Racial discrimination, knowledge, and health outcomes: The mediating role of hepatitis B-related stigma among patients with chronic hepatitis B

It is well described in current literature that Hepatitis B virus (HBV) affects Asian Americans more than any other racial group in the United States and that there is a stigma attached to this condition. The effects of stigma can be lasting, penetrating physiologically and psychologically, yet few studies have focused on the consequences of this phenomenon. The purpose of this study was to examine the mediating role of stigma in the effect of racial discrimination and knowledge (of HBV sequelae) on health status of Korean Americans with chronic hepatitis B (CHB). Three hundred sixty-five CHB patients were recruited and enrolled from two clinics in Philadelphia and Los Angeles. Depressive symptoms were measured using the Patient Health Question-9 (PHQ-9), physical health via self-rated health survey and stigma via hepatitis B quality of life (HBQOL)-stigma survey. Perceived racial discrimination and knowledge of CHB sequelae were independent variables. The cohort had an average age of 60.1 years (range 19-84, SD 10.7), 56% were male and 94% were born in South Korea. Mediational analysis found that stigma was a significant mediator between both racial discrimination (indirect effect = .037, Bootstrap 95% CI = [.010-.064]) and sequelae knowledge (indirect effect = .097, Bootstrap 95% CI = [.018-.176]) and depressive symptoms. Stigma also had a direct effect on depressive symptoms (β = .136, p < .01) and self-rated health (β = .018, p < .05). In addition, age, gender, education and employment were related to health outcomes. The findings of this study indicate that HBV-related stigma is an important mediator of mental health outcomes in this population. Future studies should identify other psychosocial factors to develop effective intervention programs to reduce stigma and improve quality of life among CHB patients.

Cardiovascular Disease Events in Adults with a History of State Care in Childhood: Pooling of Unpublished Results from 9 Cohort Studies

Background

Individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected physical and mental health problems in adulthood, however, their risk of cardiovascular disease (CVD) is uncertain. Accordingly, we pooled published and unpublished results from cohort studies of childhood care and adult CVD.

Methods

We used two approaches to identifying relevant data on childhood care and adult CVD (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the aim of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews of the impact of childhood state care on related adult health outcomes. All included studies were required to have prospective measurement of state care in childhood and a follow-up of CVD events in adulthood as the primary outcome (incident coronary heart disease and/or stroke). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality.

Findings

Thirteen studies (2 published, 11 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Relative to the unexposed, individuals with a care placement during childhood had a 50% greater risk of CVD in adulthood (summary rate ratio after basic adjustment [95% confidence interval]: 1.50 [1.22, 1.84]); range of study-specific estimates: 1.28 to 2.06; I2 = 69%, p = 0.001). This association was attenuated but persisted after multivariable adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.28 [1.10, 1.50]). There was a suggestion of a stronger state care-CVD association in women.

Interpretation

Our findings show that individuals with experience of state care in childhood have a moderately raised risk of CVD in adulthood. For timely prevention, clinicians and policy makers should be aware that people with a care history may need additional attention in risk factor management.

Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making

BACKGROUND

Although lung cancer screening (LCS) for high-risk individuals reduces lung cancer mortality in clinical trial settings, many questions remain about how to implement high-quality LCS in real-world programs. With the increasing use of telemedicine in healthcare, studies examining this approach in the context of LCS are urgently needed. We aimed to identify sociodemographic and other factors associated with screening completion among individuals undergoing telemedicine Shared Decision Making (SDM) for LCS.

METHODS

This retrospective study examined patients who completed Shared Decision Making (SDM) via telemedicine between May 4, 2020 - March 18, 2021 in a centralized LCS program. Individuals were categorized into Complete Screening vs. Incomplete Screening subgroups based on the status of subsequent LDCT completion. A multi-level, multivariate model was constructed to identify factors associated with incomplete screening.

RESULTS

Among individuals undergoing telemedicine SDM during the study period, 20.6% did not complete a LDCT scan. Bivariate analysis demonstrated that Black/African-American race, Medicaid insurance status, and new patient type were associated with greater odds of incomplete screening. On multi-level, multivariate analysis, individuals who were new patients undergoing baseline LDCT or resided in a census tract with a high level of socioeconomic deprivation had significantly higher odds of incomplete screening. Individuals with a greater level of education experienced lower odds of incomplete screening.

CONCLUSIONS

Among high-risk individuals undergoing telemedicine SDM for LCS, predictors of incomplete screening included low education, high neighborhood-level deprivation, and new patient type. Future research should focus on testing implementation strategies to improve LDCT completion rates while leveraging telemedicine for high-quality LCS.

Racial disparities in new-onset diabetes mellitus in prostate cancer patients on androgen deprivation therapy: a retrospective analysis of TriNetX data

BACKGROUND

Prostate cancer (PCa) is the most common cancer in men in the US and androgen deprivation therapy (ADT) is the most frequently used systemic therapy for PCa. Data suggest that ADT is associated with an increased risk of new-onset diabetes mellitus (NODM) and cardiovascular complications. As the incidence and mortality of PCa are highest among the African American (AA) population, it is important to evaluate the difference in the incidence of NODM and ischemic heart disease (IHD) between AA men compared to Caucasian men.

METHODS

This is a retrospective cohort study utilizing the TriNetX database to assess NODM and IHD risk, risk difference, and risk ratio (RR) after recent ADT initiation in an AA cohort and a Caucasian cohort of patients with PCa. Propensity score matching (PSM) was performed by age, BMI, and confounding comorbidities.

RESULTS

After matching, the cohort included 1159 AA patients and 843 Caucasian patients with NODM after ADT initiation. The IHD cohort included 1269 AA patients and 1248 Caucasian patients. The risk of incidence of NODM is higher among AA men at 11.6% risk compared to Caucasian men at 7.4%. The risk difference is 4.1% (95% CI = 3.4, 4.9) p = 0.000. The RR is 1.56 (95% CI = 1.43, 1.70). In contrast, risk difference and risk ratio of IHD was not significant between AA and Caucasian groups.

CONCLUSION

ADT exposure increases the risk of NODM in men with PCa, especially among AA men compared with Caucasian men. Men receiving ADT should be monitored routinely for signs and symptoms of metabolic syndrome and diabetes. Targeted close monitoring of AA men on ADT would be critical to prevent and treat metabolic complications with potential of reducing disparities in PCa morbidity.

Smoking Cessation Interventions Among Asian Americans: a Scoping Review

BACKGROUND

Tobacco use is the leading cause of morbidity and mortality in the USA, with smoking rates remaining disproportionately high among Asian-Americans, particularly in males with limited English proficiency, including Vietnamese (43%), Korean (37%), and Chinese (29%) Americans. Barriers to smoking cessation in this population include high social acceptability of smoking in participants' countries of origin, low quit intention, and limited use of linguistically appropriate smoking cessation resources. This paper aims to conduct a systematic review of studies evaluating the effectiveness of smoking cessation interventions targeting Asian-Americans.

METHODS

The researchers conducted a thorough search of Scopus, Medline, Cochrane Central, and Google Scholar from 2006 through March 2022, as well as reference lists of relevant articles. The inclusion criteria for the studies were that they described smoking cessation interventions for Asian-Americans and Asian immigrants, and reported outcomes related to feasibility, acceptability, usability, and smoking-related outcomes.

RESULTS

The review identified 14 studies with a total of 5607 participants, with participant numbers ranging from 26 to 2277. The interventions varied across 14 distinct approaches, with individual counseling being a prominent component. These interventions were found to be feasible and culturally acceptable. All studies reported positive smoking-related outcomes, including abstinence rates ranging from 26.7 to 68% and an increase in quit attempts. Culturally sensitive components and linguistically tailored content played a significant role in promoting participant engagement. The retention rates in the studies ranged from 42 to 100%, highlighting the importance of partnership with the Asian community, cultural and ethnic congruence, and family involvement and support.

CONCLUSION

The review highlighted the lack of direct in-language treatment as a disadvantage for Asian-American smokers in accessing evidence-based treatments. Despite this, the review reported the feasibility, acceptability, and effectiveness of a limited number of culturally targeted interventions for Asian-Americans, who are the fastest-growing racial-ethnic group. Future research should focus on exploring novel community-based and culturally adapted approaches for hard-to-reach and high-risk ethnic Asian subgroups to further improve smoking cessation outcomes in this population.

Characterizing Lung Cancer Burden Among Asian-American Communities in Philadelphia

Lung cancer (LC) is the leading cause of cancer death among Asian-Americans. However, there are differences in LC incidence and mortality among Asian racial subgroups. The objective of this study was to describe LC burden and disparities among race/ethnic groups (White, Black, Asian, and Hispanic) across US census tracts (CT) in Philadelphia using the Pennsylvania Cancer Registry dataset (N=11,865). ArcGIS Pro was used to geocode patient addresses to the CT level for linkage to US Census data. Despite being diagnosed more frequently with advanced-stage lung cancer compared with other race and ethnic groups in Philadelphia, Asian patients were most likely to be alive at the time of data receipt. Among Asian subgroups, Korean patients were the oldest (median age 75, p=0.024). Although not statistically different, distant stage disease was the most prevalent among Asian Indian (77.8%) and Korean (73.7%) and the least prevalent among Chinese patients (49.5%). LC was the cause of death for 77.8% of Asian Indian, 63.2% of Korean, 52.9% of other Asian, 48.5% of Chinese, and 47.5% of Vietnamese patients. CTs where Asian individuals were concentrated had lower socioeconomic status and greater tobacco retailer density compared to the entire city. Compared to all of Philadelphia, heavily Asian CTs experienced a greater age-standardized LC incidence (1.48 vs. 1.42) but lower age-standardized LC mortality (1.13 vs. 1.22). Our study suggests that LC disparities exist among Asian subgroups, with Asian Indian and Korean Philadelphians most likely to present with advanced disease. Additional studies are needed to investigate LC among high-risk racial and ethnic groups, including Asian subgroups.

Genomic characterization of early-stage hepatocellular carcinoma patients with Hepatitis B using circulating tumor DNA

BACKGROUND

Hepatocellular carcinoma (HCC) is a leading cause of mortality, with Hepatitis B virus (HBV) infection as a dominant etiology worldwide. Effective early detection strategies may facilitate curative therapies and improve survival. We investigated genomic aberrations in circulating tumor DNA (ctDNA) as potential diagnostic markers of HCC in HBV-infected patients.

METHODS

We identified early stage (BCLC 0-A) HCC cases (n = 21) and patients without HCC (n = 14) from a cohort of Asian patients with HBV, undergoing surveillance between 2013 and 2017. Circulating cell-free DNA was isolated from blood samples, and assayed by next-generation sequencing of 23 genes implicated in HCC pathogenesis. Somatic mutations were identified using a computational pipeline. Using area under the curve (AUC) in receiver operating characteristic (ROC) analysis, we evaluated gene alterations and clinical factors in an exploratory early HCC detection model.

RESULTS

Mutant ARID1A, CTNNB1, TP53 genes were increased in HCC cases vs. non-HCC patients (85.7% vs 42.9%, P = 0.011; 42.9% vs 0%, P = 0.005; 100% vs 71.4%, P = 0.019, respectively). Using these three genes, AUC for discriminating HCC from non-HCC patients was 0.844 (95% confidence interval [CI]: 0.7317-0.9553). When combining these genes with clinical factors in an exploratory early HCC detection model, AUC increased from 0.7415 (using clinical factors alone) to 0.9354 (P = 0.041).

CONCLUSION

Genomic aberrations in ctDNA were more prevalent in HBV-infected HCC patients compared with patients without HCC. Combining these alterations with clinical factors may identify HCC in HBV-infected patients at an early stage. These findings warrant validation in future studies.

A novel method for measuring the burden of breast cancer in neighborhoods

Community-based breast cancer prevention efforts often focus on women who live in the same neighborhoods, as they tend to have similar demographic characteristics, health behaviors, and environmental exposures; yet little research describes methods of selecting neighborhoods of focus for community-based cancer prevention interventions. Studies frequently use demographics from census data, or single breast cancer outcomes (e.g., mortality, morbidity) in order to choose neighborhoods of focus for breast cancer interventions, which may not be optimal. This study presents a novel method for measuring the burden of breast cancer among neighborhoods that could be used for selecting neighborhoods of focus. In this study, we 1) calculate a metric composed of multiple breast cancer outcomes to describe the burden of breast cancer in census tracts Philadelphia, PA, USA; 2) map the neighborhoods with the greatest breast cancer burden; and 3) compare census tracts with the highest burden of breast cancer to those with demographics sometimes used for geo-based prioritization, i.e., race and income. The results of our study showed that race or income may not be appropriate proxies for neighborhood breast cancer burden; comparing the breast cancer burden with demographics at the census tract level, we found few overlaps with the highest percentage African American or the lowest median incomes. Agencies implementing community-based breast cancer interventions should consider this method to inform the selection of neighborhoods for breast cancer prevention interventions, including education, screening, and treatment.

Disparities in awareness of the HPV vaccine and HPV-associated cancers among racial/ethnic minority populations: 2018 HINTS

OBJECTIVES

Human papillomavirus (HPV) is a common virus that currently infects nearly 80 million people in the United States (U.S.) and can lead to cancer. HPV vaccination provides safe, effective, and lasting protection against HPV infections. Nevertheless, vaccination rates remain suboptimal. The purpose of this study was to examine the relationship between sociodemographic characteristics, HPV and HPV vaccine awareness, and knowledge of HPV-associated cancers among U.S. adults.

DESIGN

Using responses from 3504 U.S. adults (aged 18 years and older) from the Health Information National Trends Survey 5 Cycle 2 (January-May 2018), we performed descriptive analysis to assess the level of awareness of HPV and HPV vaccines and knowledge of HPV-associated cancer. Multivariable regression analysis (including race, gender, age, level of education, marital status, number of children younger than 18) was conducted with weighted analysis.

RESULTS

About 62% of respondents had heard of HPV and HPV vaccine. Asians had a lower level of awareness than non-Hispanic Whites of HPV (36.4% vs. 66.1%) and HPV vaccine (48.7% vs. 67.1%). Multivariable analysis showed that race/ethnicity was associated with outcomes, with Asians being less likely to have heard about HPV (aOR = 0.17, 95% CI: 0.07-0.38) and non-Hispanic Blacks (aOR = 0.57, 95% CI: 0.35-0.91) and Hispanics (aOR = 0.54, 95% CI: 0.36-0.80) being less likely to have heard of the HPV vaccine than non-Hispanic Whites. In addition, gender, age, marital status, and education were associated with awareness of HPV and the HPV vaccine; in particular, individuals who were female, younger (18-45), married, and more highly educated were more likely to have heard of HPV and HPV vaccine.

CONCLUSION

Results highlight disparities in HPV and HPV vaccine awareness among racial/ethnic minority populations. Future interventions and legislation should target racial/ethnic minority populations to foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers.

Asian American Self-Reported Discrimination in Healthcare and Having a Usual Source of Care

BACKGROUND

Self-reported racial or ethnic discrimination in a healthcare setting has been linked to worse health outcomes and not having a usual source of care, but has been rarely examined among Asian ethnic subgroups.

OBJECTIVE

We examined the association between Asian ethnic subgroup and self-reported discrimination in a healthcare setting, and whether both factors were associated with not having a usual source of care.

DESIGN

Using the California Health Interview Survey (CHIS) 2015-2017, we used logistic regression models to assess associations among Asian ethnic subgroup, self-reported discrimination, and not having a usual source of care. Interactions between race and self-reported discrimination, foreign-born status, poverty level, and limited English proficiency were also analyzed.

PARTICIPANTS

Respondents represented adults age 18 + residing in California who identified as White, Black, Hispanic, American Indian/Alaska Native, Asian (including Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian), and Other.

MAIN MEASURES

We examined two main outcomes: self-reported discrimination in a healthcare setting and having a usual source of care.

KEY RESULTS

There were 62,965 respondents. After survey weighting, Asians (OR 1.78, 95% CI 1.19-2.66) as an aggregate group were more likely to report discrimination than non-Hispanic Whites. When Asians were disaggregated, Japanese (3.12, 1.36-7.13) and Koreans (2.42, 1.11-5.29) were more likely to report discrimination than non-Hispanic Whites. Self-reported discrimination was marginally associated with not having a usual source of care (1.25, 0.99-1.57). Koreans were the only group associated with not having a usual source of care (2.10, 1.23-3.60). Foreign-born Chinese (ROR 7.42, 95% CI 1.7-32.32) and foreign-born Japanese (ROR 4.15, 95% CI 0.82-20.95) were more associated with self-reported discrimination than being independently foreign-born and Chinese or Japanese.

CONCLUSIONS

Differences in self-reported discrimination in a healthcare setting and not having a usual source of care were observed among Asian ethnic subgroups. Better understanding of these differences in their sociocultural contexts will guide interventions to ensure equitable access to healthcare.

Racial Discrimination and Health-Related Quality of Life: An Examination Among Asian American Immigrants

OBJECTIVES

We aimed to examine the relationship between everyday and major racial discrimination with health-related quality of life (HRQOL), which consists of self-rated health, days of poor physical health, mental health, and activity limitation.

DESIGN

In a cross-sectional analytic sample of 524 foreign-born Asian adults, aged 18 years and older, we conducted multivariable logistic regression and multivariable negative binomial regression to examine associations between discrimination and HRQOL. Furthermore, potential effect modification was tested by gender, ethnicity, and social support.

RESULTS

Associations were found between everyday racial discrimination and days of poor physical health (incidence rate ratio, IRR = 1.05), mental health (IRR = 1.03), and activity limitation (IRR = 1.05). Stronger significant associations were observed between major racial discrimination and days of poor physical health (IRR = 1.21), mental health (IRR = 1.16), and activity limitation (IRR = 1.53), adjusting for all covariates. Racial discrimination was not associated with poor self-rated health. In addition, gender significantly modified the relationship between continuous racial discrimination and activity limitation days with associations of greater magnitude among men, while social support significantly modified the association between categorized major racial discrimination and physically unhealthy days. When stratified, the association was only significant among those with low social support (IRR = 3.04; 95% CI: 1.60, 5.79) as opposed to high social support.

CONCLUSIONS

This study supports the association between racial discrimination and worse HRQOL among Asian Americans, which can inform future interventions, especially among men and those with low social support, aimed at improving the quality of life in this population.

Racial difference in BMI and lung cancer diagnosis: analysis of the National Lung Screening Trial

Background

The inverse relationship between BMI and lung cancer diagnosis is well defined. However, few studies have examined the racial differences in these relationships. The purpose of this paper is to explore the relationships amongst race, BMI, and lung cancer diagnosis using the National Lung Screening Trial (NLST) data.

Methods

Multivariate regression analysis was used to analyze the BMI, race, and lung cancer diagnosis relationships.

Results

Among 53,452 participants in the NLST cohort, 3.9% were diagnosed with lung cancer, 43% were overweight, and 28% were obese. BMI was inversely related to lung cancer diagnosis among Whites: those overweight (aOR = .83, 95%CI = .75-.93), obese (aOR = .64, 95%CI = .56-.73) were less likely to develop lung cancer, compared to those with normal weight. These relationships were not found among African-Americans.

Conclusion

Our findings indicate that the inverse relationship of BMI and lung cancer risk among Whites is consistent, whereas this relationship is not significant for African-Americans. In consideration of higher lung cancer incidence among African Americans, we need to explore other unknown mechanisms explaining this racial difference.

Cancer PD1/PD-L1 inhibitor efficacy as stratified by smoking status: A population large database study

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Background: Delineating clinical factors that predict immune checkpoint inhibitor (ICI) cancer therapy response is a pressing need and smoking is a known factor. In this study we leveraged a large international (heavily US) database to perform the largest study to date for all cancers and major cancer sub-sites/types. Methods: Utilizing the TriNetX electronic health records database with 84.3M patients we tested the hypotheses that ICI response stratifies based on smoking, and continued smoking after ICI. Queries were constructed using billing codes for all cancer types treated with an ICI with and without smoking. The smoking cohort was subsequently sub-stratified for continuing vs cessation of smoking after ICI. Next, using ICI therapy as the index event, odds ratios (OR) with 95% confidence intervals for death, and treatment related secondary outcomes were calculated between 0.5-5 years after ICI treatment. Statistics were calculated using TriNetX's integrated statistical platform before and after 1:1 propensity score matching (PSM) for smoking related co-morbidities. Results: The OR for death after ICI therapy for smokers ( n 13336) vs non-smokers ( n 38973) for any cancer type was 1.27(1.21-1.34) and decreased to 1.11(1.04-1.19) after PSM. Further sub-stratifying the smoking cohort for continued vs cessation of smoking yielded ORs of 1.13(1.03-1.24) and 1.12(1.01-1.24) before and after PSM respectively. Secondary outcomes included ablative surgery, chemotherapy, radiation, and secondary neoplasm. ORs for receiving chemotherapy, and developing secondary neoplasm were most consistently statistically significant across comparisons. Conclusions: Smoking adversely potentiates cancer outcomes after ICI therapy. PSM for smoking related comorbid conditions decreased the magnitude of this association although the findings remained clinically and statistically significant. This highlights the key role in smoking related co-morbid conditions as prognostic clinical characteristics. Furthermore, this suggests that smoking affects ICI on a mechanistic/biological level beyond increasing burden of medical comorbidities. Lastly, as smoking cessation also improved outcomes after PSM this further suggests that washout of smoke toxins has a mechanistic/biological effect on ICI activity. [Table: see text]

Analysis of Lung Cancer Screening by Race After USPSTF Expansion of Screening Eligibility in 2021

This cross-sectional study examines differences among individuals deemed eligible for lung cancer screening under USPSTF 2013 vs under USPTSF 2021 guidelines.

Outreach to primary care patients in lung cancer screening: A randomized controlled trial

Current guidelines recommend annual lung cancer screening (LCS), but rates are low. The current study evaluated strategies to increase LCS. This study was a randomized controlled trial designed to evaluate the effects of patient outreach and shared decision making (SDM) about LCS among patients in four primary care practices. Patients 50 to 80 years of age and at high risk for lung cancer were randomized to Outreach Contact plus Decision Counseling (OC-DC, n = 314), Outreach Contact alone (OC, n = 314), or usual care (UC, n = 1748). LCS was significantly higher in the combined OC/OC-DC group versus UC controls (5.5% vs. 1.8%; hazard ratio, HR = 3.28; 95% confidence interval, CI: 1.98 to 5.41; p = 0.001). LCS was higher in the OC-DC group than in the OC group, although not significantly so (7% vs. 4%, respectively; HR = 1.75; 95% CI: 0.86 to 3.55; p = 0.123). LCS referral/scheduling was also significantly higher in the OC/OC-DC group compared to controls (11% v. 5%; odds ratio, OR = 2.02; p = 0.001). We observed a similar trend for appointment keeping, but the effect was not statistically significant (86% v. 76%; OR = 1.93; p = 0.351). Outreach contacts significantly increased LCS among primary care patients. Research is needed to assess the additional value of SDM on screening uptake.

Estimating Eligibility for Lung Cancer Screening by Neighborhood in Philadelphia Using Previous and Current USPSTF Guidelines

The National Lung Screening Trial established the benefits of low-dose computed tomography for lung cancer screening (LCS) to identify lung cancer at earlier stages. In February 2021, the US Preventive Services Task Force (USPSTF) revised the eligibility recommendations to increase the number of high-risk individuals eligible for LCS and, in effect, expand screening eligibility for vulnerable populations. One strategy for facilitating LCS is to implement targeted screening in geographic areas with the greatest need. In Philadelphia, although neighborhood smoking rates have been defined, it is not known which neighborhoods have the greatest number of people eligible for LCS. In this study, the authors estimate eligibility for LCS within Philadelphia neighborhoods using both previous and current USPSTF guidelines. They used the Public Health Management Corporation's Household Health Survey from 2010, 2012, and 2015 to identify the number of people within ever-smoker groups (current every day, current occasional, and former smokers) by neighborhood in Philadelphia. Using the 2015 National Health Interview Survey (NHIS) Cancer Supplement, they identified the percentages within ever-smoker groups that were LCS eligible using the previous and current USPSTF guidelines. Finally, they applied the percentages eligible for the ever-smoker groups from the NHIS to the numbers in these groups within Philadelphia neighborhoods. They found that the number of Philadelphians eligible for LCS increased from 41,946 to 89,231 after the revised USPSTF guidelines. The current USPSTF guidelines increased eligibility for LCS within all Philadelphia neighborhoods, with the greatest increases in the River Wards planning district. Local providers should use these results to prioritize LCS services within neighborhoods with greatest eligibility.

Linkage-to-Care Following Community-Based HBV and HCV Screening Among Immigrants from the Washington–Baltimore Metropolitan Area, 2016–2019

Understanding characteristics that impact linkage-to-care (LTC) among individuals living with HBV and/or HCV can enhance public health efforts to provide tailored care services to prevent and treat viral hepatitis among immigrants. Using HBV/HCV screening and LTC data from immigrants (2016–2019), descriptive and logistic regression analyses were conducted to assess (1) the relationship between LTC and sociodemographic factors and (2) factors associated with HBV/HCV LTC. About 87% of those positive HBsAg had LTC and 52% had LTC among those with HCVAB and confirmed PCR. Access to care was an important LTC predictor for HBV–LTC: those who had neither health insurance nor primary care provider (PCP) were more likely to have HBV–LTC than those who had either health insurance or PCP (aOR = 2.95, 95% CI = 1.32–6.59). It is essential to equally provide HBV/HCV LTC support to all immigrants from countries with high prevalence regardless of access to care.

Social media-based intervention to promote HBV screening and liver cancer prevention among Korean Americans: Results of a pilot study

Objective

In United States, Asian Americans are 10 times more likely to have hepatitis B virus (HBV) infection than Whites. Asian immigrants with limited English proficiency face extra barriers to HBV screening and many are unaware of the infectious status. This study aimed to evaluate a social media-based intervention to promote HBV screening and liver cancer prevention among Korean Americans (KA) with limited English proficiency.

Methods

Our community-academia partnership developed the “Lets talk about liver cancer” mHealth program by adapting a CDC media campaign. The program consisted of culturally tailored short video clips and pictorial messages and was delivered over 4 weeks to the participants via the popular Korean social media app, Kakao Talk. A total 100 KA living in greater Washington DC metropolitan were recruited via social media networks and completed this pre-post pilot study.

Results

Out of the 100 participants of KA, 56 were female, mean age was 60, and most have lived in the U.S. for more than 20 years, 84% had limited English proficiency, and 21% had a family history of HBV infection or liver cancer. After 4-week intervention, 95% completed the follow-up survey. Participants reported significant improvements in HBV-related knowledge, liver cancer prevention knowledge, perceived benefits of HBV testing, perceived risks of HBV infection, injunctive norms of HBV testing, and self-efficacy of HBV testing.

Conclusions

The Kakao Talk-based liver cancer prevention program for KAs was feasible and effective. We advocate for community-academia partnership to develop and implement culturally appropriate and social media-based interventions for underserved immigrants.

Assessment of Hepatitis B Virus Screening Behaviors among Asian-Americans through the Lens of Social Cognitive Theory

Background and Purpose

Asian-Americans suffer from significant liver cancer disparity caused by chronic hepatitis B virus (HBV) infection. Understanding psychosocial predictors of HBV screening is critical to designing effective interventions.

Methods

Chinese-, Korean-, and Vietnamese-Americans in the Baltimore-Washington metropolitan region (N=877) were recruited from community-based organizations. Applying the Social Cognitive Theory (SCT), three main theoretical constructs (knowledge, outcome expectancy, and self-efficacy) were tested. Descriptive analyses using Chi-square and ANOVA and multivariate logistic regression models were conducted.

Results

About 47% of participants reported ever having screening for HBV. Vietnamese-Americans had the lowest HBV screening rate (39%), followed by Korean-Americans (46%) and Chinese-Americans (55%). Multiple logistic regression analyses showed significant effects of HBV-related knowledge on screening in all three groups, whereas self-efficacy had significant effects in the Chinese and Korean subgroups, but not Vietnamese. HBV outcome expectancy had no effect on the screening outcome in any of the groups. Additionally, consistent in all three groups, those who had lived in the United States longer were less likely to have screening.

Conclusion

HBV screening rates in Asian Americans remain low; targeted interventions need to consider the differences across ethnic subgroups and address the psychosocial risk factors.

A comparison of the influencing factors of chronic pain and quality of life between older Koreans and Korean-Americans with chronic pain: a correlational study

BACKGROUND

Chronic pain is one of the most common health problems for older adults worldwide and is likely to result in lower quality of life. Living in a different culture may also influence chronic pain and quality of life in older adults. The purpose of this study was to explore how multifaceted elements affect chronic pain and quality of life in older Koreans living in Korea and in older Korean-Americans (KAs) living in the USA.

METHODS

We conducted a secondary data analysis of data from 270 adults aged 65 years or over (138 Koreans and 132 KAs). We compared the effects of multifaceted elements on pain and quality of life by testing structural equation models (SEMs) for each group, using a maximum likelihood estimation and bootstrapping.

RESULTS

SEMs for both Korean and KAs showed that age and depressive symptoms directly affected quality of life. The number of comorbidities and depressive symptoms had mediating effects on quality of life through chronic pain in both groups. In older Koreans only, perceived financial status directly affected quality of life. In older KAs only, sleep quality indirectly affected quality of life through chronic pain.

CONCLUSION

The data showed that multimorbidity and depressive symptoms play critical roles for explaining chronic pain in older Koreans and KAs and ultimately negatively influence quality of life. Future intervention program to improve quality of life in older adults with chronic pain should consider the different cultural aspects affecting quality of life for Koreans and KAs.

Racial Differences in Lung Cancer Screening Beliefs and Screening Adherence

BACKGROUND

One challenge in high-quality lung cancer screening (LCS) is maintaining adherence with annual and short-interval follow-up screens among high-risk individuals who have undergone baseline low-dose CT (LDCT). This study aimed to characterize attitudes and beliefs toward lung cancer and LCS and to identify factors associated with LCS adherence.

METHODS

We administered a questionnaire to 269 LCS participants to assess attitudes and beliefs toward lung cancer and LCS. Clinical data including sociodemographics and screening adherence were obtained from the LCS Program Registry.

RESULTS

African-American individuals had significantly greater lung cancer worries compared with Whites (6.10 vs. 4.66, P < .001). In making the decision to undergo LCS, African-American participants described screening convenience and cost as very important factors significantly more frequently than Whites (60% vs. 26.8%, P< .001 and 58.4% vs. 37.8%, P = .001; respectively). African-American individuals with greater than high school education had significantly higher odds of LCS adherence (aOR 2.55; 95% CI, 1.14-5.60) than Whites with less than high school education. Participants who described screening convenience and cost as "very important" had significantly lower odds of completing screening follow-up after adjusting for demographic and other factors (aOR 0.56; 95% CI, 0.33-0.97 and aOR 0.54; 95% CI, 0.33-0.91, respectively).

CONCLUSION

Racial differences in beliefs about lung cancer and LCS exist among African-American and White individuals enrolled in an LCS program. Cost, convenience, and low educational attainment may be barriers to LCS adherence, specifically among African-American individuals.

IMPACT

More research is needed on how barriers can be overcome to improve LCS adherence.

Acculturation and Hypertension Diagnoses Among Hispanics in California

BACKGROUND

Among U.S. Hispanic immigrants and all other Hispanics living in the USA, heart disease is the leading cause of death. Meanwhile, the prevalence of hypertension among Mexican Americans, a subgroup of the U.S. Hispanic population, is rising. The purpose of this study was to estimate the prevalence of hypertension diagnosis and to determine the association between acculturation and hypertension among Mexican Americans and Other Hispanics in California.

METHODS

Using data from the 2014 California Health Interview Survey (CHIS), we performed multivariable logistic regression to identify whether acculturation (measured by self-reported duration of U.S. residence) predicted hypertension diagnoses, after controlling for sociodemographic characteristics (e.g., age, gender, poverty level), body mass index, health insurance coverage, and cigarette smoking.

RESULTS

Of 3793 Hispanics who participated in the survey, 81.8% were Mexican Americans, and 18.2% were Other Hispanics. The prevalence of hypertension among Hispanics was 24.0% (95% CI: 21.5-26.7), which was lower than that of African Americans (40.3%, 95% CI 34.2-46.7) and Whites (31.8%, 95% CI: 29.7-34.0). In the multivariable regression analysis, acculturation was associated with hypertension for Mexican Americans (aOR = 1.71, 95% CI, 1.24-2.36) and Other Hispanics (aOR = 2.77, 95% CI, 1.71-4.51).

CONCLUSION

The results show a positive association between acculturation in the USA and hypertension diagnoses among Mexican Americans and Other Hispanics. The findings can help public health practitioners, medical providers, policymakers, and others better understand the potential influences of acculturation on Hispanic immigrants' health and inform the creation of culturally sensitive health promotion materials.

Association of Race With Lung Cancer Risk Among Adults Undergoing Lung Cancer Screening

This cross-sectional study examines whether race is associated with differences in 6-year lung cancer risk among patients eligible for US Preventive Services Task Force–recommended lung cancer screening.

The Mediating Role of Pain Catastrophizing on the Association Between Depression and Pain Severity and Interference Among Elderly Asian Immigrants with Chronic Pain

Purpose

The association between depression and chronic pain is well established. However, few studies have examined the pathways from depression to chronic pain. The present cross-cultural study aimed to test the mediating effects of pain catastrophizing on associations between depression and chronic pain (eg, pain severity, pain intensity) among Korean American elderly.

Patients and Methods

A total of 132 elderly Korean Americans with chronic pain were recruited from elderly daycare centers and Korean ethnic churches in the community. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis.

Results

The results indicated that the proportion of comorbid depression and chronic pain was 45.7%. Elderly Korean Americans with depression scored higher in pain severity, pain interference, and pain catastrophizing than those without depression. Pain catastrophizing was found to have a significant mediating effect on the relationship between depression and pain severity (indirect effect = 0.147, Bootstrap 95% CI = [0.079, 0.226]), controlling for demographic covariates, comorbidities and pain area. Pain catastrophizing also mediated the relationship between depression and pain interference (indirect effect =0.164, Bootstrap 95% CI = [0.097, 0.244]), controlling for the covariates.

Conclusion

These findings add to the literature by providing evidence that pain catastrophizing plays a role in high levels of pain severity and pain interference comorbid chronic pain and depression in Asian elderly immigrants. Appropriate culturally tailored programs to redirect pain catastrophizing cognitive process should be developed and provided for elderly Asian Americans to reduce chronic pain disparity.

Racial/Ethnic Disparities in Patient-Provider Communication and the Role of E-Health Use

Although the health care industry has strived to address racial/ethnic disparities in health communication, several gaps remain. Previous findings suggest that communication technology might help narrow the gaps; however, they do not provide a comprehensive picture of how or why. To answer these questions, we examined the potential role of communication technology in mitigating the racial/ethnic disparities in patient-provider communication. Data analysis of the 2018 Health Information National Trends Survey (N= 3,504) revealed that the levels of perceived quality of communication with health care providers were lower among Asians and Hispanics than non-Hispanic Whites while no difference emerged between Blacks and non-Hispanic Whites. Although the adoption of communication technology was relatively high across minority groups, its use appeared to play different roles in different racial/ethnic populations. The Internet and patient portals showed no particular associations with patient-provider communication except for Black Internet users, who reported poorer experiences with patient-provider communication than non-users. Among Asians and Hispanics, social media and mobile communication appeared to play different roles in impacting communication experiences with health care providers. The findings suggest that communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities.

Abstract PO-242: Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up

Background: Viral hepatitis is a major public health problem around the world and in the United States, with significant morbidity and mortality. This research aimed to provide updated prevalence estimates and linkage-to-care rates for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among foreign-born immigrants in the Washington-Baltimore metropolitan area. Methods: This retrospective cohort study analyzed screening data obtained from over 275 community-based outreach events held from 2015 to 2019. Through strategic collaborations and culturally-appropriate programs, the Hepatitis B Initiative of Washington DC was able to provide no-cost HBV and HCV testing, vaccination, and treatment linkage-to-care services to 9,489 and 9,427 individuals, respectively. We examined the prevalence of positive HBV (HBsAg+) and HCV (HCVAb+) infections and linkage-to-care with associated sociodemographic characteristics. Results: Overall, prevalence amongst foreign-born clients screened over the 5-year period was 4.3% for HBV and 1.1% for HCV. The highest HBV prevalence was among participants born in Malaysia (8.5%), Cambodia (7.7%), and Vietnam (6.9%), whereas HCV prevalence was highest among participants born in Mongolia (5.0%), Cameroon (3.2%), and Burma (1.5%). Among the 378 HBV- and 102 HCV-infected individuals who were referred to care, linkage- to-care rates were 87.0% (2016-2019) and 47.1% (2017-2019) respectively. Among those linked to care, an overwhelming proportion reported not having health insurance (74.8%) and/or a usual source of care (75.3%); the majority were also female (52.8%), over 30 years of age (96.6%), and born in Asia (78.0%). Conclusions: Foreign-born individuals from Asia and Africa had the highest prevalence of viral hepatitis. These results underscore the need to disaggregate screening data by country of birth to inform prevention and linkage-to-care programs and their impact. Additionally, optimal HBV and HCV screening and linkage-to-care can be achieved among harder-to-reach at-risk populations through partnerships with community organizations, health centers, and public health departments.

Citation Format: Daisy Le, Annie Coriolan, Jane Pan, Carla Jean Berg, Y. Alicia Hong, Angeline Nguyen, Hai Chi Le, Lorien Cindy Abroms, Hee-Soon Juon, Y. Tony Yang. Viral hepatitis among foreign-born communities in the Washington- Baltimore metropolitan area: 5-year prevalence data and implications for linkage to care follow-up [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-242.

Abstract PO-271: Does residential distance from a lung cancer screening facility predict baseline screening?

Background. Previous studies identified important correlates of receiving low-dose computerized tomography (LDCT) among those referred to a lung cancer screening program in Philadelphia. However, studies have not considered whether distance from the screening site is a factor in whether eligible patients receive screening. In this study, we examine whether residential distance to the screening facility predicts receipt of baseline LDCT among eligible patients referred to the Jefferson Lung Cancer Screening Program (JLCSP), after controlling for covariates. Methods. We retrospectively selected eligible patients referred to JLCSP between 1/1/18 and 8/31/18 (N=399). We geocoded each patients’ address using ArcGIS 10.3. We used ArcGIS Network Analysis to identify the distance from each patients’ residence to the screening facility in downtown Philadelphia. We used bivariate statistical tests (chi- square, t-tests) and multivariable logistic regression to identify correlations between individual-level patient characteristics, including distance to facility, and receipt of baseline screening. Results. Residential distance to facility was not related to receipt of baseline LDCT screening, when we treated distance as a continuous variable.

When we treated distance as categorical by quartiles, residents living in the second quartile (2.41-3.25 miles) had lower odds of receiving LDCT compared to those in the closest quartile (AOR=0.55; CI=0.30-0.99). Other correlates of receiving LDCT screening were younger age, and being a former smoker (compared to current smokers). Conclusion. Individuals that lived 2.41-3.25 miles from the screening facility had lower odds of receiving LDCT compared to those that lived closest to the facility. This relationship may be the result of inadequate public transportation, or may reflect neighborhood poverty and resource inequities in Philadelphia neighborhoods. Our study did not collect patient income data, which could confound this relationship. More research is necessary to identify the extent to which distance from screening facilities serves as a barrier for receipt of LDCT services in order to reduce this barrier and improve screening adherence.

Citation Format: Russell K. McIntire, Seif Butt, Christine Shusted, Denine Crittendon, Brooke Ruane, Charnita Zeigler-Johnson, Hee-Soon Juon, Julie Barta. Does residential distance from a lung cancer screening facility predict baseline screening? [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-271.

Black patients referred to a lung cancer screening program experience lower rates of screening and longer time to follow-up

BACKGROUND

Racial disparities are well-documented in preventive cancer care, but they have not been fully explored in the context of lung cancer screening. We sought to explore racial differences in lung cancer screening outcomes within a lung cancer screening program (LCSP) at our urban academic medical center including differences in baseline low-dose computed tomography (LDCT) results, time to follow-up, adherence, as well as return to annual screening after additional imaging, loss to follow-up, and cancer diagnoses in patients with positive baseline scans.

METHODS

A historical cohort study of patients referred to our LCSP was conducted to extract demographic and clinical characteristics, smoking history, and lung cancer screening outcomes.

RESULTS

After referral to the LCSP, blacks had significantly lower odds of receiving LDCT compared to whites, even while controlling for individual lung cancer risk factors and neighborhood-level factors. Blacks also demonstrated a trend toward delayed follow-up, decreased adherence, and loss to follow-up across all Lung-RADS categories.

CONCLUSIONS

Overall, lung cancer screening annual adherence rates were low, regardless of race, highlighting the need for increased patient education and outreach. Furthermore, the disparities in race we identified encourage further research with the purpose of creating culturally competent and inclusive LCSPs.

The Association Between Perceived Stress and Hypertension Among Asian Americans: Does Social Support and Social Network Make a Difference?

Prior research suggests that stress plays role in the etiology and progression of hypertension. To lend a more accurate depiction of the underlying mechanisms between stress and hypertension, this study aims to assess the associations between perceived stress and hypertension across varying levels of social support and social network among Asian Americans. We conducted a cross-sectional study using data on 530 Chinese, Korean and Vietnamese Americans recruited from a liver cancer prevention program in the Washington D.C.-Baltimore metropolitan area. Hypertension prevalence was 29.1%. Individuals with high perceived stress were 61% more likely to have hypertension compared to those with low levels of perceived stress (odds ratio 1.61, 95% confidence interval 1.15, 2.46). There was no evidence that social support and social network acted as effect modifiers. Social support had a direct beneficial effect on hypertension, irrespective of whether individuals were under stress. The relationship between perceived stress and hypertension was modified by gender and ethnicity whereby a significant positive association was only observed among male or Chinese participants. Our study highlights the importance of understanding the associations between stress, social support, and hypertension among Asian American subgroups. Findings from the study can be used to develop future stress management interventions, and incorporate culturally and linguistically appropriate strategies into community outreach and education to decrease hypertension risk within the Asian population.

Abstract A010: Primary prevention across the life course: Findings from the young women's breast cancer and media study

Introduction: Breast cancer is typically seen as a disease of mid-life, but growing evidence supports primary prevention throughout women's lives. Little is known about the salience of breast cancer prevention messages for younger women, especially those at risk for breast cancer disparities.

Description: Our multiphase exploratory project first analyzed a purposive sample of news and popular media messages on breast cancer aimed at young adults. We then used these mainstream and tailored media examples in 7 focus groups with Philadelphia-area African-American, Latina, Asian-American, and sexual minority women age 21-30. Identity-concordant moderators explored knowledge, attitudes, and practices regarding health in general and breast cancer specifically, and media credibility and usage patterns. Then, guided discussion of breast cancer-related media examples was used to explore audience interpretation and response to messaging. Responses to a brief structured survey and transcribed audio-recordings of focus group discussions were analyzed.

Findings: Participants had diverse levels of socioeconomic and health-related resources: 40% were born outside of the U.S., 37% were uninsured, and 37% had &lt; high school education. Most used social media (i.e., 86% Facebook, 71% Instagram), 83% read on-line news at least weekly, and 63% had searched on-line for cancer information. When asked about cancer prevention across the life course, many young women expressed limitations on ideal health behaviors at their current life stage, due to economic constraints or stressors related to school, job or family. Respondents had little knowledge of evidence supporting risk-reducing behaviors, such as breast feeding, diet and physical activity, or limiting alcohol. Most found both mainstream and culturally tailored messages about breast cancer new and compelling; however, some challenged group-specific risk information or saw culturally tailored messages as geared to older, less acculturated women. Although young women recognized the importance of risk reduction, most felt that behavior change would be more feasible, and more important, when they were older.

Conclusions: Young women of all backgrounds and levels of access to information are not well informed about primary prevention of breast cancer. Tailored information has salience but may also need to consider generational and life-stage effects. Planning for health behavior change during young adult transitional stages appears highly salient, but must consider life roles, which widely differ by SES and culture.

Citation Format: Ann Carroll Klassen, Udara Perera, Suzanne Grossman, Ana Martinez-Donate, Augusta Villanueva, Zujeil Flores, Amy Leader, HeeSoon Juon. Primary prevention across the life course: Findings from the young women's breast cancer and media study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A010.

Abstract C017: Breast cancer trends and disparities in an urban setting

Background: Although efforts have been made to decrease breast cancer disparities, recent changes in breast cancer screening recommendations can influence cancer trends by race/ethnicity. The goal of this descriptive study was to determine how recent trends in breast cancer vary by race/ethnicity in a multiethnic, urban setting.

Methods: We obtained PA cancer registry data and female breast cancer rates of patients residing in Philadelphia County (2005-2014). Race was categorized based upon data in the Cancer Registry as all cases (all races), and the most prevalent groups of cases, including white/Caucasian (47%), black/African American (46%), Hispanic (4%) and Asian (3%). Our sample of the 4 major race/ethnic groups included 10,801 women. We conducted descriptive analyses using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables. Patient characteristics included incidence, advanced tumor stage (regional and distant disease), and advanced tumor grade (poorly differentiated or undifferentiated). We also calculated the percent change in incidence and mortality rates by race/ethnicity. A cut-point of 50 years were used to examine trends in incidence among younger vs. older patients.

Results: The median age at breast cancer diagnosis differed significantly by race/ethnicity (p&lt;0.001). White women were among the oldest at diagnosis (median age 65). Asian women were among the youngest (median age 53). More black women (18%) died from breast cancer compared to white (13%), Hispanic (12%) and Asian women (11%, p&lt;0.001). Advanced tumor grade was most common among Asian women (51%) and lowest among white women (33%, p&lt;0.001). Distant stage was most common among black women (10%) and compared to each of the other groups of women (8%, p&lt;0.001). Breast cancer rates were not available across many of the years for Asian and Hispanic women. However, trends in breast cancer incidence showed that Hispanic women had lower incidence at every point in time than black or white women. Percent change in incidence rates increased by 17% in Hispanics vs. 11% in white and 4% in black women. Among older women (age 50+), breast cancer incidence increased by 17% among black women and 10% among white women. Among young women (&lt;age 50), the incidence increased by 32% among white women but decreased by 16% among black women. Among older women, advanced-stage breast cancer was consistently most common among blacks. However, among younger women, recent trends show that white women now have the highest rates of advanced-stage disease. Breast cancer mortality was consistently highest for black women, although mortality rates have decreased over time. The decrease in mortality was 21% in white women and 15% in black women.

Conclusion: We observed race/ethnic differences in breast cancer trends in patient age, tumor characteristics, and disease rates. Future studies should examine factors that have influenced recent shifts in breast cancer incidence and mortality among diverse populations.

Citation Format: Hee-Soon Juon, Russell McIntire, Scott Keith, Charnita Zeigler-Johnson. Breast cancer trends and disparities in an urban setting [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C017.

Abstract A102: Factors associated with psychological distress among chronic hepatitis B patients

Background: Psychosocial stress is a common comorbidity in chronic hepatitis B (CHB) patients. A diagnosis of CHB, the primary risk factor for liver cancer among Asian Americans, can be a significant source of psychological and emotional stress. Although the disease can be life-changing, there is a paucity of research on psychosocial stress in CHB patients. The purpose of this study is to examine the prevalence of serious psychological distress (SPD) and factors associated with SPD in Asian CHB patients.

Method: It is a prospective study design with subjects identified from an existing patient cohort that were enrolled and then subsequently followed up. Information was gathered from the CHB patients using face-to-face interviews in Korean or English. Serious psychological distress was measured by the Kessler Scale (K6). Measures of stressful life events and Hepatitis B Quality of Life (HBQOL) (e.g., psychological well-being, anticipation anxiety, stigma) were used. A multivariate logistic regression model (including gender, age, level of education) was conducted for analysis. Results. Of 50 CHB patients 18 years and older, the 12-month prevalence of SPD was estimated at 20% using the optimal cut-off (&gt;=13). In adjusted regression analysis, stressful life events and HBQOL-stigma were related to serous psychological distress: Those who had stressful life events (aOR=3.10, 95% CI 1.26-7.64) and those who had high scores of stigma (aOR=1.19, 95% CI 0.97-1.44, p=.08) had higher psychological distress. Those with more than a college education had decreased psychological distress (aOR=0.09, 95% CI 0.01-0.82).

Conclusion: The finding indicates CHB patients had a higher prevalence of serious psychological distress than the general Asian population (2.6% from California Health Interview Survey). Stigma connected to hepatitis B diagnosis and stressful life events were important factors associated with mental health. This suggests that disease burden caused by hepatitis B infection may lead to poor mental health. Future studies will identify those who are at a high likelihood of developing a mental disorder and develop effective interventions for early detection of mental illness.

Citation Format: Hee-Soon Juon, Grace Park, Klassen Ann, Hie-Won Hann. Factors associated with psychological distress among chronic hepatitis B patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A102.

Abstract A101: Hair cortisol measurement in chronic hepatitis B patients

Objectives: It is known that chronic hepatitis B (CHB) infection exerts suppressive effects on the host innate and adaptive immune responses. Although there is information about liver disease progression of CHB patients and the adverse effects of stress on the immune system, few studies focus on the effects of chronic stress in CHB patients. To our best knowledge, this is the first study to measure hair cortisol in CHB patients. To address the prolonged exposure to stress associated with CHB diagnosis, we explored the measure of the stress hormone cortisol (CORT) in the hair as a biomarker of chronic stress in CHB patients.

Methods: Eligible CHB patients identified from an existing patient cohort were enrolled in this prospective study. Data collection were done using medical chart reviews, face-to-face interview in Korean or English, and hair and blood samples. Hair samples were cut from the posterior vertex of the scalp, as close to the scalp as possible. Hair CORT in the most proximal 3-cm scalp hair segment was analyzed using luminescence immunoassay.

Results: We collected hair samples of 50 CHB patients (age 34-74 years) with duration of HBV diagnosis (1-51 years, 23.8±10). Hair samples weighing 19.6 - 29.9 mg were processed and analyzed for cortisol. Mean cortisol levels were 16.42 pg/mg (27.59 SD) ranging from 2.7 to 168.1 pg/mg. About 16% had below normal HCC (&lt;5.5 pg/mg). The rate of distress measured by Distress Thermometer (DT) (defined by the DT cutoff &gt;=4) was 48%. Distress was positively correlated with hair CORT (r=.395, p&lt;.05) among those with below normal CORT.

Conclusion: About one fifth of the patients had very low hair cortisol levels, suggesting long-term suppression of hair cortisol production in the course of HBV diagnosis and antiviral therapy. Low hair cortisol level might indicate a specific pathogenic mechanism with cortisol production. This study suggests further research to determine the longitudinal effects of chronic stress on hair cortisol levels and chronic liver disease progression in CHB patients.

Citation Format: Hie-Won Hann, Hushan Yang, Jerrold Meyer, Hee-Soon Juon. Hair cortisol measurement in chronic hepatitis B patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A101.

Parental caregiving trajectories and Metabolic Syndrome: A longitudinal study among Chinese women

Caregiving stress may play a role in the pathogenesis of Metabolic Syndrome (MetS). However, few studies have investigated the consequences of caregiving on this objectively measured health outcome. This study used population based longitudinal data to examine the causal relationship between caregiving trajectory and MetS among Chinese women. This is a retrospective analysis of 741 women using three waves of data from the Ever-Married Women Survey component of the China Health and Nutrition Survey (2004, 2006, and 2009). Group-based trajectory analysis was used to examine the caregiving trajectories among women in China. Three caregiving trajectories were identified. In multivariate analyses adjusting for potential covariates, 'rising to high-intense' caregivers (Odds Ratio (OR) = 3.78; 95% Confidence Interval (CI): 1.10, 12.93) and 'stable low-intense' caregivers (OR = 2.07; 95% CI: 1.09, 3.92) were associated with higher risk of MetS compared with non-caregivers. Moreover, caregivers who provided 'stable low-intense' parental care were found to be associated with hypertension, high glucose and high triglycerides than those awho did not provide caregiving for their parents. Our results demonstrate that the caregiving trajectories were significantly associated with the risk of MetS. Findings from the study can be used to develop future stress management interventions to decrease MetS risk among women who provide care to their parents.

Prevalence of Chronic Hepatitis B and C Infection in Mongolian Immigrants in the Washington, District of Columbia, Metropolitan Area, 2016-2017

Introduction

Mongolia has the highest liver cancer incidence in the world. Hepatocellular carcinoma is the most prevalent primary liver cancer, and the most common risk factors are hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Although viral hepatitis occurs mostly in the developing world, migration of people from high prevalence countries contributes to the health outcomes of the United States. Data on Mongolian Americans is limited. The objective of this study was to estimate HBV and HCV infection prevalence among Mongolia-born immigrants living in the Washington, District of Columbia, metropolitan area.

Methods

We tested Mongolia-born immigrants for chronic hepatitis at community-based screening events from 2016 to 2017. Descriptive statistics were generated to describe the screening results. Bivariate analysis was conducted to examine the relationship between hepatitis prevalence and sociodemographic characteristics.

Results

Of 634 participants, most did not speak English primarily, were uninsured, and did not have a regular primary care provider. Eighty-two participants (12.9%) had chronic HBV or HCV infection after accounting for HBV and HCV co-infection. Thirty-nine (6.2%) were chronically infected with HBV, and 233 (36.8%) were susceptible to HBV. Sixty-three (9.9%) participants were positive for HCV exposure, and 45 (7.1%) had confirmed chronic HCV infection. While no sociodemographic characteristics were associated with HBV infection, age and primary spoken language (Mongolian) were significantly associated with HCV exposure.

Conclusion

Foreign-born immigrants such as Mongolian Americans have a high prevalence of chronic viral hepatitis infection. Targeted screening, vaccination, and treatment programs can help decrease immigrant risk for developing hepatocellular carcinoma.

The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening

OBJECTIVE

Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population.

DESIGN

This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture.

RESULTS

Participants who had a regular physician and doctor's recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR) = 3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR = 6.61; 95% CI: 2.63, 16.65, respectively). A doctor's recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR = 4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR = 0.15; 95% CI: 0.03, 0.82 and aOR = 0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the'immigrant life,' who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer.

CONCLUSIONS

Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.

The association of perceived discrimination and depressive symptoms among Chinese, Korean, and Vietnamese Americans

OBJECTIVES

Few studies have investigated ethnic differences in discrimination and depressive symptoms, and the link between them among foreign-born Asian Americans. This study identifies if depressive symptoms and perceived discrimination differ by Asian ethnicity, and if perceived discrimination is associated with depressive symptoms among foreign-born Chinese, Korean, and Vietnamese Americans.

METHODS

This study uses data from the Asian American Liver Cancer Prevention Program (N = 600). Using nonprobability sampling, foreign-born Asian American adults (58% female, Mage = 47.3 years, SD = 11.82) were recruited from the community in the Baltimore-Washington Metropolitan Area. Perceived discrimination was defined using everyday and major discrimination scales; the Centers for Epidemiological Studies-Depression Scale defined the outcome of depressive symptoms. Multiple logistic regressions were conducted to determine if this association exists.

RESULTS

A high prevalence of depressive symptoms (one third to one fifth per ethnicity) and ethnic differences between foreign-born Chinese, Korean, and Vietnamese Americans were found; increased perceived discrimination was associated with worse depressive symptomology. Those with "high" and "mild discrimination" had greater odds of being depressed than those who had never experienced discrimination; those with "unfair treatment" had greater odds of being depressed than those who had none. Major experiences of discrimination were less common and less likely associated with depressive symptoms than everyday experiences.

CONCLUSIONS

Foreign-born Asian Americans experience substantial discrimination and depressive symptoms. Future studies should stratify by Asian ethnicity and examine the differences between minor and major experiences of discrimination to provide appropriate mental health prevention and treatment for this population. (PsycINFO Database Record

Abstract B02: News they can use? The portrayal of breast cancer risk and prevention in print news and popular press for young women

Background: Inherited risk accounts for only 5-10% of breast cancers; furthermore, there is growing evidence regarding strategies for reduction of risk for breast cancer through primary prevention, including healthful diet, physical activity and body size, avoidance of alcohol and possibly tobacco, and breast feeding when possible. Although the median age of breast cancer diagnosis is 61, and there are likely unidentified critical time periods for each exposure, women may benefit most by establishing healthful behaviors early in life and maintaining them across adulthood. However, it is not well known how breast cancer risk and prevention is presented to young women, and how sources such as the media influence susceptibility, self-efficacy, and preventive behaviors, especially across diverse groups.

Approach: Within a multiphase exploratory study, we analyzed a purposive sample of 79 examples from 2003-2017, U.S. and international English language print news, popular press, and websites targeted to young women from diverse ethnic and sexual identity backgrounds. Stories were coded, using both structured codes and qualitative memoing methods. Here, we focus on the extent to which news and popular stories contained messages congruent with prevention recommendations.

Results: Our sample of stories included 43 from 29 different standard news sources, 32 from 10 popular magazines, and 1 from each of 4 websites. Stories appeared in both general-audience as well as ethnically targeted media, including O, Jet, Korean Times, and Philippines Today. Thirty-four percent of stories featured a personal narrative from someone experiencing breast cancer, or at risk, and celebrities were mentioned or quoted in 9% of stories. Groups mentioned for excess risk most often were those with family histories (19% of stories), followed by African-Americans (15%), poor women (14%), Latina women (10%), and Asian women (9%). Excess risk for LGBT women was mentioned in only 4% of stories.

Forty three percent of stories had a positive prevention and/or survivorship tone, and only 15% had fear-inducing or fatalistic content without any actionable prevention recommendations. The top prevention strategies mentioned included diet (24%), exercise (22%), avoiding overweight/staying lean (22%), learning family history (20%), and limiting alcohol intake (19%). However, despite this generally positive content, our qualitative content analysis found that stories also tended to overemphasize young-onset breast cancers, without clarifying the age distribution of the disease, emphasized mammography screening and secondary over primary prevention, overemphasized hereditary risk, highlighted race-based differences, and contained frequent mentions of “magic bullet” prevention approaches, such as specific foods and supplements, rather than broader dietary strategies.

Findings point to many areas for improved cancer prevention communication tailored to young women. Given the frequent coverage of breast cancer in media geared to this audience, more effort should be made by cancer prevention scientists to improve messages regarding prevention. We are currently using this content with diverse groups of young women in focus groups, to better understand interpretation of these messages by the target audiences.

Citation Format: Ann Carroll klassen, Amy Leader, Ana Martinez-Donate, Augusta Villanueva, Suzanne Grossman, Udara Perera, Tashi Lhamo, HeeSoon Juon. News they can use? The portrayal of breast cancer risk and prevention in print news and popular press for young women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B02.

Social Norm, Family Communication, and HBV Screening among Asian Americans

Individuals' behaviors are influenced by those of others in their social environment (i.e., descriptive norms), as well as by how individuals perceive they should behave in that environment (e.g., injunctive norms). Although social norms are thought to play an important role in hepatitis B virus (HBV) screening, limited theoretical or empirical guidance exists on how the underlying process works. In addition, norms are social phenomena that are spread through family discussion about the importance of getting HBV screening. Using the theory of normative social behavior (TNSB), this study examined the roles of injunctive norms (IN), descriptive norms (DN), and family discussion in HBV screening behavior among Asian Americans. Data from a survey of Asian Americans in the Baltimore Washington metropolitan area (N = 877) were used to test underlying theoretical propositions. DN and family discussion emerged as key factors in HBV screening behavior among all Asian Americans. IN were associated with HBV screening among Chinese and Korean Americans, but not for Vietnamese Americans. Family discussion moderated the influence of DN on behavior among Chinese and Vietnamese Americans. However, the main effect of DN on screening behavior was not modified by IN (no interactions between DN and IN). The results indicate that family discussion and social norms are integral in enabling Asian Americans to undergo HBV screening and warrant sensitivity in the design and implementation of a liver cancer prevention program in this high-risk group of Asian Americans.

Abstract 4223: Colorectal cancer knowledge and screening among Asian Americans aged 50-75 years old

Background: Chinese, Vietnamese, and Korean Americans, three of the largest Asian American (AA) subgroups, have particularly high rates of colorectal cancer (CRC) incidence and mortality. However, CRC screening rates among these Asian Americans remain very low. Increased knowledge of CRC has been shown to be positively correlated with a person’s inclination to undergo screening.

Purpose: This study estimated the prevalence of up to date CRC screening and examined the predictors of CRC knowledge and screening compliance among Chinese, Korean, and Vietnamese Americans living in the Baltimore-Washington metropolitan area.

Methods: A cross-sectional sample was employed in this study and included 274 Chinese, Korean, and Vietnamese Americans between ages 50-75 years old. A questionnaire was given to participants in either their preferred native language or in English. Data was collected in person.

Results: Data from the 2009 California Health Interview Survey (CHIS) indicates that Chinese Americans had higher rates of FOBT at 32.2% than Vietnamese Americans (27.3%) and Korean Americans (24.8%). Compared to these rates from CHIS, we had significantly lower rates of up to date FOBT: less than 10% (9.1%) reported having FOBT in the past year. Vietnamese had the highest rate (13.8%) followed by Korean (7.5%) and Chinese (6.9%). For the prevalence of up to date colonoscopy (&lt;10 years), CHIS data disaggregated by ethnicity among AA shows that Vietnamese Americans (63.7%) had highest rates of having colonoscopy followed by Korean Americans (51.1%) and Chinese Americans (48.7%). In our study, Chinese had higher rates of up to date colonoscopy (63.3%) than Vietnamese (47.5%) and Korean (43.0%). The average CRC Knowledge Score was 6.10 out of 9 (SD=2.91). In bivariate analysis, education, marital status, and self-rated health were highly correlated with CRC knowledge. Those with higher education levels, those married, and those rated with good physical health had increased CRC knowledge. In multivariate analysis, education, health insurance, and CRC knowledge were significantly related to having colonoscopy. Those with high CRC knowledge were more likely to have colonoscopy than those low knowledge (aOR=2.74, 95% CI, 1.13, 6.64). Those who had health insurance had higher likelihood of having colonoscopy than those without health insurance (aOR=4.40, 95% CI, 2.33, 8.32). Those more than high school education were less likely to have colonoscopy than those with less than high school education (aOR=0.37, 95% CI, 0.16, 0.84). Conclusions: The findings of this study suggest that CRC knowledge is a strong predictor of CRC screening behavior in Asian Americans. Lack of CRC screening knowledge still remains an important barrier to screening, and future strategies to increase public awareness on CRC is necessary to achieve greater screening compliance amongst AA populations.

Citation Format: Jenny Guo, Hee-Soon Juon, Sunmin Lee. Colorectal cancer knowledge and screening among Asian Americans aged 50-75 years old [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4223. doi:10.1158/1538-7445.AM2017-4223

Abstract C72: Social norms, family communication, and hepatitis B screening among Asian Americans

Background: Although social norms are thought to play an important role in hepatitis B screening behaviors, limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), we examined the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and hepatitis B screening behavior among Asian Americans.

Methods: Chinese, Korean, and Vietnamese Americans in the Washington D.C.-Baltimore metropolitan area (N=877) were recruited from community-based organizations. Self-administered baseline surveys collected information on their demographic, social norms (e.g., descriptive and injunctive norms), interpersonal communication, and HBV screening behavior.

Results: Social norms and family communication emerged as key factors in HBV screening. For Vietnamese Americans, family communication moderated the influence of descriptive norms on behavior. Injunctive norm moderated the influence of descriptive norms on behavior among Korean Americans. However, there was no significant interaction for Chinese Americans.

Discussion: Family communication and social Snorms are integral in enabling Asian Americans to have HBV screening and warrant sensitivity in the design of liver cancer prevention program in this high risk group of Asian Americans.

Citation Format: Hee-Soon Juon, Rajiv Rimal, Sunmin Lee. Social norms, family communication, and hepatitis B screening among Asian Americans. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C72.

Do Recommendations by Healthcare Providers, Family-members, Friends, and Individual Self-Efficacy Increase Uptake of Hepatitis B Screening? Results of a Population-Based Study of Asian Americans

BACKGROUND

Hepatitis B virus (HBV) infection disproportionately affects Asian Americans but HBV screening rates among Asian American are substantially low. This study examines the impact of multiple recommendations and self-efficacy on HBV screening uptake among Asian Americans.

METHODS

Data for this study were from 872 Chinese, Korean and Vietnamese recruited for a liver cancer prevention program in the Washington D.C - Baltimore metropolitan area.

RESULTS

410 (47%) respondents reported previous HBV screening. Only 19.8% recalled a physician recommendation. Higher level of HBV screening was reported among people who had physician recommendation, family member recommendation or friend recommendation. Perceived self-efficacy was also an important predictor to HBV screening. The effect of self-efficacy was significant in subgroup analyses among Chinese and Korean, but not for Vietnamese.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

The disproportional prevalence of HBV infection among Asian Americans is considered to be one of the most important health disparities for Asian population. Understanding the condition and screening behavior in this population is especially important. Our findings suggest that recommendation from physician and social networks should be encouraged for HBV screening among Asian Americans. Both recommendation and self-efficacy of HBV screening are important psychosocial constructs to be targeted in liver cancer prevention interventions.

Sociodemographic characteristics, knowledge and prevalence of viral hepatitis infection among Vietnamese Americans at community screenings

Few studies have investigated the prevalence of hepatitis B virus (HBV) and C virus (HCV) infection among Vietnamese Americans (VAs). The purpose of this paper is to assess the prevalence of HBV and HCV infection, identify the sociodemographic characteristics of the HBV infected population and the level of HBV knowledge among VAs in the Baltimore-Washington metropolitan areas with data from a health fair in 2011. A total of 617 VAs received serological testing for HBV and HCV, and 329 completed a survey of HBV knowledge assessment. About 9% were infected with HBV and 5% with HCV. Vietnamese Americans younger than 30 years had the highest HBV prevalence (13.1%) followed by those age 41-50 years (12.1%). The prevalence of HCV infection was particularly higher among those older than 70 years old (13.9%). Misunderstanding HBV as a food-borne disease is prevalent among VAs. Efforts to develop public health screening and education programs targeting this population are warranted.

Health Examination Is Not a Priority for Less Acculturated Asian Americans

This study examines the associations between acculturation and three health examination behaviors (physical, dental, and eye exams) among 846 Chinese, Korean, and Vietnamese Americans. The study was part of a randomized, community-based trial on liver cancer prevention that targeted Asian Americans in Washington DC metropolitan area. Acculturation was assessed using Suinn-Lew Asian Self-Identity Acculturation (SL-ASIA) scale, acculturation clusters, and length of stay. Health examination behaviors in the last 2 years were self-reported. Potential confounders such as age, gender, ethnicity, income, marital status, self-rated health status, health insurance, and having a regular physician were adjusted. Increased acculturation was associated with greater receipt of preventive services when acculturation was measured by SL-ASIA and acculturation clusters. Compared to those in the "Asian" cluster, those in the "American" cluster and "bicultural" clusters were more likely to have physical exams (American odds ratio (OR) = 1.83, 95 % confidence interval (CI) 0.99, 3.88; bicultural OR = 1.11; 95 % CI 0.72, 1.70), dental exams (American OR = 1.99, 95 % CI 1.09, 3.65; bicultural OR = 1.83, 95 % CI 1.21, 2.78), and eye exams (American OR = 4.48, 95 % CI 2.67, 7.66; bicultural OR = 1.92, 95 % CI 1.31, 2.81). A gradient was observed in these associations with the American cluster having stronger associations than the bicultural cluster. Interaction was found between acculturation and gender for receipt of a physical exam. Future studies are needed to further explicate how access to health care impacts the association between acculturation and health examinations among Asian Americans.

Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial

Background

This study aimed to evaluate the effect of a lay health worker (LHW) telephone intervention on completing a series of hepatitis B virus (HBV) vaccinations among foreign-born Asian Americans in the Baltimore-Washington Metropolitan area.

Methods

During the period of April 2013 and March 2014, we recruited Asian Americans who were 18 years of age and older in the community-based organizations. Of the 645 eligible participants, 600 (201 Chinese, 198 Korean, 201 Vietnamese) completed a pretest survey and received hepatitis B screening. Based on the screening results, we conducted a randomized controlled trial among those unprotected (HBsAg-/HBsAB-) by assigning them either to an intervention group (n = 124) or control group (n = 108). The intervention group received a list of resources by mails for where to get free vaccinations as well as reminder calls for vaccinations from trained LHWs, while the control group received only list of resources by mail. Seven months after mailing the HBV screening results, trained LHWs followed up with all participants by phone to ask how many of the recommended series of 3 vaccinations they had received: none, 1 or 2, or all 3 (complete). Their self-reported vaccinations were verified with the medical records. Multinomial logistic regressions were used to examine the effect of the LHW intervention. Process evaluation was conducted by asking study participants in the intervention group to evaluate the performance of the LHWs.

Results

After seven months, those in the intervention group were more likely to have 1 or more vaccines than the control group, compared to the no vaccination group (OR = 3.04, 95% CI, 1.16, 8.00). Also, those in the intervention group were more likely to complete a series of vaccinations than the control group, compared to the no vaccination group (OR = 7.29, 95% CI 3.39, 15.67). The most important barrier preventing them from seeking hepatitis B vaccinations was lack of time to get the vaccination. The most important promoters to getting vaccinations, among those who had vaccinations (n = 89), were our intervention program (70.8%) and self-motivation (49.4%). The majority of participants in the intervention group received the phone calls from LHWs (93%) and almost all of them got the reminder to receive vaccines (98%).

Conclusion

The LHW intervention was successful at increasing HBV vaccinations rates among foreign-born Asian Americans. This study suggests that this culturally integrated intervention program may be useful for reducing liver cancer disparities from chronic HBV infection in high risk Asian Americans.

Trial Registration

ClinicalTrials.gov NCT02760537

Ethnic Group Differences in Health Outcomes Among Asian American Men in California

The numbers of Asian American men are continually increasing, yet limited research exists on this understudied population. Addressing this lack of research is necessary to better inform how best to improve quality of care. This study examined health outcome differences across ethnically diverse groups of Asian American men in California, compared with non-Hispanic White men. Using data from the 2007, 2009, and 2011-2012 California Health Interview Survey, distributions of health status and health-related characteristics across ( n = 43,030) racial/ethnic groups of men (Chinese, Japanese, Korean, Filipino, Vietnamese, Other Asian Americans, and non-Hispanic Whites) were calculated. Compared with non-Hispanic Whites, odds of reporting fair or poor health were higher among Vietnamese, while odds of diabetes were higher among Korean, Filipino, and Other Asian Americans. Odds of high blood pressure were higher among Filipino and Vietnamese but lower among Other Asian Americans, while odds of disability were lower across all ethnic groups except Filipino and Vietnamese. This study's findings highlight the importance of understanding ethnic heterogeneity to develop culturally appropriate health interventions for Asian American men.

Pathways from Early Childhood Adversity to Later Adult Drug Use and Psychological Distress: A Prospective Study of a Cohort of African Americans

Drawing on the life course perspective, this research addresses the direct and indirect pathways between childhood adversity and midlife psychological distress and drug use across a majority of the life span in an African American cohort (N = 1,242) followed from age 6 to 42 (1966 to 2002). Results from structural equation models highlight the impact of low childhood socioeconomic status (SES), poor maternal mental health, and the role of first-grade maladaptation in launching a trajectory of social maladaptation from age 6 to 42. Specifically, for men, we found a direct pathway from early low SES to drug use in mid adulthood and an indirect pathway to psychological distress through first-grade maladaptation and adolescent poor mental health. For females, early SES affected first-grade maladaptation and low school bonds, which then predicted later drug use.

Abstract A53: Revisiting the importance of a culturally integrated liver cancer education program among Asian Americans

Background: Asian Americans are at high risk of contracting the hepatitis B virus (HBV). Culturally integrated liver cancer educational program has increased HBV knowledge which leads to HBV screening, vaccinations, and treatment, which reduce cancer health disparities from HBV infection. The purpose of this study is to evaluate the effect of culturally integrated education program on HBV knowledge as opposed to a stand-alone video education program.

Methods: Asian American adults were recruited from community-based organizations (Study 1) and from Pan Asian Volunteer Health Clinic (Study 2) in the Baltimore-Washington Metropolitan area. 441 participants in Study 1 received the 30-minute intervention program including power point presentation with Q & A, role play video, and distribution of photonovel. In Study 2, 276 participants watched the 10-minute video presentation without any interaction with the staff. Both intervention programs focus on general knowledge of the HBV, the importance of vaccinations, and follow-up for those infected. All participants completed baseline survey after signing the informed consent. Then they received two different education programs either a culturally integrated program or a video presentation. After the education program, they completed a post-education survey. The outcome measures were correct answers to knowledge questions related to HBV infection, including the modes of HBV transmission (10 questions) and sequelae of chronic HBV (7 questions). Paired sample t-test was used.

Results: The culturally integrated education program was more effective than the video education. It increased their knowledge of HBV infection appreciably (4.18 vs 1.31 for mode of transmission, p&lt;.001; 2.06 vs. 0.69 for sequelae, p&lt;.001). In the pretest, less than one fourth of the participants had the correct answer to two questions: (1) eating food that had been pre-chewed by an infected person; and (2) breast feeding from an infected mother. Only one third knew that HBV is significantly more contagious than HIV/AIDS.

Conclusion: This study suggests that it is very critical to implement the culturally integrated education program to reduce liver cancer health disparities among Asian Americans.

Citation Format: Hee-Soon Juon, Frederic Kim, Patrick Lam. Revisiting the importance of a culturally integrated liver cancer education program among Asian Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A53.