients. METHODS Using a multifaceted model of health behavior, the Health Behavior Framework, we conducted a comprehensive assessment of knowledge, attitudes, beliefs, and barriers to HBV care. RESULTS We enrolled 510 patients, with mean age 46 years; 53.1% men; and 71.6% Asian or Hawaiian/Pacific Islander. Patients were knowledgeable about HBV infection, but one-fifth did not think that HBV was a treatable disease; over a quarter felt it was so common among family and friends that it did not concern them, and less than half of patients believed they were likely to have liver problems or transmit HBV to others during their lifetime. Perceived susceptibility to disease risk was the only independent predictor of willingness to accept HBV treatment (β = 0.23, p = 0.0005), and contrary to expectations, having a doctor that speaks the same language was predictive of lower patient satisfaction with provider communication about their HBV care (β = - 0.65, p < 0.0001). CONCLUSIONS Patients with greater perceived susceptibility to the health consequences of HBV infection are more likely to accept treatment, and patient-provider language concordance impacts patient satisfaction with communication regarding HBV care in an unexpected direction.
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Affiliation(s)
- Nizar A. Mukhtar
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, 2350 Geary Blvd., 2 Floor, San Francisco, CA 94115
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 8010 Burnett-Womack Building, 101 Manning Drive, Chapel Hill, NC 27599
| | - Colina Yim
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, 585 University Ave., Norman Urquhart Building, 13 floor, Toronto, ON, M5G 2N2
| | - Anna S. Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109
| | - Nadra Lisha
- Department of Medicine, University of California San Francisco, 530 Parnassus Ave., Rm 363, San Francisco, CA 94143
| | - Mauricio Lisker-Melman
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8124, St. Louis, MO 63110
| | - Mohamed Hassan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, 420 Delaware Street SE, MMC 36, Minneapolis, MN 55455
| | - Harry L.A. Janssen
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, 585 University Ave., Norman Urquhart Building, 13 floor, Toronto, ON, M5G 2N2
| | - Mandana Khalili
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 1001 Potrero Ave., Ward 3D-4, San Francisco, CA 94110
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Srisai P, Phaiyarom M, Suphanchaimat R. Perspectives of Migrants and Employers on the National Insurance Policy (Health Insurance Card Scheme) for Migrants: A Case Study in Ranong, Thailand. Risk Manag Healthc Policy 2020; 13:2227-2238. [PMID: 33117001 PMCID: PMC7585867 DOI: 10.2147/rmhp.s268006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/24/2020] [Indexed: 01/09/2023] Open
Abstract
Background and Purposes Thailand has implemented a nationwide insurance policy for migrants, namely the Health Insurance Card Scheme (HICS), for a long time. However, numerous implementation challenges remain and migrant perspectives on the policy are rarely known. The aim of this study was to examine migrant service users’ perspectives and their consequent response towards the HICS. Methods A qualitative case-study approach was employed. In-depth interviews with ten local migrants and four employers were conducted in one of the most densely migrant-populated provinces in Thailand. Document review was used as a means for data triangulation. Inductive thematic analysis was exercised on interview data. Results The findings revealed that most migrants were not aware of the benefit, they are entitled to receive from the HICS due to unclear communication and inadequate announcements about the policy. The registration costs needed for legalising migrants’ precarious status were a major concern. Adequate support from employers was a key determining factor that encouraged migrants to participate in the registration process and purchase the insurance card. Some employers sought assistance from private intermediaries or brokers to facilitate the registration process for migrants. Conclusion Proper communication and promotion regarding the benefits of the HICS and local authorities taking action to expedite the registration process for migrants are recommended. The policy should also establish a mechanism to receive feedback from migrants. This will help resolve implementation challenges and lead to further improvement of the policy.
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Affiliation(s)
- Patinya Srisai
- International Health Policy Program (IHPP), The Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Mathudara Phaiyarom
- International Health Policy Program (IHPP), The Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), The Ministry of Public Health, Nonthaburi 11000, Thailand.,Division of Epidemiology, Department of Disease Control, The Ministry of Public Health, Nonthaburi 11000, Thailand
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Cancer surveillance and preventive services in a diverse sample of breast and colorectal cancer survivors. J Cancer Surviv 2020; 15:213-223. [PMID: 32794009 DOI: 10.1007/s11764-020-00925-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer survivors diagnosed at an early age remain at risk for cancer recurrence and other chronic diseases. This study assessed engagement in surveillance for recurrence, cancer screening, and other recommended preventive health services among breast and colorectal cancer survivors with early-onset disease (≤ 50 years) who were diagnosed in California. METHODS Breast and colorectal cancer survivors diagnosed with early-onset cancer between 1999 and 2009 were identified through the California Cancer Registry, the state-based cancer registry, and surveyed. Multivariable regression analyses were used to assess correlates of receipt of cancer surveillance, cancer screening, and other preventive health services. RESULTS Of the 497 survivors that were invited to participate in the study, 156 completed the survey for a response rate of 31%. The sample was 50 years of age on average (range 32-69 years) with a mean time since diagnosis of 9 years. The majority of the sample (71%) was a racial/ethnic minority (24% Latino, 15% African American, 29% Asian). Overall, 80% received appropriate surveillance for recurrence, and 72% received recommended screening for early detection of other cancers (breast, cervical, colorectal). Increasing age was associated with lower likelihood of early detection screening (adjusted odds ratio (aOR) 0.28, 95% confidence interval (CI) 0.11-0.69), and higher income was associated with a greater likelihood (aOR 4.89, 95% CI 1.62-14.81). Screening rates were highest for blood pressure (96%), cholesterol (86%), and diabetes (81%), followed by dental visits (64%) and flu vaccination (35%). Greater use of recommended preventive health services was associated with increasing age, female sex, higher education level, and having health insurance. CONCLUSIONS Although the majority of survivors received appropriate surveillance for recurrence, engagement in other preventive health services varied substantially. IMPLICATIONS FOR CANCER SURVIVORS Efforts are needed to address gaps in the use of recommended cancer screening and preventive health services among cancer survivors, particularly survivors with early-onset disease who may be at increased risk for additional cancers and common chronic conditions over their lifetime.
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Hepatitis B Birth Dose among Children in District 2 Hospital, Ho Chi Minh City, Vietnam: Prevalence and Associated Factors. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:5680154. [PMID: 32733622 PMCID: PMC7378624 DOI: 10.1155/2020/5680154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/20/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
Background A birth dose of the hepatitis B vaccine will prevent most perinatally acquired infections and offers early protection from horizontal transmission. This article assessed the prevalence of the hepatitis B birth dose and associated factors among children in the District 2 Hospital. Methods A prospective cross-sectional study between June and December 2017 recruited parents/caregivers of children aged 12–59 months who were randomly selected at the vaccination department in the District 2 Hospital. The structured questionnaire applied was to collect the characteristics of participants and check the vaccination schedule. The birth dose was defined as the hepatitis B vaccine, which was given to children within 24 hours after birth. Additionally, a semistructured questionnaire was used for interviews and focus group discussions (FGDs) to assess the risk perceptions and barriers to vaccination. Results A total of 292 parents/caregivers had a mean age of 32.7 ± 6.8 years; among them, 88.7% were females. Their children had a mean age of 30.3 ± 13.9 months and 71.6% of these children received the hepatitis B birth dose, which correlated with the age of gestation (P < 0.05). In-depth interviews and FGDs found that most participants did not know that hepatitis B could be transmitted through childbirth, and barriers that affected the birth dose vaccine included children being sick, premature infants, or reason relating to physicians. Conclusions The rate of hepatitis B birth dose was low, which resulted from associated factors such as premature birth, likely to be linked with false contraindications and beliefs that, potentially, the 2013 incident is still fresh in people's minds. Therefore, strategies to implement policies around the hepatitis B birth dose should be in line with current World Health Organization recommendations and strategies to modify current beliefs about vaccination.
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Fokuo JK, Masson CL, Anderson A, Powell J, Bush D, Ricco M, Zevin B, Ayala C, Khalili M. Recommendations for Implementing Hepatitis C Virus Care in Homeless Shelters: The Stakeholder Perspective. Hepatol Commun 2020; 4:646-656. [PMID: 32363316 PMCID: PMC7193125 DOI: 10.1002/hep4.1492] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/07/2020] [Indexed: 01/09/2023] Open
Abstract
Compared with the general population, homeless individuals are at higher risk of hepatitis C infection (HCV) and may face unique barriers in receipt of HCV care. This study sought the perspectives of key stakeholders toward establishing a universal HCV screening, testing, and treatment protocol for individuals accessing homeless shelters. Four focus groups were conducted with homeless shelter staff, practice providers, and social service outreach workers (n = 27) in San Francisco, California, and Minneapolis, Minnesota. Focus groups evaluated key societal, system, and individual-level facilitators and barriers to HCV testing and management. Interviews were transcribed and analyzed thematically. The societal-level barriers identified were lack of insurance, high-out-of-pocket expenses, restriction of access to HCV treatment due to active drug and/or alcohol use, and excessive paperwork required for HCV treatment authorization from payers. System-level barriers included workforce constraints and limited health care infrastructure, HCV stigma, low knowledge of HCV treatment, and existing shelter policies. At the individual level, client barriers included competing priorities, behavioral health concerns, and health attitudes. Facilitators at the system level for HCV care service integration in the shelter setting included high acceptability and buy in, and linkage with social service providers. Conclusion: Despite societal, system, and individual-level barriers identified with respect to the scale-up of HCV services in homeless shelters, there was broad support from key stakeholders for increasing capacity for the provision of HCV services in shelter settings. Recommendations for the scale-up of HCV services in homeless shelter settings are discussed.
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Affiliation(s)
- J Konadu Fokuo
- Department of Psychiatry University of California San Francisco San Francisco CA
| | - Carmen L Masson
- Department of Psychiatry University of California San Francisco San Francisco CA
| | - August Anderson
- Department of Medicine Division of Gastroenterology and Hepatology University of California San Francisco San Francisco CA
| | | | - Dylan Bush
- Department of Medicine Division of Gastroenterology and Hepatology University of California San Francisco San Francisco CA
| | | | - Barry Zevin
- San Francisco Department of Public Health, Street Medicine and Shelter Health San Francisco CA
| | - Claudia Ayala
- Department of Medicine Division of Gastroenterology and Hepatology University of California San Francisco San Francisco CA
| | - Mandana Khalili
- Department of Medicine Division of Gastroenterology and Hepatology University of California San Francisco San Francisco CA
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12
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Nankya-Mutyoba J, Aizire J, Makumbi F, Ocama P, Kirk GD. Hepatitis B virus perceptions and health seeking behaviors among pregnant women in Uganda: implications for prevention and policy. BMC Health Serv Res 2019; 19:760. [PMID: 31655575 PMCID: PMC6815411 DOI: 10.1186/s12913-019-4516-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/09/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With most countries in sub-Saharan Africa (SSA) lagging behind schedule to implement a comprehensive viral hepatitis elimination strategy, several barriers to accurate information and hepatitis B virus (HBV) services still exist, that are unique to different regions. In an obstetric population of a high HBV burden SSA setting without antenatal HBV services, we systematically evaluated perceptions and prevention behavioral intentions in relation to HBV and liver cancer. METHODS Eligible consenting pregnant women were recruited from public health care facilities in the central and northern regions of Uganda, between October 2016 and December 2017. Standardized procedures and instruments based on the health belief model and theory of planned behavior were used to collect data on socio-demographic characteristics, HBV perceptions and behavioral intentions. Descriptive analysis using Chi-square tests was done to obtain distribution of respondents by levels of perceived risk of HBV and liver cancer for themselves, their child under 5 years and their spouse. Modified Poisson regression analyses were used to evaluate relationships between perception variables and different behavioral outcomes (intention to screen, vaccinate and treat HBV). RESULTS Perceived risk (PRR = 0.95(0.90-1.00), p = 0.055) was inversely associated with intention to screen for HBV. Conversely, perceived self-efficacy showed a consistent association with intention to screen for HBV (PRR = 1.18(1.10-1.23) p = 0.005), to vaccinate (PRR = 1.20(1.05-1.36) p = 0.006) and to seek treatment for HBV (PRR = 1.40(1.18-1.67) p < 0.001). Women from the north, compared to the central region (PRR = 1.76 (1.13-2.72) p = 0.012), and those who self-identified as Catholic (PRR = 1.85 (0.99-3.56) p = 0.056), and as Protestant, (PRR = 2.22 (1.22-4.04) p = 0.002), were more likely to have higher perceived self-efficacy, compared to Muslims. Age and education were not related to perceived self-efficacy. CONCLUSION Women in both regions hold incorrect perceptions of HBV and liver cancer risk, with women from the central reporting higher perceived risk than those from the north. High perceived self-efficacy influenced intention to participate in HBV prevention. Programs and policies geared towards enhancing HBV prevention in this sub-population may consider socio-cultural factors observed to influence prevention behaviors. These findings may guide HBV interventions aimed at improving capacity to seek HBV prevention services, thereby promoting HBV micro-elimination in this sub-population.
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Affiliation(s)
- Joan Nankya-Mutyoba
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Jim Aizire
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Fredrick Makumbi
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Ponsiano Ocama
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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13
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Momin B, Millman AJ, Nielsen DB, Revels M, Steele CB. Promising practices for the prevention of liver cancer: a review of the literature and cancer plan activities in the National Comprehensive Cancer Control Program. Cancer Causes Control 2018; 29:1265-1275. [PMID: 30506129 DOI: 10.1007/s10552-018-1094-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/02/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are risk factors for hepatocellular carcinoma, a type of primary liver cancer, and are most prevalent in people born 1945-1965. Relatively little information is available for liver cancer prevention, compared to other cancers. In this review, we provide a summary of current promising public health practices for liver cancer prevention from the literature, as well as liver cancer-related initiatives in the National Comprehensive Cancer Control Program (NCCCP). METHODS Two types of source materials were analyzed for this review: published literature (2005-present), and current cancer plans from the NCCCP (2005-2022). A search strategy was developed to include a review of several scientific databases. Of the 73 articles identified as potentially eligible, 20 articles were eligible for inclusion in the review. Eligible articles were abstracted using a data abstraction tool. Three independent keyword searches on 65 NCCCP plans were conducted. Keyword searches within each of the plans to identify activities related to liver cancer were conducted. Relevant information was abstracted from the plans and saved in a data table. RESULTS Of the 20 eligible articles, 15 articles provided information on interventions related to liver cancer and hepatitis B or hepatitis C prevention. All 15 of the intervention articles were related to hepatitis; 13 were hepatitis B-focused, two were hepatitis C-focused, and 14 focused on Asian/Pacific Islander American populations. The independent keyword search of NCCCP plans produced 46 results for liver, 27 results for hepatitis, and 52 results for alcohol. Two plans included activities related to liver cancer. Twenty-four plans included activities related to hepatitis. DISCUSSION A majority of the intervention articles published focused on HBV infection in Asian/Pacific Islander American populations, and a small percentage of NCCCP plans included liver-related content. The findings from this review will inform the development of an Action Plan on liver cancer prevention for the NCCCP, which will assist programs with the adoption and uptake of promising practices for the prevention of liver cancer.
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Affiliation(s)
- Behnoosh Momin
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA.
| | - Alexander J Millman
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - C Brooke Steele
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA
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Raoofi A, Hatefnia E, Kazemnejad A. Helping to prevent hepatitis B in family setting, by educating women to vaccinate before marriage. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:354-365. [PMID: 30004828 DOI: 10.1080/19371918.2018.1487358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hepatitis B (HB) is one of the major public health problems and a major cause of liver cirrhosis and hepatocellular carcinoma (HCC). The aim of this study was to evaluate the effect of a model-based educational intervention on preventive health behavior of hepatitis B vaccination among women who were going to get married (pending marriage women). Seventy pending marriage women were selected from martial counseling centers. The participants' knowledge, health beliefs model (HBM) constructs, and intention to receive HB vaccination were collected using a questionnaire based on HBM. The questionnaire was based on the Likert-type scale with the score range of 1 to 5. An educational intervention was carried out based on pretest results. The baseline and follow-up level of the variables was statistically significant within the case group. The mean score of the variables in the two groups showed a statistically significant difference in favor of the case group. Our study showed a positive effect of educational intervention on the participants' knowledge, HBM constructs, and intention to receive HB vaccination, indicating that educational intervention based on HBM could be used as an appropriate tool to improve preventive behavior of HB vaccination.
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Affiliation(s)
- Azam Raoofi
- a Department of Health Education and Promotion, School of Public Health , Alborz University of Medical Sciences , Karaj , Iran (the Islamic Republic of)
- b Medical Ethics Department , Breast Cancer Research Center, Motamed Cancer Institute, ACECR , Tehran , Iran (the Islamic Republic of)
| | - Effat Hatefnia
- c Social Determinants of Health Research Center , Alborz University of Medical Sciences , Karaj , Iran (the Islamic Republic of)
| | - Anoshirvan Kazemnejad
- d Department of Biostatistics, Faculty of Medical Sciences , Tarbiat Modares University , Tehran , Iran (the Islamic Republic of)
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Glenn BA, Hamilton AS, Nonzee NJ, Maxwell AE, Crespi CM, Ryerson AB, Chang LC, Deapen D, Bastani R. Obesity, physical activity, and dietary behaviors in an ethnically-diverse sample of cancer survivors with early onset disease. J Psychosoc Oncol 2018; 36:418-436. [PMID: 29764334 PMCID: PMC6209096 DOI: 10.1080/07347332.2018.1448031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess weight status, physical activity, and dietary behaviors in an ethnically-diverse sample of breast and colorectal cancer survivors with early onset disease (≤ 50 years). METHODS Breast and colorectal cancer survivors, diagnosed between 1999 and 2009 with early-stage cancer diagnosed by 50 years of age, were identified through a population-based cancer registry and surveyed. Descriptive and regression analyses were conducted to characterize the sample and identify correlates of lifestyle behaviors. FINDINGS The majority of participants (n = 156) were female (83%), insured (84%), and racial/ethnic minorities (29% Asian, 24% Latino, 15% African American). Participants' mean age at response was 50 years and mean time since diagnosis was 9 years. Over half of survivors were overweight or obese. Few participants reported engaging in regular physical activity (31%) and adhering to minimum guidelines for fruit and vegetable consumption (32%). A substantial proportion of survivors consumed fast food in the past week (75%) and nearly half (48%) reported daily consumption of sugar-sweetened beverages. Lower income was associated with inadequate fruit and vegetable intake. Fast food and sugar-sweetened beverage consumption was significantly higher among racial/ethnic minority survivors compared to non-Latino whites. CONCLUSIONS High prevalence of overweight and suboptimal adherence to recommended nutrition and physical activity behaviors were observed among cancer survivors with early onset disease. Cancer survivors diagnosed at a young age may benefit from targeted interventions to address overweight and suboptimal nutrition and physical activity.
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Affiliation(s)
- Beth A Glenn
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Ann S Hamilton
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Narissa J Nonzee
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Annette E Maxwell
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Catherine M Crespi
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - A Blythe Ryerson
- c Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - L Cindy Chang
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Dennis Deapen
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Roshan Bastani
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
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16
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Chu JN, Le PV, Kennedy CJ, McPhee SJ, Wong C, Stewart SL, Nguyen TT. Factors Associated with Hepatitis B Knowledge Among Vietnamese Americans: A Population-Based Survey. J Immigr Minor Health 2018; 19:801-808. [PMID: 27900593 DOI: 10.1007/s10903-016-0526-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Vietnamese Americans have high rates of hepatitis B virus (HBV) infection but low rates of knowledge and screening. A population-based survey conducted in 2011 of Vietnamese Americans in two geographic areas (n = 1666) was analyzed. The outcome variables were having heard of HBV and a score summarizing knowledge of HBV transmission. Most respondents (86.0%) had heard of HBV. Correct knowledge of transmission ranged from 59.5% for sex, 68.1% for sharing toothbrushes, 78.6% for during birth, and 85.0% for sharing needles. In multivariable analyses, factors associated with having heard of HBV and higher knowledge included Northern California residence, longer U.S. residence, higher education, family history of HBV, and discussing HBV with family/friends. Higher income was associated with having heard of HBV. English fluency and being U.S.-born were associated with higher knowledge. Interventions to increase knowledge of HBV transmission are needed to decrease this health disparity among Vietnamese Americans.
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Affiliation(s)
- Janet N Chu
- Division of General Internal Medicine, Department of Medicine, UCSF Medical Center, University of California, San Francisco, 1545 Divisadero Street, San Francisco, CA, 94143, USA. .,Asian American Research Center on Health, San Francisco, CA, USA.
| | - Phuoc V Le
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Chris J Kennedy
- Travers Department of Political Science, University of California, Berkeley, Berkeley, CA, USA
| | - Stephen J McPhee
- Division of General Internal Medicine, Department of Medicine, UCSF Medical Center, University of California, San Francisco, 1545 Divisadero Street, San Francisco, CA, 94143, USA.,Asian American Research Center on Health, San Francisco, CA, USA
| | - Ching Wong
- Division of General Internal Medicine, Department of Medicine, UCSF Medical Center, University of California, San Francisco, 1545 Divisadero Street, San Francisco, CA, 94143, USA.,Asian American Research Center on Health, San Francisco, CA, USA
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Tung T Nguyen
- Division of General Internal Medicine, Department of Medicine, UCSF Medical Center, University of California, San Francisco, 1545 Divisadero Street, San Francisco, CA, 94143, USA.,Asian American Research Center on Health, San Francisco, CA, USA
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Dang JHT, Chen MS. Increasing Hepatitis B Testing and Linkage to Care of Foreign-Born Asians, Sacramento, California, 2012-2013. Public Health Rep 2017; 131 Suppl 2:119-24. [PMID: 27168671 DOI: 10.1177/00333549161310s218] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Without medical intervention, about one-quarter of the 1.4-2.2 million Americans chronically infected with the hepatitis B virus (HBV) will die of HBV-associated conditions, including liver failure and hepatocellular carcinoma. We report on a program in Sacramento County, California, that offered HBV screening to at-risk adults, referred infected individuals to care, and vaccinated uninfected adults who were susceptible to HBV infection (i.e., individuals who tested negative for hepatitis B surface antigen and who were never vaccinated against HBV). METHODS We engaged organizations linked to Chinese, Hmong, Korean, and Vietnamese communities to cosponsor HBV screenings of Asian Americans as part of the Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites. We held 28 hepatitis B community screening events throughout Sacramento County, California, in collaboration with these groups from September 2012 to September 2013. RESULTS We screened 1,004 Asian American adults (i.e., 283 Koreans, 242 Chinese, 233 Vietnamese, 223 Hmong, and 23 people from other Asian communities) for HBV, of whom 98% were foreign born and 87% had a language preference other than English. Of the 76 participants who tested positive for HBV (31 Hmong, 23 Vietnamese, 17 Chinese, two Koreans, and three from other Asian communities), we provided posttest counseling to 51 participants. CONCLUSION By collaborating with community groups and addressing barriers to screening, we highlighted the importance of disaggregating chronic HBV infection rates by Asian ethnicity and sex vs. aggregated Asian American rates. Future HBV screening initiatives should target Hmong and Vietnamese men.
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Affiliation(s)
- Julie H T Dang
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA
| | - Moon S Chen
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA
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18
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Ma GX, Fang CY, Seals B, Feng Z, Tan Y, Siu P, Yeh MC, Golub SA, Nguyen MT, Tran T, Wang M. A Community-Based Randomized Trial of Hepatitis B Screening Among High-Risk Vietnamese Americans. Am J Public Health 2017; 107:433-440. [PMID: 28103075 PMCID: PMC5296686 DOI: 10.2105/ajph.2016.303600] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a community-based liver cancer prevention program on hepatitis B virus (HBV) screening among low-income, underserved Vietnamese Americans at high risk. METHODS We conducted a cluster randomized trial involving 36 Vietnamese community-based organizations and 2337 participants in Pennsylvania, New Jersey, and New York City between 2009 and 2014. We randomly assigned 18 community-based organizations to a community-based multilevel HBV screening intervention (n = 1131). We randomly assigned the remaining 18 community-based organizations to a general cancer education program (n = 1206), which included information about HBV-related liver cancer prevention. We assessed HBV screening rates at 6-month follow-up. RESULTS Intervention participants were significantly more likely to have undergone HBV screening (88.1%) than were control group participants (4.6%). In a Cochran-Mantel-Haenszel analysis, the intervention effect on screening outcomes remained statistically significant after adjustment for demographic and health care access variables, including income, having health insurance, having a regular health provider, and English proficiency. CONCLUSIONS A community-based, culturally appropriate, multilevel HBV screening intervention effectively increases screening rates in a high-risk, hard-to-reach Vietnamese American population.
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Affiliation(s)
- Grace X Ma
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Carolyn Y Fang
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Brenda Seals
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Ziding Feng
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Yin Tan
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Philip Siu
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Ming Chin Yeh
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Sarit A Golub
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Minhhuyen T Nguyen
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Tam Tran
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
| | - Minqi Wang
- Grace X. Ma, Brenda Seals, and Yin Tan are with the Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Carolyn Y. Fang and Minhhuyen T. Nguyen are with the Fox Chase Cancer Center, Temple University Medical System, Philadelphia. Ziding Feng is with the Department of Biostatistics, Anderson Cancer Center, University of Texas, Houston. Philip Siu is with Chinatown Medical Services, Philadelphia. Ming Chin Yeh is with the Nutrition Program, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with the Department of Psychology, Hunter College, City University of New York. Tam Tran is with the Viet Community, Asian American Buddhist Association, Philadelphia. Minqi Wang is with the School of Public Health, University of Maryland, College Park
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Kim SY, Shen Y, Hou Y, Tilton KE, Juang L, Wang Y. Annual Review of Asian American Psychology, 2014. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2015; 6:291-332. [PMID: 26925199 PMCID: PMC4765738 DOI: 10.1037/aap0000031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This 2014 review of Asian American psychology is the sixth review in the series. It includes 316 articles that met the inclusion criteria established by the past five annual reviews. Featured articles were derived from three sources: 137 were generated via the search term "Asian American" in PyscINFO, 111 were generated via a search for specific Asian American ethnic groups, and 32 were generated via author searches of articles that met the inclusion criteria. The top primary topic was health and health-related behaviors, the most frequently employed study design was cross-sectional, and the most studied Asian American ethnic group was Chinese. This year's review includes information on the target population of the primary topic, the age range and developmental period of participants, and whether the study design was cross-sectional or longitudinal. It also identifies top authors and journals contributing to the 2014 annual review. These new features reveal that the most common target population of the primary topic was youths; studies most commonly included emerging adults ages 18-25; cross-sectional study design was employed more often than longitudinal design; the top contributor to the 2014 review was Stephen Chen, who authored the highest number of papers included; and the Asian American Journal of Psychology generated the highest number of publications for this review.
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Affiliation(s)
- Su Yeong Kim
- University of Texas at Austin, Department of Human Development and Family Sciences, 108 East Dean Keeton Street, Stop A2702, Austin, TX 78712, , (512) 471-5524
| | - Yishan Shen
- University of Texas at Austin, Department of Human Development and Family Sciences, 108 East Dean Keeton Street, Stop A2702, Austin, TX 78712, , (512) 983-7551
| | - Yang Hou
- University of Texas at Austin, Department of Human Development and Family Sciences, 108 East Dean Keeton Street, Stop A2702, Austin, TX 78712, , (512) 660-2236
| | - Kelsey E Tilton
- University of Texas at Austin, Department of Human Development and Family Sciences, 108 East Dean Keeton Street, Stop A2702, Austin, TX 78712, , (512) 956-459-4212
| | - Linda Juang
- University of Potsdam, College of Human Sciences, Education, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany, +49 (0)172 1882255,
| | - Yijie Wang
- University of Texas at Austin, Department of Human Development and Family Sciences, 108 East Dean Keeton Street, Stop A2702, Austin, TX 78712, , (512) 289-8136
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Chen Jr MS, Dang J. Hepatitis B among Asian Americans: Prevalence, progress, and prospects for control. World J Gastroenterol 2015; 21:11924-30. [PMID: 26576081 PMCID: PMC4641114 DOI: 10.3748/wjg.v21.i42.11924] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/18/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
After tobacco use, chronic hepatitis B (CHB) viral infections are the most important cause of cancer globally in that 1 out of 3 individuals have been infected with the hepatitis B virus (HBV). Though infection rates are low (< 1%) in the United States, Asian Americans who comprise about 6% of the population experience about 60% of the CHB burden. This paper reviews the magnitude of hepatitis B (HBV) burden among Asian Americans and the progress being made to mitigate this burden, primarily through localized, community-based efforts to increase screening and vaccination among Asian American children, adolescents, and adults. This review brings to light that despite the numerous community-based screening efforts, a vast majority of Asian Americans have not been screened and that vaccination efforts, particularly for adults, are sub-optimal. Greater efforts to integrate screenings by providers within existing healthcare systems are urged. Evidence-based strategies are offered to implement CDC's three major recommendations to control and prevent hepatitis B through targeted screening and enhanced vaccination efforts.
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Bastani R, Glenn BA, Maxwell AE, Jo AM, Herrmann AK, Crespi CM, Wong WK, Chang LC, Stewart SL, Nguyen TT, Chen MS, Taylor VM. Cluster-Randomized Trial to Increase Hepatitis B Testing among Koreans in Los Angeles. Cancer Epidemiol Biomarkers Prev 2015; 24:1341-9. [PMID: 26104909 PMCID: PMC4560609 DOI: 10.1158/1055-9965.epi-14-1396] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/02/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared with the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently suboptimal. METHODS We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing, and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews. RESULTS We recruited 1,123 individuals, 18 to 64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included were as follows: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, P < 0.001), with 19% of intervention and 6% of control group participants reporting a HBV test. CONCLUSION Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae. IMPACT The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups.
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Affiliation(s)
- Roshan Bastani
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California.
| | - Beth A Glenn
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Annette E Maxwell
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Angela M Jo
- Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Alison K Herrmann
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Catherine M Crespi
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Weng K Wong
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - L Cindy Chang
- Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | - Susan L Stewart
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Tung T Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis, Davis, California
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Effectiveness of a 12-month randomized clinical trial to increase physical activity in multiethnic postpartum women: results from Hawaii's Nā Mikimiki Project. Prev Med 2014; 69:214-23. [PMID: 25285751 PMCID: PMC4312232 DOI: 10.1016/j.ypmed.2014.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/16/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Few postpartum ethnic minority women perform leisure-time moderate-to-vigorous physical activity (MVPA). The study tested the effectiveness of a 12-month tailored intervention to increase MVPA in women with infants 2-12months old. METHODS From 2008 to 2011, women (n=311) with infants (average age=5.7months) from Honolulu, Hawaii were randomly assigned to receive tailored telephone calls and access to a mom-centric website (n=154) or access to a standard PA website (n=157). MVPA was measured at baseline, 6, and 12months using self-report and acclerometers. RESULTS Controlling for covariates, the tailored condition significantly increased self-reported MVPA from an average of 44 to 246min/week compared with 46 to 156min/week for the standard condition (p=0.027). Mothers with≥2 children had significantly greater increases in MVPA in response to the tailored intervention than those with one child (p=0.016). Accelerometer-measured MVPA significantly increased over time (p=0.0001), with no condition differences. There was evidence of reactivity to initially wearing accelerometers; the tailored intervention significantly increased MVPA among women with low baseline accelerometer MVPA minutes, but not among those with high minutes (pinteraction=0.053). CONCLUSION A tailored intervention effectively increased MVPA over 12months in multiethnic women with infants, particularly those with more than one child.
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