H. Hoai Do

Hepatitis B and liver cancer beliefs among Korean immigrants in Western Washington

Hepatocellular cancer occurs more frequently among Koreans, Vietnamese, and Chinese than other racial/ethnic groups in the U.S. This excess risk can be attributed to high rates of chronic hepatitis B viral (HBV) infection and low rates of HBV vaccination among Asian immigrants. However, there is little available information regarding the hepatitis B knowledge, beliefs, and practices among Koreans, the fifth‐largest Asian population in the U.S. This brief report summarizes results from 30 qualitative interviews and two focus groups investigating hepatitis and liver cancer prevention, behavior, and beliefs among first‐generation Korean immigrant adults ages 18–64 years residing in the Seattle–Tacoma metropolitan area of Washington State. The report concludes with suggestions for future investigations to address the high rates of chronic HBV infection and hepatocellular cancer in this vulnerable population. Cancer 2005.

Knowledge about Cervical Cancer Risk Factors, Traditional Health Beliefs, and Pap Testing Among Vietnamese American Women

AbstractIntroduction: The objective of this paper was to examine knowledge about cervical cancer risk factors and traditional health beliefs in relation to Papanicolaou (Pap) testing among Vietnamese women. Methods: A population-based survey was conducted in Seattle (n<352, response rate=82%) during 2002. Results: The proportions of women who knew that older age, not getting regular Pap tests, and Vietnamese ethnicity are associated with an elevated cervical cancer risk were only 53%, 62%, and 23%, respectively. The majority (87%) incorrectly believed poor women’s hygiene is a risk factor for cervical cancer. Approximately two-thirds (68%) of the women had received a Pap test during the preceding three years. Knowing that lack of Pap testing increases the risk of cervical cancer was strongly associated (p<0.001) with recent Pap smear receipt. Conclusion: Our results confirm that Vietnamese women have lower levels of cervical cancer screening than non-Latina white women. Intervention programs addressing Pap testing in Vietnamese communities should recognize women’s traditional beliefs while encouraging them to adopt biomedical preventive measures into their daily lives.

Cervical Cancer Screening Among Chinese Immigrants in Seattle, Washington

Introduction: Chinese American women have high rates of invasive cervical cancer, compared to the general population. However, little is known about the Pap testing behavior of ethnic Chinese immigrants. Methods: We conducted a community-based survey of Chinese immigrants living in Seattle, Washington, during 1999. Two indicators of cervical cancer screening participation were examined: at least one previous Pap smear and Pap testing in the last 2 years. Results: The overall estimated response rate was 64%, and the cooperation rate was 72%. Our study sample for this analysis included 647 women. Nearly one quarter (24%) of the respondents had never had a Pap test, and only 60% had been screened recently. Factors independently associated with cervical cancer screening use included marital status, housing type, and age at immigration. Conclusion: Our findings confirm low levels of cervical cancer screening among Chinese immigrants to North America. Culturally and linguistically appropriate Pap testing intervention programs for less acculturated Chinese women should be developed, implemented, and evaluated.

Lessons Learned from the Application of a Vietnamese Surname List for Survey Research

Surname lists are increasingly being used to identify Asian study participants. Two Vietnamese surname lists have previously been published: the Vietnamese Community Health Promotion Program (VCHPP) list and the Lauderdale list. This report provides findings from a descriptive analysis of the performance of these lists in identifying Vietnamese. To identify participants for a survey of Vietnamese women, a surname list (that included names that appear on the VCHPP list and/or Lauderdale list) was applied to the Seattle telephone book. We analyzed surname data for all addresses in the survey sample, as well as survey respondents. The VCHPP list identified 4,283 potentially Vietnamese households, and 79% of the households with established ethnicity were Vietnamese; and the Lauderdale list identified 4,068 potentially Vietnamese households, and 80% of the households with established ethnicity were Vietnamese. However, the proportions of contacted households that were Vietnamese varied significantly among commonly occurring surnames. The characteristics of women with surnames on the VCHPP and Lauderdale lists were equivalent. The two lists performed equally well in identifying Vietnamese households. Researchers might consider using different combinations of Vietnamese surnames, depending on whether accuracy or high population coverage is the more important consideration.

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 familys 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. Cancer 2005.

“To be healthy and to live long, we have to exercise” – Psychosocial factors related to physical activity among Cambodian Americans

Regular physical activity produces various health benefits; however, relatively few adults in the United States (US) get enough physical activity. Little is known about physical activity behaviors, and barriers and facilitators to physical activity among Cambodian-Americans. Cambodian Americans were recruited from community venues to participate in one-on-one interviews and focus groups. A total of 20 adults (10 women and 10 men) participated in one-on-one interviews and 37 adults (23 women and 14 men) participated in one of four focus groups. Fifteen of the 20 interviews and all the focus groups were conducted in Khmer. Participants were generally born in Cambodia and over two-thirds had a high school education or less. About one-half of the participants met or exceeded the 2008 US Department of Health and Human Services physical activity guidelines. Commonly reported types of physical activity were walking, running, and working out at the gym. Barriers to physical activity included lack of time, inconvenient work hours, and family responsibilities. Perceived benefits of physical activity included improved health, improved appearance, and reductions in stress. Sweating caused by physical activity was thought to produce a variety of health benefits. Data from this qualitative study could be used to inform the development of culturally-relevant physical activity survey measures and culturally-relevant physical activity interventions for Cambodian Americans.

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.

Provider Perspectives on Promoting Cervical Cancer Screening Among Refugee Women

Many refugees in the United States emigrated from countries where the incidence of cervical cancer is high. Refugee women are unlikely to have been screened for cervical cancer prior to resettlement in the U.S. National organizations recommend cervical cancer screening for refugee women soon after resettlement. We sought to identify health and social service providers’ perspectives on promoting cervical cancer screening in order to inform the development of effective programs to increase screening among recently resettled refugees. This study consisted of 21 in-depth key informant interviews with staff from voluntary refugee resettlement agencies, community based organizations, and healthcare clinics serving refugees in King County, Washington. Interview transcripts were analyzed to identify themes. We identified the following themes: (1) refugee women are unfamiliar with preventive care and cancer screening; (2) providers have concerns about the timing of cervical cancer education and screening; (3) linguistic and cultural barriers impact screening uptake; (4) provider factors and clinic systems facilitate promotion of screening; and (5) strategies for educating refugee women about screening. Our findings suggest that refugee women are in need of health education on cervical cancer screening during early resettlement. Frequent messaging about screening could help ensure that women receive screening within the early resettlement period. Health education videos may be effective for providing simple, low literacy messages in women’s native languages. Appointments with female clinicians and interpreters, as well as clinic systems that remind clinicians to offer screening at each appointment could increase screening among refugee women.

Results From a Pilot Video Intervention to Increase Cervical Cancer Screening in Refugee Women

Many refugee women emigrate from countries with high cervical cancer incidence rates and have low rates of cervical cancer screening both before and after resettlement. Refugee women face many barriers to cervical cancer screening, including limited knowledge of cervical cancer and screening recommendations and cultural and linguistic barriers to being screened. Our pilot study aimed to develop and evaluate educational videos to promote cervical cancer screening among Karen-Burmese and Nepali-Bhutanese refugees, two of the largest groups of refugees arriving to the United States in recent years. We developed culturally tailored narrative videos for each ethnic group. Karen-Burmese and Nepali-Bhutanese women (N = 40) were recruited through community health educators to participate in a pre- and posttest study. We assessed changes in cervical cancer knowledge and intentions to be screened, and satisfaction with the videos. We found that women were significantly more likely to report having heard of a test for cervical cancer and indicated significantly greater intentions to be screened after watching the video. Their knowledge about cervical cancer and screening also improved significantly, and they reported high levels of acceptability with the video. Our results suggest that culturally tailored narrative educational videos were acceptable to the target audiences and may be effective in increasing cervical cancer screening among refugee women. Further research should assess how health care and social service providers could implement video-based interventions to encourage women to be screened for cervical cancer during early resettlement.

We Should Know Ourselves: Burmese and Bhutanese Refugee Women's Perspectives on Cervical Cancer Screening

Abstract:Refugee women are at increased risk for cervical cancer and have low rates of cervical cancer screening both in their countries of origin and in the U.S. Using the Behavioral Model for Vulnerable Populations as a conceptual framework, we conducted eight focus groups with Burmese and Bhutanese refugee women to gather information about factors influencing cervical cancer screening (31 Burmese and 27 Bhutanese participants). Less than one-third (28%) reported being screened for cervical cancer before coming to the U.S. and only 45% reported being screened after resettling in the U.S. Participants had limited knowledge about cervical cancer and the need for screening, and faced multiple barriers including competing priorities and cost. However, trusted providers and interpreters were seen as means of facilitating screening. Cervical cancer screening among Bhutanese and Burmese refugee women could be improved with culturally tailored health education and increased access to female providers and trained interpreters.