Yin Tan

A Multifaceted Intervention to Increase Cervical Cancer Screening among Underserved Korean Women

Objective: Despite the proven survival benefits associated with cervical cancer screening, use of the Pap test continues to be suboptimal in some population subgroups, such as among Korean-American women who face considerable barriers to screening. Therefore, we evaluated a multifaceted intervention that combined psychoeducational counseling with patient navigation to address both psychosocial and access barriers to screening. Method: Women (n = 102) were recruited from Korean community centers and assigned to the intervention or control condition. The intervention group received cervical cancer education and patient navigation delivered by bilingual Korean health educators. The control group received general health education, including information about cervical cancer and screening. Assessments were obtained at baseline and postintervention. Screening behavior was assessed at 6 months postintervention. Results: At baseline, 17% of participants reported having had a Pap test in the previous year. At 6 months postintervention, 83% of women in the intervention group had obtained screening compared with 22% in the control group, χ2(1) = 41.22, P < 0.001. Multivariate logistic regression analyses indicated that participation in the intervention was associated with screening (P < 0.001). Fewer psychosocial barriers (e.g., discomfort at having a stranger perform Pap) and greater self-efficacy were also associated with screening (P < 0.05). Conclusion: A combined modality intervention that delivers education with patient navigation training and assistance resulted in increased screening rates. Multifaceted approaches may be effective in reducing the psychosocial, access, and language barriers that contribute to cancer health disparities in underserved populations. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1–5)

Prevalence and Predictors of Tobacco Use Among Asian Americans in the Delaware Valley Region

OBJECTIVES This study examined tobacco use rates and potential predictors of use among Asian Americans residing in the Delaware Valley region. METHODS A cross-sectional survey design was used. The sample consisted of 1174 Chinese, Koreans, Vietnamese, and Cambodians. RESULTS Findings indicated that the mean age at initiation of tobacco use was 18.3 years. Among the respondents, 40.2% had a history of tobacco use, and 29.6% were current users. Men were more likely than women to smoke. There were significant differences between never smokers, current smokers, and ex-smokers in sex, ethnicity, educational attainment, and marital and employment status. CONCLUSIONS The findings suggest that tobacco use is still a serious public health problem among Asian Americans, especially men.

Community-based colorectal cancer intervention in underserved Korean Americans

BACKGROUND Despite evidence of a decline in both incidence and prevalence of colorectal cancer nationwide, it remains the second most commonly diagnosed cancer and the third highest cause of mortality among Asian Americans, including Korean Americans. This community-based and theoretically guided study evaluated a culturally appropriate intervention program that included a bilingual cancer educational program among Korean Americans including information on CRC risks, counseling to address psychosocial and access barriers, and patient navigation assistance. METHODS A two-group quasi-experimental design with baseline and post-intervention assessment and a 12-month follow-up on screening was used in the study. Korean Americans (N=167) were enrolled from six Korean churches. The intervention group received culturally appropriate intervention program addressing accessibility and psychosocial barriers, and navigation assistance for screening. The control group received general health education that included cancer-related health issues and screening. RESULTS There was a significant difference (p<0.05) between the post-intervention and control groups in awareness of CRC risk factors. There was also a significant improvement in the pre-post across HBM measures in the intervention group for perceived susceptibility (p<0.05) and benefits and barriers to screening (p<0.001). At baseline, 13% of participants in the intervention group and 10% in control group reported having had a CRC cancer screening test in the previous year. At the 12-month post-intervention follow-up, 77.4% of participants in the intervention group had obtained screening compared to 10.8% in the control group. CONCLUSION While health disparities result from numerous factors, a culturally appropriate and church-based intervention can be highly effective in increasing knowledge of and access to, and in reducing barriers to CRC screening among underserved Koreans.

Evidence-Based Intervention to Reduce Access Barriers to Cervical Cancer Screening Among Underserved Chinese American Women

OBJECTIVE The primary objective of the present study was to evaluate the effects of a community-based pilot intervention that combined cervical cancer education with patient navigation on cervical cancer screening behaviors among Chinese American women residing in New York City. METHODS Chinese women (n = 134) who had not had a Pap test within the previous 12 months were recruited from four Asian community-based organizations (CBOs). Women from two of the CBOs received the intervention (n = 80) consisting of education, interaction with a Chinese physician, and navigation assistance, including help in identifying and accessing free or low-cost screening services. The control group (n = 54) received education delivered by Chinese community health educators and written materials on general health and cancer screening, including cervical cancer, the Pap test, and information about sites that provided free screening. Study assessments were obtained in-person at baseline and postintervention. Screening behavior was self-reported at 12-month postintervention and verified by medical staff. RESULTS In the 12-month interval following the program, screening rates were significantly higher in the intervention group (70%) compared to the control group (11.1%). Hierarchical logistic regression analyses indicated that screening behavior was associated with older age (OR = 1.08, 95% CI = 1.01-1.15, p < .05). In addition, women with poorer English language fluency (OR = 0.30, 95% CI = 0.10-0.89, p < .05) and who did not have health insurance were less likely to obtain screening (OR = 0.15, 95% CI = 0.02-0.96, p < .05). Among health beliefs, greater perceived severity of disease was positively associated with screening behavior (OR = 4.26, 95% CI = 1.01-18.04, p < .05). CONCLUSIONS Community-based programs that provide combined education and patient navigation may be effective in overcoming the extensive linguistic and access barriers to screening faced by Chinese American women.

Ethnic differences in adolescent smoking behaviors, sources of tobacco, knowledge and attitudes toward restriction policies.

The purpose of this study was to examine racial/ethnic differences in adolescent smoking behavior, sources of tobacco, knowledge of and attitudes toward youth tobacco restriction policies, and perceptions of tobacco availability by adolescents. The study is important as it will add to the growing body of literature regarding tobacco use by minors, and will help policymakers and public health professionals develop efficacious policies and interventions to prevent and reduce tobacco use among adolescents. Minors obtain tobacco from social and commercial sources. Previous studies have emphasized rural homogeneous populations and so the present study addresses the need to determine these sources of tobacco to youth in a large urban, heterogeneous population, such as Philadelphia. A stratified multistage purposive sampling procedure was used to ensure an ethnically/racially sample. A 68-item questionnaire was administered to 645 students in Grades 8-10 in five public and nonpublic funded schools in a culturally diverse part of Philadelphia. Correlations between selected independent variables and smoking behavior were determined. Results from this study indicate that rates of smoking are high among students, with 50% of students ever having smoked, 19% within the last month, 17% weekly, and 15% smoke daily. Further, there were differences in rates of smoking between ethnic/racial groups. Social sources were the most common sources of tobacco reported, with friends being the most frequent source. There were differences in social and commercial ever sources of cigarettes between ethnic/racial groups and in perceived school and parental sanctions for tobacco use. The results of this study suggest that more financial and educational resources should be committed to prevent and reduce smoking behaviors among adolescents. Educational prevention programs, especially parenting programs should be employed to reduce smoking.

The Impact of Acculturation on Smoking in Asian American Homes

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Differences in stages of change of smoking behavior among current smokers of four Asian American subgroups.

This study assessed the impact of demographics and acculturation on stages of change in smoking behavior among Asian current smokers (Koreans, Chinese, Vietnamese, and Cambodians) who live in the Delaware Valley region. Three stages (precontemplation, contemplation, and preparation) that applied to current smokers in Prochaskas Transtheoretical Model were measured, with a small modification. A cross-sectional self-report survey was conducted by utilizing a stratified cluster proportional sampling technique. Recruited were 1374 Asian Americans from 26 randomly selected community organization clusters and 1174 completed the survey (83%). Data were analyzed using the Pearson chi(2) test of significance. Education was negatively associated with stages of smoking behavior change. Time living in the United States showed a statistically significant positive correlation. Individuals older than 21 years appeared more seriously inclined to quit (be in the preparation stage) than those below age 21. Among the four subgroups, Cambodians (91%) were more likely to fall in either contemplation or preparation, while Chinese had the highest rate in precontemplation stage. Men were more likely than women to be in the preparation stage. Immigration status was not a significant predictor of stages.

Perceived risks of certain types of cancer and heart disease among Asian American smokers and non-smokers.

This study assessed knowledge levels of health risks of tobacco use among the Asian American (AA) community in the Delaware Valley region of Pennsylvania and New Jersey, including metropolitan Philadelphia. A cross-sectional self-report survey was conducted to collect the information, and a stratified-cluster proportional sampling technique was used to obtain a representative sample size of the target population of Chinese, Korean, Vietnamese, and Cambodians. 1374 AA were recruited from 26 randomly selected community organization clusters; of the total recruited, 1174 completed the survey, which consisted of 410 Chinese, 436 Korean, 196 Vietnamese, 100 Cambodian and 32 other-group. Other-group was excluded for this study. Ten questions were asked to determine the knowledge level of the sample population. Results indicated that the vast majority of respondents (82.2%) recognized the association between smoking and increased risk of developing various types of cancers and heart disease. Between 81.3% and 93.3% of respondents recognized the increased risk for lung, mouth, throat and esophageal cancer and heart disease. For these variables, there were statistically significant differences between the ethnic groups: Koreans were the most knowledgeable, followed by Chinese, Vietnamese, and Cambodians. For bladder, pancreatic, cervical, and kidney cancers, the percentage of respondents indicating an association between these cancers and smoking ranged from 49.2 to 56.8. There were no statistically significant differences among the four ethnic groups for these variables. Generally, however, results showed that the awareness level was higher among women and the more educated respondents, non-smokers and former smokers, and Chinese and Korean groups.

A Community-Based Participatory Approach to a Hepatitis B Intervention for Korean Americans

Background: Hepatitis B virus (HBV) infection and liver cancer are severe health problems among Korean Americans. Most Korean Americans are neither screened nor vaccinated against HBV owing to substantial access barriers. Objectives: The primary objective of this article is to highlight how our team of academic researchers and community partners worked together to apply a community-based participatory research (CBPR) approach to developing, implementing, and evaluating a culturally appropriate, church-based HBV screening and vaccination intervention program for Korean Americans. Methods: Guided by CBPR, multiple strategies were used to form academic–community partnerships in the development and implementation of the culturally appropriate HBV intervention program in the Korean-American community. These include the formation of a community advisory board (CAB) and adoption of CBPR principles, community needs assessment, development and evaluation of the pilot intervention program, and the full-scale community controlled trial. Results: The pilot intervention results indicated significant increases in screening and vaccination rates in the intervention group compared with the control group. With the success of the partnership and pilot study, Korean church leaders, CAB members, and researchers are currently co-leading a full-scale intervention study to further evaluate the effectiveness of the intervention program. Conclusion: The current study highlights the role and contributions of multiple partners through five phases and discusses the challenges and lessons learned for how to sustain intervention programs by emphasizing common vision, trust development, shared recognition, capacity building, long-term commitments to partnership building, and balance between science and community needs.

Perceptions of risks of smoking among Asian Americans

BACKGROUND Tobacco use is the single most preventable cause of illness and death in the United States. Few studies focus on Asian Americans, one of the fastest growing but underserved populations in the United States. METHODS A cross-sectional survey method was used for this study. The study sample was identified by using a stratified-cluster proportional sampling technique. A questionnaire was developed in English, translated into the four Asian languages (Chinese, Koreans, Vietnamese, and Cambodians), and back-translated. The sample consisted of 1174 individuals, distributed as follows: Chinese, 34.9%; Korean, 37.1%, Vietnamese, 16.7%; Cambodian, 8.4%; and others, 2.7%. RESULTS Findings indicated that attitudes toward tobacco-related dangers were associated with smoking status: former and never smokers held more negative perceptions regarding smoking compared to current smokers. Further, results indicated that the Asian American subgroups differed in their respective attitudes. The study is the first to compare attitudes toward tobacco-related dangers among racial/ethnic and language subgroups of Asian Americans. CONCLUSION The growing body of empirical data on smoking among Asian Americans indicates that smoking cessation programs should take into account variations in smoking-related perceptions and attitudes across the ethnic subgroups.