Hepatitis B ESL education for Asian immigrants

Asian communities in North America include large numbers of immigrants with limited English proficiency. Hepatitis B virus (HBV) infection is endemic in most Asian countries and, therefore, Asian immigrant groups have high rates of chronic HBV infection. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B English as a second language (ESL) educational curriculum for Asian immigrants. Eighty ESL classes were randomized to experimental (hepatitis B education) or control (physical activity education) status. Students who reported they had not received a HBV test (at baseline) completed a follow-up survey 6 months after randomization. The follow-up survey assessed recent HBV testing and HBV-related knowledge. Provider reports were used to verify self-reported HBV tests. The study group included 218 students who reported they had not been tested for HBV. Follow-up surveys were completed by 180 (83%) of these students. Provider records verified HBV testing for 6% of the experimental group students and 0% of the control group students (P = 0.02). Experimental group students were significantly (P < 0.05) more likely than control group students to know that immigrants have high HBV infection rates, HBV can be spread during sexual intercourse and by sharing razors, and HBV infection can cause liver cancer. Our ESL curriculum had a meaningful impact on HBV-related knowledge and a limited impact on HBV testing levels. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups and other health topics, as well as other intervention approaches to increasing levels of HBV testing in Asian immigrant communities.

Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women

OBJECTIVES

We conducted a trial to evaluate the effectiveness of a cervical cancer control intervention for Vietnamese American women that used lay health workers.

METHODS

The study group included 234 women who had not received a Papanicolaou (Pap) test in the last 3 years. Experimental group participants received a lay health worker home visit. Our trial endpoint was Pap test receipt within 6 months of randomization. Pap testing completion was ascertained through women's self-reports and medical record reviews. We examined intervention effects among women who had ever received a Pap test (prior to randomization) and women who had never received a Pap test.

RESULTS

Three quarters of the women in the experimental group completed a home visit. Ever-screened experimental group women were significantly more likely to report Pap testing (P < .02) and to have records verifying Pap testing (P < .04) than were ever-screened control group women. There were no significant differences between the trial arms for women who had never been screened.

CONCLUSIONS

Our findings indicate that lay health worker-based interventions for Vietnamese American women are feasible to implement and can increase levels of Pap testing use among ever-screened women but not among never-screened women.

Pap smear receipt among Vietnamese immigrants: the importance of health care factors

OBJECTIVE

Recent US data indicate that women of Vietnamese descent have higher cervical cancer incidence rates than women of any other race/ethnicity, and lower levels of Pap testing than white, black, and Latina women. Our objective was to provide information about Pap testing barriers and facilitators that could be used to develop cervical cancer control intervention programs for Vietnamese American women.

DESIGN

We conducted a cross-sectional, community-based survey of Vietnamese immigrants. Our study was conducted in metropolitan Seattle, Washington, DC. A total of 1532 Vietnamese American women participated in the study. Demographic, health care, and knowledge/belief items associated with previous cervical cancer screening participation (ever screened and screened according to interval screening guidelines) were examined.

RESULTS

Eighty-one percentage of the respondents had been screened for cervical cancer in the previous three years. Recent Pap testing was strongly associated (p<0.001) with having a regular doctor, having a physical in the last year, previous physician recommendation for testing, and having asked a physician for testing. Women whose regular doctor was a Vietnamese man were no more likely to have received a recent Pap smear than those with no regular doctor.

CONCLUSION

Our findings indicate that cervical cancer screening disparities between Vietnamese and other racial/ethnic groups are decreasing. Efforts to further increase Pap smear receipt in Vietnamese American communities should enable women without a source of health care to find a regular provider. Additionally, intervention programs should improve patient-provider communication by encouraging health care providers (especially male Vietnamese physicians serving women living in ethnic enclaves) to recommend Pap testing, as well as by empowering Vietnamese women to specifically ask their physicians for Pap testing.

HPV vaccine knowledge and beliefs among Cambodian American parents and community leaders

BACKGROUND

The cervical cancer incidence rate among Cambodian American women is 15.0 per 100,000, compared to 7.7 per 100,000 among non-Latina white women. HPV infection has been identified as a universal risk factor for cervical cancer. The HPV vaccine was recently approved in the United States for females aged 9-26 years. There is little information about HPV vaccination knowledge and beliefs in Southeast Asian communities.

METHODS

We conducted 13 key informant interviews with Cambodian community leaders, as well as four focus groups with Cambodian parents (37 participants). Two of the focus groups included fathers and two of the focus groups included mothers. Interview and focus group questions addressed HPV vaccine barriers and facilitators.

RESULTS

Participants had limited knowledge about HPV infection and the HPV vaccine. Barriers to HPV vaccination included a lack of information about the vaccine, as well as concerns about vaccine safety, effectiveness, and financial costs. The most important facilitators were a health care provider recommendation for vaccination and believing in the importance of disease prevention.

DISCUSSION

Future cervical cancer control educational programs for Cambodians should promote use of the HPV vaccine for age-eligible individuals. Health care providers who serve Cambodian communities should be encouraged to recommend HPV vaccination.

Evaluation of a hepatitis B lay health worker intervention for Chinese Americans and Canadians

Hepatitis B testing is recommended for immigrants from countries where hepatitis B infection is endemic. However, only about one-half of Chinese in North America have received hepatitis B testing. We conducted a randomized controlled trial to evaluate the effectiveness of a hepatitis B lay health worker intervention for Chinese Americans/Canadians. Four hundred and sixty individuals who had never been tested for hepatitis B were identified from community-based surveys of Chinese conducted in Seattle, Washington, and Vancouver, British Columbia. These individuals were randomly assigned to receive a hepatitis B lay health worker intervention or a direct mailing of physical activity educational materials. Follow-up surveys were completed 6 months after randomization. Self-reported hepatitis B testing was verified through medical records review. A total of 319 individuals responded to the follow-up survey (69% response rate). Medical records data verified hepatitis B testing since randomization for 9 (6%) of the 142 experimental group participants and 3 (2%) of the 177 control group participants (P = 0.04). At follow-up, a higher proportion of individuals in the experimental arm than individuals in the control arm knew that hepatitis B can be spread by razors (P < 0.001) and during sexual intercourse (P = 0.07). Our findings suggest that lay health worker interventions can impact hepatitis B-related knowledge. However, our hepatitis B lay health worker intervention had a very limited impact on hepatitis B testing completion. Future research should evaluate other intervention approaches to improving hepatitis B testing rates among Chinese in North America.

Sources of health information among Chinese immigrants to the Pacific Northwest

BACKGROUND

Chinese immigrants to North America experience cancer-related health disparities and underutilize preventive care. Little is known about Chinese immigrants' sources of health information.

METHODS

A population-based survey of Chinese immigrants was conducted in Vancouver, British Columbia, Canada and Seattle, Washington.

RESULTS

The study group included 899 individuals. Less than three fourths of the respondents reported receiving health information from health care providers, and only a minority used the Internet as a source of health information. We found significant differences between the sources of health information in Seattle and Vancouver.

CONCLUSIONS

Health educators should consider available media outlets as well as the characteristics of a target community when planning intervention programs for Chinese immigrants.

Hepatitis B knowledge and practices among Cambodian immigrants

BACKGROUND

Chronic hepatitis B infection is the most common cause of liver cancer among Cambodians. Our objective was to describe Cambodian Americans' hepatitis B knowledge, testing, and vaccination levels.

METHODS

A community-based telephone survey was conducted in Seattle. Our study sample included 111 individuals.

RESULTS

Less than one half (46%) of our study group had received a hepatitis B blood test, and about one third (35%) had been vaccinated against hepatitis B. Only 43% knew that Cambodians are more likely to be infected with hepatitis B than whites.

CONCLUSIONS

Over 50% of our respondents did not recall being tested for hepatitis B. We identified important knowledge deficits about hepatitis B. Continued efforts should be made to implement hepatitis B educational campaigns for Cambodians.

Development of an ESL curriculum to educate Chinese immigrants about physical activity

Regular physical activity reduces the risk of many chronic conditions. Multiple studies have shown that Asians in North America engage in less physical activity than the general population. One area for strategic development in the area of health education is the design and evaluation of English as a second language (ESL) curricula. The PRECEDE model and findings from focus groups were used to develop a physical activity ESL curriculum for Chinese immigrants. In general, focus group participants recognized that physical activity contributes to physical and mental wellbeing. However, the benefits of physical activity were most commonly described in terms of improved blood circulation, immune responses, digestion, and reflexes. The importance of peer pressure and the encouragement of friends in adhering to regular physical activity regimens were mentioned frequently. Reported barriers to regular physical activity included lack of time, weather conditions, and financial costs. The ESL curriculum aims to both promote physical activity and improve knowledge, and includes seven different ESL exercises. Our curriculum development methods could be replicated for other health education topics and in other limited English-speaking populations.

Feasibility and Acceptability of an English-as-a-Second Language Curriculum on Hepatitis B for Older Chinese American Immigrants

Asian immigrants to the U.S. have an increased prevalence of hepatitis B virus (HBV) infection compared to native born individuals; an estimated 10 percent of Chinese immigrants are infected with HBV. Using qualitative data from focus groups, we developed an English-as-a-Second Language (ESL) curriculum that aimed to improve knowledge about key hepatitis B facts. The curriculum was pilot-tested among 56 students aged 50 and older from intermediate-level ESL classes at a community-based organization that serves Chinese immigrants. Post-curriculum data showed increases in knowledge that hepatitis B can cause liver cancer (73% at pre-test vs. 91% at post-test; p value = 0.01) and that individuals can be infected with hepatitis B for life (34% vs. 81%; p value <0.0001). These findings suggest that an ESL curriculum can successfully improve knowledge about the severity of hepatitis B and its routes of transmission among older Chinese American adults.

Opinions from ESL instructors and students about curricula on hepatitis B for use in immigrant communities

BACKGROUND

Chinese immigrants in Canada have a disproportionately high risk for hepatitis B compared with non-Hispanic Whites. Hepatitis B is the leading cause of hepatocellular carcinoma among Asian immigrants to North America. English-as-a-second-language (ESL) classes are an effective way of reaching newly immigrated individuals and are a potential channel for delivering health messages.

METHODS

Using data from 6 focus groups among ESL instructors and students, we characterized perceptions about activities that are successfully used in ESL classrooms and strategies for delivering hepatitis B information. RESULTS. Instructors and students generally reported that activities that focused on speaking and listening skills and that addressed content relevant to students' daily lives were successful in the classroom. Instructors generally avoided material that was irrelevant or too difficult to understand. Focus group participants offered strategies for delivering hepatitis B information in ESL classrooms; these strategies included addressing symptoms and prevention and not singling out a specific population subgroup to avoid stigmatization.

CONCLUSIONS

These findings might assist efforts to develop ESL curricula that target immigrant populations.

Heart disease prevention among Chinese immigrants

There is little information about the heart disease prevention behavior of Asian immigrants. Chinese are the largest Asian sub-group in the United States (US), and 69% of Chinese Americans are foreign-born. Our objective was to describe Chinese immigrants' heart disease prevention practices. A community-based, in-person survey of Chinese men and women was conducted in Seattle during 2005. Our study sample included 395 Chinese immigrants. Only 15% of the respondents consumed five or more servings of fruit/ vegetables per day, and less than one-third (31%) engaged in regular physical activity. Smoking rates were significantly higher among men (21%) than women (1%). About three-quarters (74%) of the study group had received a cholesterol test in the previous five years. Recent immigrants had higher levels of fruit/ vegetable consumption and physical activity than those who had been in the US for 10 years or more. Conversely, longer duration of US residence was positively associated with recent cholesterol testing. Heart disease prevention programs should be developed, implemented, and evaluated in Chinese immigrant populations. These efforts should specifically aim to increase fruit/ vegetable consumption and regular physical activity. Future efforts to increase cholesterol testing should focus on recent immigrants.

Promoting culturally appropriate colorectal cancer screening through a health educator: a randomized controlled trial

BACKGROUND

Colorectal cancer (CRC) is a leading cause of cancer mortality in the US. Surveys reveal low CRC screening levels among Asians in the US, including Chinese Americans.

METHODS

A randomized controlled trial was conducted with Chinese patients to evaluate a clinic-based, culturally and linguistically appropriate intervention promoting fecal occult blood test (FOBT) screening. The multifaceted intervention included a trilingual and bicultural health educator, bilingual materials (a video, a motivational pamphlet, an informational pamphlet, and FOBT instructions), and three FOBT cards. Patients in the control arm received usual care. Our primary outcome measure was FOBT screening within 6 months after randomization. The proportion of FOBT completion in the intervention and control arms was compared by using a chi-square test, and logistic regression analysis was performed to adjust for the effects of sociodemographic variables and prior screening history. Potential effect modifications were also tested by using logistic regression models.

RESULTS

Our intervention had a strong effect on FOBT completion (intervention group, 69.5%; control group, 27.6%), and the adjusted odds of FOBT slightly increased to over 6-fold greater in the intervention arm compared with the control arm. No effect modification by age, gender, language, insurance, or prior FOBT was found.

CONCLUSIONS

The authors' multifaceted, culturally appropriate intervention significantly increased FOBT screening in a group of low-income and less-acculturated minority patients. Given the large effect size, future research should determine the effective core component(s) that can increase CRC screening in both the general and minority populations.

Tobacco knowledge and beliefs in Chinese American men

BACKGROUND

Chinese American men have relatively high smoking rates. However, there are limited data about the tobacco-related knowledge, attitudes, and beliefs of this racial/ethnic group.

METHODS

We conducted a community-based telephone survey in Seattle, Washington during 2004. Households were identified by applying a previously validated list of Chinese last names to an electronic version of the Seattle telephone book. Interviews were completed in Cantonese, Mandarin, or English. Survey items addressed tobacco knowledge, cultural beliefs, and practices.

RESULTS

The study sample included 168 Chinese American men. Current, former, and never smoking rates were 22%, 42%, and 36%, respectively. Current smokers were less likely to be proficient in English than never smokers, and were less likely to have a regular doctor than former smokers. They also had lower levels of knowledge about the health effects of tobacco, and were more likely to have traditional Chinese cultural beliefs about tobacco use than non-smokers.

CONCLUSION

Tobacco use continues to be a public health problem among Chinese American men. Smoking cessation programs should target men with limited English proficiency and those without a regular source of health care. Educational materials should specifically address the negative health effects of smoking. They should also both acknowledge and address Chinese cultural beliefs about tobacco use.

Health Care Access and Sociodemographic Factors Associated with Hepatitis B Testing in Vietnamese American Men

Chronic hepatitis B viral (HBV) infection greatly increases the risk for cirrhosis and hepatocellular carcinoma. HBV serologic testing is important for the identification of chronically infected individuals, who may benefit from antiviral treatment and regular monitoring for disease sequelae. Elevated rates of cirrhosis and hepatocellular carcinoma among Vietnamese American men can largely be attributed to high rates of chronic HBV infection. We surveyed 509 Vietnamese men aged 18-64 years in Seattle, Washington and examined sociodemographic and health care access factors associated with HBV serology testing. Nearly two-thirds (65%) reported past testing. The following were among those factors associated with HBV testing in bivariate comparisons: older age; short proportion of life in the US; low English fluency; private health insurance; identifying a regular source of medical care; reporting no long waits for medical appointments; and having access to interpreter services. The following were independently associated with HBV testing in multiple logistic regression analysis: older age; college education; low English fluency; private health insurance; having a regular medical provider; and reporting no long waits for medical appointments. Younger and less educated men, and those with difficulty accessing medical care may be at particular risk for never having had HBV testing. Programs to reduce HBV transmission and sequelae should make special effort to target these vulnerable Vietnamese Americans.

Hepatitis B knowledge and practices among Chinese immigrants to the United States

INTRODUCTION

Chinese immigrants to the United States experience high rates of liver cancer. Chronic carriage of hepatitis B virus (HBV) is the most common underlying cause of liver cancer among Chinese Americans. Our objective was to describe Chinese immigrants' hepatitis B knowledge, testing, and vaccination levels.

METHODS

A community-based, in-person survey of Chinese men and women was conducted in Seattle during 2005. Our study sample included 395 individuals.

RESULTS

Less than one-half (48%) of our study group indicated they had received a hepatitis B blood test, and about one-third (31%) indicated they had been vaccinated against hepatitis B. The proportions of respondents who knew HBV can be spread during childbirth, during sexual intercourse, and by sharing razors were 70%, 54%, and 55%, respectively. Less than one-quarter of the study group knew that HBV cannot be spread by eating food that was prepared by an infected person (23%) and by sharing eating utensils with an infected person (16%).

DISCUSSION

Over 50% of our respondents did not recall being tested for HBV. Important knowledge deficits about routes of hepatitis B transmission were identified. Continued efforts should be made to develop and implement hepatitis B educational campaigns for Chinese immigrant communities.

AANCART best practices: cancer awareness activities for Seattle's Combodian community

Census data indicate that Cambodian Americans are economically disadvantaged and linguistically isolated. In addition, cancer registry data show that Southeast Asians experience several cancer-related health disparities (e.g., markedly elevated risks of cervical and liver cancer). The Seattle regional Asian American Network for Cancer, Awareness, Research, and Training (AANCART) site has implemented a community-based cancer awareness program for Cambodian immigrants in collaboration with a Cambodian community coalition. Our cancer awareness program has the following goals: to assist individuals and organizations in advocating for a healthy community, to provide information within a cultural context, and to deliver information in ways that are useful and meaningful to the community. The program was guided by a community assessment that included the use of published data as well as information from qualitative interviews, focus groups, and quantitative surveys. Examples of community awareness activities include group presentations at community-based organizations (e.g., during English as a second language classes), health fair participation (including at nontraditional venues such as a farmers' market serving Cambodians), and educational displays in neighborhood locations (e.g., at Cambodian video stores). In addition, the Seattle AANCART site has both inventoried and developed culturally appropriate Khmer language cancer education materials and disseminated materials through the ETHNO-MED website. Our approach recognizes that limited English language proficiency may preclude many Cambodians from understanding publicly disseminated information, and Cambodian immigrants are often isolated and tend to stay close to their own neighborhoods.

Development of an English as a second language curriculum for hepatitis B virus testing in Chinese Americans

Chinese Americans are at disproportionately high risk of liver cancer. A major risk factor for liver cancer in Asia is infection with hepatitis B virus (HBV): Approximately 80% of liver cancers are linked to HBV, and chronic carriers of HBV are > 100 times more likely to develop liver cancer compared with noncarriers. However, many adults, particularly those who have immigrated to the U.S., remain untested and therefore unvaccinated or unmonitored for the disease. Chinese Americans are mostly foreign born, and more recent arrivals face multiple social and health challenges. Many require special attention from public health professionals because of low levels of acculturation and difficulties learning English. It has long been established that an English as a Second Language (ESL) curriculum can teach immigrant adults and their family's important life skills, such as job training and citizenship. The authors report on their plans to develop and pilot test a culturally appropriate curriculum that will motivate Chinese ESL students to obtain a blood test for the detection of the HBV.

"Heat in their intestine": colorectal cancer prevention beliefs among older Chinese Americans

OBJECTIVE

Data regarding disease prevention behaviors among Asian-American populations are limited. This study explored the beliefs of older Chinese Americans toward colorectal cancer screening modalities, including fecal occult blood testing (FOBT).

DESIGN AND PARTICIPANTS

We conducted 30 semistructured, open-ended, qualitative interviews in Mandarin and Cantonese, focusing on colorectal cancer prevention and health-seeking behavior. Participants were Chinese patients 50-79 years of age recruited from a community clinic in Seattle, Washington.

RESULTS

When asked about colorectal cancer prevention, interviewees discussed such concepts as maintenance of positive energy (qi) and spirit (jing shen) and moderation of exercise and diet. Until prompted, participants did not discuss FOBT. Interviewees believed that colorectal cancer was caused by diets high in foods with "heat" (huo qi) or by intestinal toxins from frequent constipation. Participants presumed that FOBT is unnecessary in the absence of symptoms.

CONCLUSIONS

Patients in our study expressed beliefs about health promotion and causes of colorectal cancer that differed from Western biomedical concepts. Failure to recognize these different beliefs may create inadvertent confusion among elderly Chinese-American patients. Health promotion programs to increase colorectal cancer screening must incorporate these concepts to improve cultural relevance among Chinese-American patients.

Hepatitis B knowledge and testing among Vietnamese-American women

The study objective was to examine factors associated with previous hepatitis B virus (HBV) testing among Vietnamese women. A population-based survey was conducted in Seattle. The survey was completed by 370 women (response rate: 82%). Sixty-eight percent of the respondents reported previous HBV testing. Only 44% recalled a physician recommendation for the test. The following factors were associated with previous testing in bivariate comparisons: knowing that HBV can be spread during childbirth, during sexual intercourse, and by sharing toothbrushes; doctor(s) had recommended testing; family member(s) and friend(s) had suggested testing; and family member(s) were chronically infected with HBV. In a multiple regression analysis, women who reported a previous physician recommendation had nearly a five times higher odds of testing than those who did not. Education about HBV transmission may stimulate Vietnamese women to seek testing. Intervention strategies that target social networks might be effective in increasing testing levels. Physicians should be educated about the importance of testing Asian immigrants for HBV.

Pap testing adherence among Vietnamese American women

OBJECTIVES

Vietnamese American women are five times more likely to be diagnosed with cervical cancer than their White counterparts. Previous research has demonstrated low levels of Papanicolaou (Pap) testing among Vietnamese. Our study objective was to examine factors associated with interval Pap testing adherence.

METHODS

A population-based, in-person survey of Vietnamese women aged 18-64 years was conducted. Questionnaire content was guided by the Health Behavior Framework (HBF). The study sample was randomly selected from 1639 south Seattle households. Statistical methods included chi(2) tests and logistic regression.

RESULTS

The response rate among eligible households was 82%, and the study included 352 women. Sixty-eight percent of the participants had been screened during the preceding 3 years. The following HBF factors were associated (P < 0.05) with interval Pap testing in bivariate comparisons: believing Pap tests decrease the risk of cervical cancer and believing cervical cancer is curable if detected early (perceived effectiveness); knowing testing is necessary for women who are asymptomatic, sexually inactive, or postmenopausal (knowledge); reporting concern about pain/discomfort as a barrier to screening (barriers); family member(s) and friend(s) had suggested testing (social support); doctor(s) had recommended testing; and had asked doctor(s) for testing (communication with provider). In a multivariate analysis, being married, knowing Pap testing is necessary for asymptomatic women, doctor(s) had recommended testing, and had asked doctor(s) for testing were independently associated (P < 0.05) with screening participation.

CONCLUSION

Our results confirm low levels of Pap testing among Vietnamese women and demonstrate the importance of physician-patient communication in increasing screening adherence. Health education efforts should target unmarried women and reinforce the importance of Pap testing for all Vietnamese women.

Pap Testing Adherence among Vietnamese American Women

Objectives: Vietnamese American women are five times more likely to be diagnosed with cervical cancer than their White counterparts. Previous research has demonstrated low levels of Papanicolaou (Pap) testing among Vietnamese. Our study objective was to examine factors associated with interval Pap testing adherence. Methods: A population-based, in-person survey of Vietnamese women aged 18–64 years was conducted. Questionnaire content was guided by the Health Behavior Framework (HBF). The study sample was randomly selected from 1639 south Seattle households. Statistical methods included χ2 tests and logistic regression. Results: The response rate among eligible households was 82%, and the study included 352 women. Sixty-eight percent of the participants had been screened during the preceding 3 years. The following HBF factors were associated (P &lt; 0.05) with interval Pap testing in bivariate comparisons: believing Pap tests decrease the risk of cervical cancer and believing cervical cancer is curable if detected early (perceived effectiveness); knowing testing is necessary for women who are asymptomatic, sexually inactive, or postmenopausal (knowledge); reporting concern about pain/discomfort as a barrier to screening (barriers); family member(s) and friend(s) had suggested testing (social support); doctor(s) had recommended testing; and had asked doctor(s) for testing (communication with provider). In a multivariate analysis, being married, knowing Pap testing is necessary for asymptomatic women, doctor(s) had recommended testing, and had asked doctor(s) for testing were independently associated (P &lt; 0.05) with screening participation. Conclusion: Our results confirm low levels of Pap testing among Vietnamese women and demonstrate the importance of physician-patient communication in increasing screening adherence. Health education efforts should target unmarried women and reinforce the importance of Pap testing for all Vietnamese women.

"Good health for new years": development of a cervical cancer control outreach program for Vietnamese immigrants

BACKGROUND

Cervical cancer incidence rates are higher among Vietnamese American women than among any other race/ethnic group in the United States. High rates of cervical cancer are associated with low rates of Papanicolao (Pap) testing adherence.

METHODS

Twenty-five qualitative interviews and 5 focus groups were conducted with Vietnamese women.

RESULTS

Interviews and focus groups revealed unanticipated information about sociocultural influences on women's beliefs about risk factors for cervical cancer. These data were utilized to develop culturally appropriate outreach materials.

CONCLUSIONS

Engaging with the target community enabled the development of culturally appropriate materials addressing cervical cancer risk factors and encouraging Pap testing adherence.

Hepatitis B testing among Vietnamese American men

Vietnamese American men are over 10 times more likely to be diagnosed with liver cancer than their white counterparts. This health disparity is attributable to high rates of hepatitis B virus (HBV) infection. Our study objective was to examine factors associated with HBV testing among Vietnamese men. A population-based survey was conducted in Seattle. The questionnaire content was guided by an earlier qualitative study and the Health Behavior Framework. The survey was completed by 345 men (response rate: 80%). About one-third (34%) of the respondents reported they had not been tested for HBV. The following factors were associated (P < 0.01) with previous testing in bivariate comparisons: having a regular source of care and regular provider; knowing that HBV can be spread during childbirth; believing HBV can cause liver cancer; and doctor(s) had recommended testing as well as had asked doctor(s) for testing. Three variables were independently associated with HBV testing in a logistic regression model: regular source of care (OR = 4.5; 95% CI = 2.6-7.9), physician recommendation (OR = 2.3, 95% CI = 1.3-4.0), and knowing HBV can be spread during childbirth (OR = 2.1; 95% CI = 1.2-3.9). Low levels of HBV testing remain a public health problem in some Vietnamese American sub-groups. Health education about HBV transmission may stimulate patients to seek testing. Intervention programs should specifically target Vietnamese men without a regular source of health care and physicians who serve Vietnamese communities.

A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America

BACKGROUND

North American Chinese women have lower levels of Papanicolaou (Pap) testing than other population subgroups. We conducted a randomized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America.

METHODS

Four hundred and eighty-two Pap testing underutilizers were identified from community-based surveys of Chinese women conducted in Seattle, Washington, and Vancouver, British Columbia. These women were randomly assigned to one of two experimental arms or control status. Several Chinese-language materials were used in both experimental arms: an education-entertainment video, a motivational pamphlet, an educational brochure, and a fact sheet. Women in the first experimental group (outreach worker intervention) received the materials, as well as tailored counseling and logistic assistance, during home visits by trilingual, bicultural outreach workers. Those in the second experimental group (direct mail intervention) received the materials by mail. The control group received usual care. Follow-up surveys were completed 6 months after randomization to ascertain participants' Pap testing behavior. All statistical tests were two-sided.

RESULTS

A total of 402 women responded to the follow-up survey (83% response rate). Of these women, 50 (39%) of the 129 women in the outreach group, 35 (25%) of the 139 women in the direct mail group, and 20 (15%) of the 134 women in the control group reported Pap testing in the interval between randomization and follow-up data collection (P<.001 for outreach worker versus control, P =.03 for direct mail versus control, and P =.02 for outreach worker versus direct mail). Intervention effects were greater in Vancouver than in Seattle.

CONCLUSION

Culturally and linguistically appropriate interventions may improve Pap testing levels among Chinese women in North America.

Cervical cancer screening among Chinese Americans

STUDY PURPOSE

Chinese women in North America have high rates of invasive cervical cancer and low levels of Papanicolaou (Pap) testing use. This study examined Pap testing barriers and facilitators among Chinese American women.

BASIC PROCEDURES

A community-based, in-person survey of Chinese women was conducted in Seattle, Washington during 1999. Four hundred and thirty-two women in the 20-79 years age-group were included in this analysis. The main outcome measures were a history of at least one previous Pap smear and Pap testing within the last 2 years.

MAIN FINDINGS

Nineteen percent of the respondents had never received cervical cancer screening and 36% had not been screened in the previous 2 years. Eight characteristics were independently associated with a history of at least one Pap smear: being married, thinking Pap testing is necessary for sexually inactive women, lack of concerns about embarrassment or cancer being discovered, having received a physician or family recommendation, having obtained family planning services in North America, and having a regular provider. The following characteristics were independently associated with recent screening: thinking Pap testing is necessary for sexually inactive women, lack of concern about embarrassment, having received a physician recommendation, having obtained obstetric services in North America, and having a regular provider.

PRINCIPAL CONCLUSIONS

Pap testing levels among the study respondents were well below the National Cancer Institute's Year 2000 goals. The findings suggest that cervical cancer control interventions for Chinese are more likely to be effective if they are multifaceted.

Evaluation of an outreach intervention to promote cervical cancer screening among Cambodian American women

INTRODUCTION

Southeast Asian women have low levels of Papanicolaou (Pap) testing participation. We conducted a group-randomized controlled trial to evaluate a cervical cancer screening intervention program targeting Seattle's Cambodian refugee community.

METHODS

Women who completed a baseline, community-based survey were eligible for the trial. Neighborhoods were the unit of randomization. Three hundred and seventy survey participants living in 17 neighborhoods were randomized to intervention or control status. Intervention group women received home visits by outreach workers and were invited to group meetings in neighborhood settings. The primary outcome measure was self-reported Pap testing in the year prior to completing a follow-up survey.

RESULTS

The proportion of women in the intervention group reporting recent cervical cancer screening increased from 44% at baseline to 61% at follow-up (+17%). The corresponding proportions among the control group were 51 and 62% (+11%). These temporal increases were statistically significant in both the intervention (P < 0.001) and control (P = 0.027) groups.

DISCUSSION

This study was unable to document an increase in Pap testing use specifically in the neighborhood-based outreach intervention group; rather, we found an increase in both intervention and control groups. A general awareness of the project among women and their health care providers as well as other ongoing cervical cancer screening promotional efforts may all have contributed to increases in Pap testing rates.