First Year Open Enrollment Findings: Health Insurance Coverage for Asian Americans and the Role of Navigators

The health insurance coverage established by the Patient Protection and Affordable Care Act has created an opportunity to reduce racial/ethnic disparities in healthcare. It is expected that of the 24 million individuals projected to join, nearly one-half will be non-white and one-fourth will speak a language other than English at home. Asian Americans are one of the fastest growing racial/ethnic groups in the USA. The majority are foreign born and experience limited English proficiency. The role of navigators has been shown to increase enrollment rates of public insurance programs. They are trusted for their shared traditions and sense of community. By conducting culturally-targeted outreach, Cambodian, Chinese, Vietnamese, Korean, and Laotian community-based organizations were able to reach individuals for whom the percentage of uninsured is disproportionately high. They enrolled eligible Asians immigrants in coverage despite language barriers and limited health knowledge. Through a collaborative network, a community-level intervention was implemented that was associated with increases in first year marketplace enrollment and greater likelihood of obtaining a primary care physician. Preventable illnesses, lost productivity, and inadequate healthcare are major hardships in immigrant communities that bear similar burdens to society. Bringing primary care to the underserved helps to contain these costs.

Colorectal cancer screening among Chinese American immigrants

The purpose of this study was to examine the factors determining fecal occult blood test (FOBT) uptake in Chinese American immigrants. This study used a prospective, cross-sectional design with convenience sampling. An educational session on colorectal cancer screening (CRS) was provided to the participants during a health fair, and each participant was offered a no-cost FOBT kit. Data was collected over two consecutive years during three different health fairs. A questionnaire was used to collect demographic data. A total of 113 participants were recruited and 72% of them returned the FOBT kit. There was a significant association between having a primary-care physician (PCP) and having CRS in the past, even after controlling for age, gender and the length of time in the US (P = .009). Participants who visited a doctor for health maintenance were less likely to participate in the FOBT, compared to participants who never visited a doctor or who only visited a doctor when they were sick (P = .001). The length of time in the US had a significant effect on having a PCP (P = .002). However, having a PCP or having CRS in the past was not associated with participating in the screening and so was feeling at risk for CRC. In fact, 49% of Chinese women and 45% of Chinese men felt no risk of CRC. Future research and interventions that address knowledge deficits and focus on recent immigrants and their access to health care may have the potential to increase CRS among Chinese American immigrants.

Abstract B84: Determinants of colorectal cancer screening in three Asian communities

Objectives: While cancer screening has been shown to be effective in detecting cancer at early stages and reducing mortality, Asian-Americans are the least likely racial/ethnic group to obtain cancer screening tests. The purpose of this study is to describe colorectal cancer screening (CRS) by sigmoidoscopy or a colonoscopy across three different Asian communities (Chinese, Cambodian and Vietnamese) in Chicago. Specially, we examined determinants, such as health insurance coverage, regular facility for health care, understanding health information given by health providers, years in the U.S. and age, on CRS behavior.

Methods: This was a cross-sectional study, using data collected from the Chicago Asian Community Survey (CACS). Participants were recruited from three Asian communities - Chinese, Cambodian and Vietnamese. CACS consisted of face-to-face interviews. With a three-stage random sampling of the Chinese community and Respondent Driven Sampling (RDS) of the Cambodian and Vietnamese communities, 383 Chinese, 250 Vietnamese, and 150 Cambodian community members were interviewed using cultural and language- specific survey guidelines. The survey questionnaire was developed from several validated national health surveys, including the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES), and the National Health Interview Survey (NHIS).

Results: A total of 783 participants completed the survey; 465 were aged 50 or older. The proportion of adults aged 50 or older who reported ever having a sigmoidoscopy or a colonoscopy was 27% Chinese, 36% Cambodian, and 31% Vietnamese. Overall, 83%, 91%, and 83% of Chinese, Cambodian, and Vietnamese, respectively, reported they had health insurance and nearly 86% were covered by either Medicare or Medicaid, or both. In addition, 89%, 84%% and 96% of Chinese, Cambodian and Vietnamese respectively, reported they had a regular health care facility. The majority of Chinese and Vietnamese, 84% and 87% respectively, reported they usually understood information given by their health providers. For Cambodian, only 44% reported they usually understood information given by their health providers and this subgroup was less likely to be screened before (p < .004). Vietnamese who were older (p = .037) and Chinese who were in the U.S. longer (p < .0005) were more likely to report having a sigmoidoscopy or a colonoscopy before.

Conclusion: Despite access to care (health insurance and regular facility for health care), CRS rates were extremely low among these Asian communities. For Cambodians, understanding information given by health providers was negatively associated with having a sigmoidoscopy or a colonoscopy before. Older Vietnamese were more likely to report having a sigmoidoscopy or a colonoscopy before, as were Chinese who were in the U.S. longer.

Citation Format: Karen Kim, Helen Vallina, Edwin Chandrasekar. Determinants of colorectal cancer screening in three Asian communities. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B84.

Abstract B85: Chinese American women's beliefs in mammogram

Objectives: From the Theory of Planned Action (TPA), a woman's intention to have a mammogram can be determined by three factors: the woman's attitudes toward breast cancer screening, the social normative influence of the people who are important in her life, and her perception of the ease with having a mammogram. These determinants are from corresponding sets of beliefs. TPA posits that individual behavior is driven by behavioral intention. Thus, a woman's beliefs in mammogram will influence her intention toward screening, and eventually to carry out the behavior. The purpose of this study is to explore beliefs in mammogram among Chinese American women and to examine how these beliefs influence screening intention.

Methods: A total of 212 participants were recruited from a homemaker program at a Chinese community-based organization located in the Midwest. Participants were asked to fill out a questionnaire on their beliefs in mammogram prior to an educational program on breast cancer screening. The questionnaire was developed by modifying Rakowski's Decisional Balance Scale on Mammography, which included six positive statements and six negative statements. A belief score was calculated by adding all 12 scores from each item. A higher belief score indicated that the participant has more positive beliefs. Screening behaviors were measured by asking participants whether they had a mammogram in the past 10 years, and whether they planned to have a mammogram in the next 1 to 2 years.

Results: Sixty-two percent of the participants reported that they had a mammogram in the past 10 years and nearly 78% intended to have a mammogram within the next 1-2 years. Participants who were younger (p = .045) and who had more years of education (p = .039) were more likely to plan to have a mammogram in the next 1-2 years. The belief score was significantly associated with participants' history of breast cancer screening (p < .0005), yearly family income (p = .03) and years of education (p = .01). Both belief score and having a mammogram in the past significantly predicted the intention to have a mammogram in the next 1-2 years, and accounted for 25% (Cox & Snell) to 38% (Nagelkerke) of the variances. Even after considering for years of education and age, both predictors remained significant (p < .0005).

Conclusion: Our study finds that Chinese American women's beliefs in mammogram not only had a significant impact on their past breast cancer screening but also their intention to have a mammogram in the future. Chinese American women who had more positive beliefs in mammogram were more likely to have a mammogram in the past 10 years and plan to have a mammogram in the next 1 – 2 years. Having a mammogram in the past and having more positive beliefs in mammogram significantly predicted the intention to have a mammogram, even after controlling for years of education and age.

Citation Format: Helen Vallina, Karen Kim. Chinese American women's beliefs in mammogram. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B85.