Christopher N. H. Jenkins

Health care access and preventive care among Vietnamese immigrants: Do traditional beliefs and practices pose barriers?

Some have speculated that underutilization of Western health services among non-Western populations can be explained by traditional health beliefs and practices rooted deep within cultures. These beliefs and practices may act as barriers to access to and utilization of services. Among Vietnamese, in particular, a number of traditional health beliefs and practices have been identified which are said to pose barriers to Western medical care. No studies to date, however, have examined this hypothesis empirically. To examine this hypothesis, we measured traditional health beliefs and practices among Vietnamese in the San Francisco Bay area and analyzed the relationships between these factors and access to health care and use of preventive health services. The results of this study show clearly that many Vietnamese possess traditional health beliefs and practices which differ from those of the general U.S. population. Yet, the data do not support the hypothesis that these traditional beliefs and practices act as barriers to access to Western medical care or to utilization of preventive services. Being married and poverty status were the most consistent predictors of health care access. Furthermore, the components of access to health care (having some form of health insurance or having a regular doctor, for example) were the strongest predictors of preventive health care services utilization. Importantly, the cultural attributes of individuals did not explain either lack of health care access or underutilization of preventive health care services.

The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men.

OBJECTIVES This study evaluated an anti-tobacco campaign targeting Vietnamese men in San Francisco, Calif. METHODS The intervention included Vietnamese-language media, health education materials, and activities targeting physicians, youth, and businesses. Evaluation involved pretest and posttest cross-sectional telephone surveys and multiple logistic regression analyses designed to identify variables associated with smoking and quitting. RESULTS At posttest, the odds of being a smoker were significantly lower (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.68, 0.99), and the odds of being a quitter were significantly higher (OR = 1.65, 95% CI = 1.27, 2.15), in San Francisco than in a comparison community. CONCLUSIONS Despite modest success, further efforts are needed to reduce smoking among Vietnamese-American men.

Pathways to Early Cancer Detection for Vietnamese Women: Suc Khoe La Vang! (Health is Gold!):

To promote breast and cervical screening among Vietnamese women, a neighborhood-based intervention was developed that included small-group education, distribution of Vietnamese-language educational materials, and health fairs. The rationale for these modes of intervention is described. A pretest/posttest controlled trial is used to evaluate the intervention. San Francisco, California, is the experimental community; Sacramento, California, is the comparison community. The study hypothesizes that postintervention measurements of screening rates will reflect significantly greater increases among women in the experimental community than in the comparison community. This article reports results from the 1992 baseline household survey of 306 Vietnamese women in San Francisco and of 339 Vietnamese women in Sacramento. There were no significant differences in screening rates between the two communities. Only 50-54% of women had received routine checkups; 44-55%, mammograms; 40-45%, clinical breast examinations; 40-46%, Pap smear tests; and 58-65%, pelvic examinations.

Printed Health Education Materials for Diverse Communities: Suggestions Learned from the Field:

Health education materials designed for the general population may be perceived as unattractive, irrelevant, or unclear by members of certain cultural groups. Given the increasingly multicultural demographics of the United States, planners need to be aware of the specific characteristics of a target audience to address cultural differences and similarities in health messages. The authors describe the use of the subjective culture methodology and social marketing to develop health education materials targeted to multicultural populations, illustrate cultural factors that should be considered when designing printed materials, and outline steps in the design of attractive, stimulating, and culturally appropriate materials. The authors describe the challenges and problems in designing printed materials for multiethnic communities, give suggestions for written educational messages, present a summary of the lessons learned in the development of materials for ethnically diverse populations, and give examples of success stories in multiethnic communities.

Cigarette Smoking among Vietnamese Immigrants in California

In the 18 years since 1975, more than 600,000 Vietnamese have arrived in the United States from Vietnam. Census figures for 1990 show that Vietnamese are the fastest-growing Asian/Pacific Islander ethnic group in the United States, with a growth rate of 135% in the decade since 1980.1 Population projections show that by 2030 they will vie with Filipinos to be the largest Asian-Pacific Islander population in the country. 2 In previous research conducted in 1987, we found a high cigarette-smoking prevalence rate of 56% among Vietnamese men. ~ Concern about this high prevalence led us to develop and evaluate an antitobacco program targeting this population in the San Francisco Bay area, To assess preintervention baseline smoking behavior, we conducted a survey of Vietnamese in the San Francisco/Oakland (intervention) and Los Angeles (control) areas in the spring of 1989. This article reports the survey results.

Problems and Progress in Translation of Health Survey Questions: The Pathways Experience:

Pathways to Early Cancer Detection in Four Ethnic Groups is a program project funded by the National Cancer Institute aimed at increasing the use of breast and cervical cancer screening among underserved African American, Chinese, Hispanic, and Vietnamese women. The program project core is dedicated to cross-cultural studies including development of survey questions that are comparable in four languages. This article describes the Pathways surveys, summarizes the challenges encountered in question translation, and presents an adapted approach to translation. Concurrent, multilingual, decentered translation was the process through which an English version of each question was selected only when it could be directly and meaningfully translated into Mandarin, Cantonese, Spanish, and Vietnamese. Examples of challenges and how these were addressed in the Pathways surveys are presented, along with lessons learned throughout this process.

Promoting early detection of breast cancer among Vietnamese-American women

Although breast cancer is the second most common cancer among Vietnamese‐American women, previous research has shown that they are less likely to have ever had, and to be more often overdue for, clinical breast examinations (CBE) and mammograms than women in the general population.

A survey of depressive symptoms among Vietnamese-American men in three locales: Prevalence and correlates

Vietnamese are one of the fastest growing ethnic minority groups in the United States. The purpose of this study was to determine the prevalence and correlates of high depression scores among Vietnamese men in three locales. Computer assisted telephone interviews were conducted with adult Vietnamese men in San Francisco/Alameda Counties, Santa Clara County, and the city of Houston. Telephone numbers of households with Vietnamese surnames were chosen randomly from area telephone books. Depression was assessed using a previously validated Vietnamese language depression screening instrument with 86% sensitivity and 96% specificity for major depression. Between 8.2% and 9.8% of the men scored above the cut-off. Logistic regression analysis revealed that men who were the least proficient in English, poorer, unemployed or disabled, veterans, and those living in Houston were more likely to have a high depression score. Based on the characteristics of the screening instrument, rates of clinical depression among Vietnamese men may be modestly higher than rates for men in the general population. However, high-risk subgroups identified by our analyses may suffer from substantially higher rates of clinical depression. To our knowledge, ours is the first study to show that community context or locale is an independent predictor of high depressive symptoms in this population. These findings have important implications for prevention and intervention approaches to depression among Vietnamese men.

Liver carcinoma prevention among Asian Pacific Islanders

For the past 20 years, the hepatitis B virus (HBV) has infected at least 250,000 persons annually in the United States. Persons with chronic HBV infection are at increased risk for liver carcinoma. Among immigrants to the United States from countries with high HBV endemicity, high rates of chronic HBV infection account in large part for their high incidence rates of liver carcinoma. Among those who have not been infected, hepatitis B and hepatitis B–related liver carcinoma can be prevented through hepatitis B vaccine immunizations. In this article, the authors examine hepatitis B vaccine coverage rates from surveys of Asian and Pacific Islander children in Houston, Texas and Los Angeles County, California.

Applying the Quit & Win contest model in the Vietnamese community in Santa Clara County

OBJECTIVE To evaluate the effectiveness of modifying and applying a Quit & Win contest model to Vietnamese Americans. DESIGN Uncontrolled trial, multicomponent program, including two Quit & Win incentive contests, smoking cessation classes, videotape broadcasts, and newspaper articles. SUBJECTS AND SETTING Vietnamese smokers living in Santa Clara County, California. MAIN OUTCOME MEASURES Contest participation rates and quit rates at six month follow up; saliva cotinine validation of quitting. RESULTS There were 57 eligible contest entrants to the 1995 contest, approximately 0.9% of the potential pool of smokers, and 32 entrants to the 1996 contest, approximately 0.5% of the potential pool. Overall, 48 of 49 (98%) individuals who said that they had quit smoking had validation of that fact by saliva cotinine testing. At six months, telephone follow up of 76 individuals revealed a self reported continued abstinence rate of 84.2%. CONCLUSION Modification and application of the Quit & Win contest model for Vietnamese resulted not only in reasonable participation by Vietnamese male smokers, but also good success in initial quitting and an unexpectedly high abstinence rate at six month follow up.