Angela M. Jo

Colorectal cancer screening among underserved Korean Americans in Los Angeles County.

ObjectivesUse of colorectal cancer screening is extremely low among Korean Americans. The objective of this study was to gather information on predictors, facilitators, barriers, and intervention preferences with respect to colorectal cancer screening that may inform the development of future interventions for underserved Korean Americans.DesignWe developed a questionnaire guided by the Health Behavior Framework and administered it to a convenience sample of 151 Korean Americans aged 40–70 recruited through a community based organization in Los Angeles.ResultsIn our sample in which 60% of the subjects did not have health insurance, only 17% reported having received a stool blood test within the past year or sigmoidoscopy or colonoscopy within the past 5 years. Having received a physician recommendation was significantly associated and having symptoms of the disease was marginally associated with the outcome variable. Although 64% of respondents reported having a primary care physician, only 29% received a screening recommendation from a physician. Barriers to colorectal cancer screening were lack of health insurance and inability to afford testing, not knowing where to go for testing, language barrier, and fear of being a burden to the family. Intervention preferences included educational seminars, media campaigns, and print materials.ConclusionOur findings point to the need for a multi-faceted approach that includes educational seminars at community venues, a media campaign, and physician education to increase colorectal cancer screening in this underinsured Korean American population.

Conducting health research in Korean American churches: perspectives from church leaders.

Korean Americans experience many challenges to obtaining adequate health care coverage and access to needed services. Because a large proportion of Korean Americans attend churches on a regular basis, churches may be a promising venue where health programs can be delivered. In order to gain an in-depth understanding of Korean American churches with respect to conducting future health intervention research, we conducted exploratory interviews and focus groups with 58 leaders from 23 Korean American churches and three community organizations. From these interviews and focus groups, we found that Korean churches and church leaders seek to meet a variety of social and health needs of their congregation and their surrounding community. Several leaders have stated that assisting with social and medical needs of their members is an important component of their current ministry. They described profound health needs of their congregations and have suggested various ways in which the university can partner with the local churches to help address these needs through research. Additionally, they described various resources churches can provide to researchers such as: their personal assistance, church volunteer base, church facility, and church network and contacts. Our findings suggest that Korean churches have a high potential to serve an important role in the health of Korean Americans. On the basis of the promising results of the present study, we are planning to conduct a cross sectional survey of Korean church leaders and members in Los Angeles County to substantiate our findings in a larger representative sample.

Why are Korean American Physicians Reluctant to Recommend Colorectal Cancer Screening to Korean American Patients? Exploratory Interview Findings

Background Korean Americans have one of the lowest screening rates for colorectal cancer. Although physician recommendation is one of the most important predictors of cancer screening across populations, only few Korean American patients receive such a recommendation. Methods We interviewed 14 Korean American physicians in Los Angeles area who primarily serve Korean Americans to explore why they are reluctant to recommend colorectal cancer screening to their Korean patients. Results Physicians identified barriers attributable to themselves (i.e., lack of knowledge, fear of medicolegal liability), their patients (i.e., patient’s unfamiliarity with the concept of screening), and the health care system (i.e., lack of referral network, poor reimbursement). Discussion Our results suggest the need for multi-faceted interventions directed at the physicians, their patients, and the health care system. Further research is needed to validate our results and to assess the extent to which they apply to physicians from other racial/ethnic groups.

Impact of a print intervention to increase annual mammography screening among Korean American women enrolled in the National Breast and Cervical Cancer Early Detection Program

BACKGROUND Although Korean American women have one of the lowest rates of mammography screening, only few interventions have been developed for them. We developed a theory-based Korean-language print intervention to increase annual mammography screening with the goal to disseminate it through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS Korean American staff and patients at a community clinic advised on the content and layout of the brochure. We pilot tested the intervention from July to September 2005 at a community clinic in Koreatown, Los Angeles County that provides free mammograms through the NBCCEDP. The proportion of Korean American women who received a repeat mammogram during the intervention period was compared to the pre-intervention period using a NBCCEDP database. RESULTS We found a non-significant 6 percentage point increase in repeat screening from 32% to 38%. A debriefing survey with a subsample of 59 women revealed that only 32% recalled receipt of the brochure and a subsequent investigation revealed that only about 60% had identical address information in the NBCCEDP records and in their charts. CONCLUSIONS Although dissemination of print information through NBCCEDP is very feasible, the reach and effectiveness of the intervention was limited due to incorrect or outdated address information.

Cluster-randomized trial to increase hepatitis B testing among Koreans in Los Angeles

Background: In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared with the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently suboptimal. Methods: We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing, and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews. Results: We recruited 1,123 individuals, 18 to 64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included were as follows: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, P < 0.001), with 19% of intervention and 6% of control group participants reporting a HBV test. Conclusion: Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae. Impact: The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups. Cancer Epidemiol Biomarkers Prev; 24(9); 1341–9. ©2015 AACR.

Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial.

Asian Americans have lower colorectal cancer (CRC) screening rates than non‐Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans.

Lay health educators and print materials for the promotion of colorectal cancer screening among Korean Americans: A randomized comparative effectiveness study

Colorectal cancer (CRC) is the second most commonly diagnosed cancer among Korean American men and women. Although CRC screening is effective in reducing the burden of this disease, studies have shown that Korean Americans have low screening rates.

Results of a lay health education intervention to increase colorectal cancer screening among Filipino Americans: A cluster randomized controlled trial

Filipino colorectal cancer (CRC) screening rates fall below Healthy People 2020 goals. In this study, the authors explore whether a lay health educator (LHE) approach can increase CRC screening among Filipino Americans ages 50 to 75 years in Hawai‘i.

Abstract CN03-02: Community-based intervention to reduce liver cancer disparities in Asian Americans: A cluster randomized trial

Asians experience the highest liver cancer incidence and mortality rates of all racial/ethnic groups in the U.S. Approximately 80% of liver cancers are etiologically related to chronic infection with the hepatitis B virus (HBV), which is endemic in Asia. It is therefore recommended that Asian adults first be tested for HBV to identify, counsel, and monitor virus carriers and that only those found susceptible be referred for vaccination. In light of the rapid growth and high interracial marriage rates of the U.S. Asian population, prevention and control of HBV infection through testing and vaccination is a critical public health priority. Koreans have the highest liver cancer incidence and mortality rates in Los Angeles County, home to the largest concentration of Koreans in the U.S. To date, no intervention studies have focused on HBV prevention and control among Korean adults. Therefore, we conducted a cluster randomized trial to test the effectiveness of a culturally-tailored small group intervention in increasing HBV serologic testing rates in a community sample of Korean adults in Los Angeles. The sample was recruited through churches, given the large proportion of Korean Americans that attend church. Methods: Study Design. A 2-group design, with cluster randomization at the church level, was used. Churches (N=50) were stratified by size (small: 50-200 members, medium: 201-900 members, large: 900+ members) and geographic location (Koreatown vs. outside Koreatown). Randomization was conducted within each stratum. The intervention consisted of a 1-hour discussion session on HBV, using an interactive, nondidactic format, aided by PowerPoint materials and take-home materials. The control group received a 1-hour discussion session, using a similar format, on nutrition and physical activity (NPA) as well as take-home materials. Lay health educators served as facilitators for the discussions in both study conditions. Church members were recruited on site, in conjunction with routine weekend church services, and invited to participate in a discussion on cancer prevention. Participants had no advance knowledge of their church9s study condition assignment. Eligibility criteria included: Korean ethnicity, age 18-64 years, and no prior history of HBV testing. Individuals previously tested, but unaware of their results, were also eligible. Baseline surveys were administered in person, by interviewers, immediately prior to discussion sessions. Subjects were contacted by telephone 6 months post-intervention to assess study outcomes. Theoretical Framework. The Health Behavior Framework (HBF) guided the interventions and data collection instruments. 1 The HBF is a comprehensive conceptual framework that includes individual, health system, community, and societal level variables that can influence health behavior. The focus of this trial was primarily on modifying individual (e.g., knowledge, health beliefs) and community level (e.g., social norms) constructs. Data Collection Instruments. Data collection instruments assessed HBF constructs including demographics, cultural factors and knowledge, beliefs, barriers, and supports related to HBV and NPA. To assess the effect of answering a lengthy survey (testing effect) on HBV testing, approximately half the sample completed an abbreviated baseline interview. Results: Recruitment. To date (7/31/10) 1,826 individuals have been screened at 50 churches, and 1174 (64%) were eligible for the study participation. Ninety-four percent (N = 1105) of those eligible were enrolled into the trial (target enrollment =1200). The vast majority of participants completed baseline interviews in Korean (98%) and attended their assigned session (92%). Among participants due for 6-month follow-up (N = 972), the retention rate in both study conditions was 86%. Demographic Characteristics of Sample. Nearly all participants were born in Korea (97%), with an average stay in the U.S. of 16 years and a mean age of 45.5 years. Participants were well-educated (54% have a college degree or more) with a wide range of incomes (25% earn less than

D/deaf Breast Cancer Survivors: Their Experiences and Knowledge

30,000 and 23% earn more than